{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"J   SINNEDNAMREBEIL ","gend":0,"add":"ODAEM 8023DVLB ELADW","city":"RICHMOND","state":"VA","zip":"23234-9998","dob":"1980-02-09","age":"","mstatus":"","insh":"3512210*40","cliId":"","pno":"38\/4086486-7","cno":"804\/837-6846","email":"","ename":"","eno":"","pphy":"JENKINS JR, JAMES MD","ppno":"804\/780-0840","pcpadd":"719 N 25TH ST","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23223,"pcpcounty":"","pcpid":"","pcpname":"","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":["F15.20","S60.552A","L40.50","F33.1","R53.83","J40.","G51.9","E87.6","N17.9","M79.89","T40.5X1A","M62.82","F11.20","R47.1","R29.810","F15.10","E87.5","R74.0","S00.81XA","F17.210","E66.9","F14.188","F32.9","Z68.25","M19.90","F11.10","F14.10","L40.9","Z79.899","Z71.89","Z00.00","I10.","F41.1","J30.89","F17.200","F14.20","F12.20","M79.605","F41.9","W45.8XXA","W27.0XXA","F19.10","M79.652","Z88.6","Z88.0","R94.5"],"date":["2021-05-31","2021-12-11","2022-07-26","2022-04-27","2022-04-27","2022-06-29","2020-03-17","2020-03-17","2020-03-23","2020-03-19","2020-03-17","2020-03-23","2020-03-17","2020-03-17","2020-03-17","2020-03-17","2020-03-17","2020-03-19","2020-03-17","2020-03-17","2020-03-17","2020-03-17","2020-03-17","2020-03-17","2021-04-28","2021-07-23","2020-03-19","2020-03-19","2020-03-19","2021-03-31","2021-07-23","2021-07-23","2021-07-23","2021-07-23","2021-04-02","2021-04-02","2021-04-02","2020-03-17","2020-03-23","2021-12-11","2021-12-11","2020-03-17","2020-03-17","2020-03-19","2020-03-19","2020-03-17"],"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":[]},{"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":[["","00078063998","COSENTYX","INJ 300DOSE","2","Select","Select",""],["","71093011204","GABAPENTIN","TAB 800MG","90","Select","Select",""],["","43547028910","BUPROPION","TAB 150MG SR","60","Select","Select",""],["","00168003346","BETAMETH","OIN 0.001","90","Select","Select",""],["","00168008031","HYDROCORT","CRE 0.025","90","Select","Select",""],["","00093005301","BUSPIRONE","TAB 5MG","60","Select","Select",""],["","00591544305","PREDNISONE","TAB 20MG","14","Select","Select",""],["","45802065087","LORATADINE","TAB 10MG","30","Select","Select",""],["","00054074287","ALBUTEROL","AER HFA","7","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00904671740","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","58406002104","ENBREL","INJ 50MG\/ML","8","Select","Select",""],["","00536137223","NICOTINE","GUM 4MG MINT","100","Select","Select",""],["","51660052605","ALLERGY","TAB 10MG","30","Select","Select",""],["","10370010103","BUPROPN","TAB 150MG XL","30","Select","Select",""],["","23155050201","HYDROXYZ","TAB 50MG","90","Select","Select",""],["","00904662735","EAR","DRO 0.065","15","Select","Select",""],["","00472038245","AUG","OIN 0.0005","45","Select","Select",""],["","13811071330","VENLAFAXINE","TAB 75MG ER","15","Select","Select",""],["","59572063255","OTEZLA","TAB 10\/20\/30","55","Select","Select",""],["","51672125903","CLOBETASOL","OIN 0.0005","120","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":""}]}]}