{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"OM HTEVIORGENETN","gend":1,"add":"OWHCEEB 12911RD TSEROF DO","city":"CHESTERFIELD","state":"VA","zip":"23838-9998","dob":"1975-06-30","age":"","mstatus":"","insh":"3713210*01","cliId":"","pno":"03\/4083403-6","cno":"804\/306-3043","email":"","ename":"","eno":"","pphy":"ST GERMAIN, MARY NP","ppno":"804\/655-2794","pcpadd":"8600 QUIOCCASIN ROAD SUITE 105","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23229,"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":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01.419","F32.1","F41.1","F32.9","M54.2","M47.812","M54.12","M25.50","R00.0","F41.9","N39.3","N39.0","O03.4","R17.","I47.1","R39.15","R06.00","R00.2","Z68.24","F40.298","N39.41","Z01.411","N76.0","N81.6","Z00.00","Z20.828","R06.02","E86.0","Z91.89","N30.00","H10.023","R07.9","S63.601A","R31.9","S30.0XXA","Z32.01","M70.61","M79.7","M89.49","M70.62","Z68.23","N30.01","R30.0","J01.90","Z12.31","B35.4","G44.319","W17.89XA","R42.","O02.1"],"date":["2022-03-11","2020-12-07","2021-06-04","2021-06-04","2021-06-09","2021-06-09","2021-06-09","2021-08-02","2021-10-14","2021-10-14","2022-08-16","2022-08-16","2021-06-15","2021-08-30","2021-10-19","2022-08-16","2021-10-19","2021-10-19","2021-10-19","2020-08-03","2020-08-13","2021-03-04","2021-03-04","2021-03-04","2020-11-04","2021-01-14","2021-09-27","2021-09-27","2022-02-11","2020-09-04","2021-09-01","2021-10-06","2020-10-11","2020-10-14","2020-10-11","2021-05-21","2021-08-02","2021-08-02","2021-08-02","2021-08-02","2021-08-02","2021-12-03","2021-12-03","2021-01-13","2021-10-06","2020-08-07","2020-10-14","2020-10-14","2020-10-14","2021-06-22"],"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":[]},{"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":[["","00093532862","JUNEL","TAB 44581","28","Select","Select",""],["","00469260130","MYRBETRIQ","TAB 25MG","30","Select","Select",""],["","70010002703","TROSPIUM","CAP 60MG ER","30","Select","Select",""],["","65162068210","PHENAZOPYRID","TAB 200MG","30","Select","Select",""],["","51862048601","TRIMETHOPRIM","TAB 100MG","30","Select","Select",""],["","68462073129","HAILEY","TAB FE","28","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","10","Select","Select",""],["","52268001201","SUPREP","SOL PREP KIT","354","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","00430042014","LO","TAB 40188","84","Select","Select",""],["","00904791524","IBUPROFEN","TAB 200MG","30","Select","Select",""],["","00185012201","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","00093506201","HYDROXYZ","TAB 50MG","60","Select","Select",""],["","68382005105","MELOXICAM","TAB 15MG","30","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","61314062810","POLYMYXIN","SOL TRIMETHP","10","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","00904530760","BANOPHEN","CAP 50MG","1","Select","Select",""],["","00054001920","PREDNISONE","TAB 50MG","3","Select","Select",""],["","68462018117","CLOTRIMAZOLE","CRE 0.01","15","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","20","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","10","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}