{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   HAJADSILLIW M","gend":1,"add":"RAM E 009TS LLAHS","city":"RICHMOND","state":"VA","zip":"23219-9998","dob":"1999-11-02","age":"","mstatus":"","insh":"2959810*43","cliId":"","pno":"03\/4081853-6","cno":"804\/343-6936","email":"","ename":"","eno":"","pphy":"HOPKINS, SYMONE M NP","ppno":"804\/893-8676","pcpadd":"5855 BREMO RD STE 406","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23226,"pcpcounty":"","pcpid":"","pcpname":"MONUMENT INTERNAL MEDICINE","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J02.0","Z01.419","Z11.3","Z87.59","R10.9","N94.6","N92.0","E66.01","Z68.54","O26.842","V23.5","Z3A.19","J02.9","N91.1","Z32.01","O10.012","O99.212","Z3A.24","Z33.1","O16.4","Z37.0","Z3A.39","Z34.82","Z3A.15","O10.013","Z3A.30","Z79.82","Z67.10","V58.89","O10.92","O71.4","O69.81X0","O99.214","E66.9","Z82.49","Z82.62","Z83.3","O10.02","O69.89X0","O71.89","S01.81XA","H57.11","W26.8XXA","Y92.89","Y93.89"],"date":["2021-10-21","2021-06-28","2021-06-28","2021-06-28","2019-08-22","2019-08-22","2019-08-22","2020-02-05","2019-08-22","2019-12-30","2020-02-05","2019-12-30","2021-10-21","2019-09-19","2019-09-19","2020-02-05","2020-02-05","2020-02-05","2020-05-13","2020-05-16","2020-05-16","2020-05-16","2019-12-03","2019-12-03","2020-03-17","2020-03-17","2020-05-15","2020-03-17","2020-12-16","2020-05-15","2020-05-15","2020-05-16","2020-05-15","2020-05-15","2020-05-15","2020-05-15","2020-05-15","2020-05-16","2020-05-16","2020-05-16","2020-12-11","2020-12-11","2020-12-11","2020-12-11","2020-12-11"],"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":[["","00527600274","LIDOCAINE","SOL 2% VISC","100","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","","NYSTATIN","SUS 100000","","Select","Select",""],["","","VITAMIN","DRO 400UNIT","","Select","Select",""],["","60505006500","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","4","Select","Select",""],["","68180016106","AZITHROMYCIN","TAB 500MG","2","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","60","Select","Select",""],["","57896098112","ASPIRIN","TAB 81MG EC","30","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":""}]}]}