{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANNASORYDARF ","gend":1,"add":"72 356TS HT","city":"NEWPORT NEWS","state":"VA","zip":"23607-9998","dob":"1987-05-28","age":"","mstatus":"","insh":"3223210*49","cliId":"","pno":"44\/2034977-4","cno":"","email":"","ename":"","eno":"","pphy":"WUNDER, NICHOLAS PA","ppno":"804\/968-5700","pcpadd":"5000 COX ROAD SUITE 100","pcpcity":"GLEN ALLEN","pcpstate":"VA","pcpzip":23060,"pcpcounty":"","pcpid":"","pcpname":"PATIENT FIRST RICHMOND MEDICAL GROUP PLLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","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":["J02.9","R30.0","Z30.40","H10.023","N89.8","R35.8","F41.1","F32.0","H10.32","H10.9","G89.29","M54.9","J32.9","N30.00","R11.0","J00.","N39.0","F33.0","M54.5","Z98.890","L65.9","L70.0","Z71.9","N32.81","Z11.3","N30.01","L81.4","J01.00","NO DATA","N76.0","R35.0"],"date":["2020-12-17","2021-08-05","2021-03-18","2021-06-04","2021-08-05","2021-08-05","2021-10-12","2021-09-24","2021-09-28","2021-06-05","2020-10-30","2021-02-15","2020-10-15","2021-07-26","2021-07-26","2021-09-02","2020-11-25","2021-09-30","2020-10-30","2020-10-30","2021-10-14","2021-10-14","2021-04-20","2020-12-02","2021-11-22","2021-02-15","2021-10-14","2021-10-25","2021-10-25","2021-11-22","2021-11-22"],"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":[["","53746010901","HYDROCO\/APAP","TAB 5-325MG","20","Select","Select",""],["","59762453802","MEDROXYPR","INJ 150MG\/ML","1","Select","Select",""],["","60758011905","PREDNISOLONE","SUS 1% OP","10","Select","Select",""],["","43386002606","FLUOCINONIDE","SOL 0.0005","60","Select","Select",""],["","17478071310","OFLOXACIN","DRO 0.3% OP","5","Select","Select",""],["","24208091055","ERYTHROMYCIN","OIN 5MG\/GM","4","Select","Select",""],["","00472011745","TRETINOIN","CRE 0.00025","45","Select","Select",""],["","69367016204","PHENAZOPYRID","TAB 100MG","6","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","61314062810","POLYMYXIN","SOL TRIMETHP","10","Select","Select",""],["","00172541211","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","00378075101","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","00093227534","AMOX\/K","TAB 875-125","20","Select","Select",""],["","00185012201","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","","LIDOCAINE","SOL 2% VISC","","Select","Select",""],["","","CETIRIZ\/PSE","TAB 5-120MG","","Select","Select",""],["","","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","","OXYBUTYNIN","TAB 5MG","","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":""}]}]}