{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  LEINADLLEZE R ","gend":0,"add":"RTNEC 4205DAOR AILA","city":"RICHMOND","state":"VA","zip":"23237-9998","dob":"1980-06-17","age":"","mstatus":"","insh":"17200210*60","cliId":"","pno":"17\/4087224-5","cno":"","email":"","ename":"","eno":"","pphy":"ROSE, ANDREW MD","ppno":"804\/717-5300","pcpadd":"SUITE 117 16011 IRONBRIDGE ROAD","pcpcity":"CHESTER","pcpstate":"VA","pcpzip":23831,"pcpcounty":"","pcpid":"","pcpname":"IRONBRIDGE FAMILY PRACTICE","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z23.","F31.72","F41.0","R09.89","F31.81","F51.01","L40.0","L40.50","L29.8","L40.59","L85.3","D48.5","L40.9","Z04.9","M54.5","R45.89","F31.89","R03.0","M54.9","G89.29","Z68.31","M77.50","M77.9","H10.10","S91.131S","M53.3","F33.1","F41.9","R56.9","G47.00","T17.908A","J02.9","Z87.891","K59.00","K12.0","K21.9","R10.11","R10.84","Z79.899","J01.00","R07.9","M79.671","M67.432","R10.13","S33.5XXA","NO DATA","R10.9","Z86.73","I10.","F15.23","R51.9","X58.XXXA","J10.1","Z20.828","T88.7XXA","I63.9","S76.912A","M06.4","J01.80","Z20.822","S39.011A","R10.32","K40.90"],"date":["2020-02-01","2021-07-13","2020-02-26","2020-11-28","2021-03-10","2021-03-10","2022-11-23","2022-11-23","2021-11-16","2021-11-16","2021-11-16","2021-11-16","2021-09-24","2021-07-21","2021-07-25","2021-03-17","2021-03-17","2021-07-27","2021-07-27","2021-07-27","2021-07-27","2020-01-07","2020-01-07","2020-04-18","2020-07-18","2021-05-15","2022-04-18","2022-04-18","2022-07-25","2020-11-25","2020-11-28","2020-11-28","2022-11-08","2019-05-01","2019-10-20","2022-08-03","2019-04-05","2022-07-25","2022-04-18","2019-12-24","2022-07-17","2019-11-09","2019-01-11","2022-07-17","2022-09-20","2022-09-20","2022-07-25","2022-11-08","2022-08-17","2022-08-17","2022-08-17","2022-11-08","2022-06-02","2022-06-02","2022-08-17","2022-04-18","2022-11-08","2022-11-23","2022-10-31","2022-10-31","2022-11-08","2022-11-08","2022-11-17"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","13107008305","LORAZEPAM","TAB 0.5MG","90","Select","Select",""],["","00049398060","GEODON","CAP 60MG","30","Select","Select",""],["","45802000403","HYDROCORT","CRE 0.025","28","Select","Select",""],["","00115165903","PROPRANOLOL","TAB 10MG","60","Select","Select",""],["","51672127406","BETAMETH","CRE 0.0005","45","Select","Select",""],["","45802091987","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","65862070560","ZIPRASIDONE","CAP 80MG","14","Select","Select",""],["","00378001401","METHOTREXATE","TAB 2.5MG","18","Select","Select",""],["","00074055402","HUMIRA","INJ 40\/0.4ML","2","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","20","Select","Select",""],["","68462060965","PIMECROLIMUS","CRE 0.01","60","Select","Select",""],["","68462031066","CALCIPOTRIEN","OIN 0.00005","120","Select","Select",""],["","68180095604","CLOBETASOL","CRE 0.0005","120","Select","Select",""],["","13668000805","ZOLPIDEM","TAB 10MG","14","Select","Select",""],["","00378668910","PANTOPRAZOLE","TAB 40MG","20","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","11534018701","BUT\/APAP\/CAF","CAP ","30","Select","Select",""],["","00093221001","SUCRALFATE","TAB 1GM","100","Select","Select",""],["","67877032005","IBUPROFEN","TAB 600MG","20","Select","Select",""],["","64380071207","BENZONATATE","CAP 100MG","15","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","69315012710","FOLIC","TAB 1000MCG","30","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","20","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","00185014101","OXAPROZIN","TAB 600MG","28","Select","Select",""],["","59572063106","OTEZLA","TAB 30MG","60","Select","Select",""],["","50222030260","ENSTILAR","AER ","60","Select","Select",""],["","","FEXOFENADINE","TAB 180MG","","Select","Select",""],["","00378064110","PREDNISONE","TAB 10MG","30","Select","Select",""],["","00002144511","TALTZ","INJ 80MG\/ML","1","Select","Select",""],["","14539067501","HYDROXYZ","CAP 50MG","20","Select","Select",""],["","69097096607","NABUMETONE","TAB 750MG","60","Select","Select",""],["","","DICLOFENAC","TAB 75MG DR","","Select","Select",""],["","51672140204","CALCIP\/BETAM","SUS ","60","Select","Select",""],["","68180065208","DOXYCYC","CAP 100MG","60","Select","Select",""],["","","OLOPATADINE","DRO 0.001","","Select","Select",""],["","","ANTIBIOTIC","OIN ","","Select","Select",""],["","","ADACEL","INJ ","","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","","VRAYLAR","CAP 1.5MG","","Select","Select",""],["","53489011905","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","10","Select","Select",""],["","50383077504","LIDOCAINE","SOL 2% VISC","100","Select","Select",""],["","00143312601","DICYCLOMINE","CAP 10MG","15","Select","Select",""],["","64980032005","TRIAMCINOLON","PST DEN 0.1%","5","Select","Select",""],["","00054414622","CLOTRIMAZOLE","TRO 10MG","40","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}