{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  AJEDNAUQSENRAB T ","gend":1,"add":"EROMXE 403D2 TPA TC ","city":"RICHMOND","state":"VA","zip":"23222-9998","dob":"1993-05-27","age":"","mstatus":"","insh":"3990210*47","cliId":"","pno":"46\/4081985-8","cno":"804\/302-0673","email":"","ename":"","eno":"","pphy":"MARTIN, CAITLIN E MD","ppno":"804\/628-6777","pcpadd":"1001 E LEIGH STREET","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23298,"pcpcounty":"","pcpid":"","pcpname":"MCV ASSOCIATED PHYSICIANS","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":["F31.9","Z30.46","Z39.0","O99.323","F14.93","F11.93","F12.93","O99.333","F17.210","O99.891","D06.9","Z3A.28","O99.325","F14.90","F11.20","Z39.2","F11.23","F12.90","O99.335","O99.345","F41.9","F32.89","F51.9","Z79.899","F33.1","F41.1","F32.9","F12.980","Z86.59","Z87.410","NO DATA","Z72.0","R10.9","R74.8","R82.90","E87.6","V23.89","O34.33","Z3A.36","K52.9","R11.2","R19.7","O98.313","A59.00","O62.3","O99.324","Z37.0","O69.81X0","F11.90","O77.0","O99.334","Z20.822","O14.04","Z3A.37","Z83.3","Z82.49","O80.","K85.90","D72.829","O99.343","O26.893","L29.9","Z34.83","Z3A.34","O70.0","Z3A.38","R87.810","R87.610","Z87.891","F41.8","N76.0","Z32.02","O60.03","Z3A.35","V23.7","Z33.1","Z23.","Z3A.27","F33.2","F12.10","F17.200","Z34.93","O26.892","N94.9","Z3A.17","O99.332","Z3A.18","O47.03","Z36.89","Z3A.30","F14.20","F43.10","F34.1","G47.09","A53.9","N30.00","Z20.2"],"date":["2020-07-22","2021-08-27","2021-08-27","2021-06-22","2021-06-22","2021-06-22","2021-06-22","2021-08-20","2021-10-19","2021-06-22","2021-06-22","2021-06-22","2021-09-03","2021-08-24","2022-03-23","2021-09-03","2021-11-03","2021-09-03","2021-09-03","2021-09-03","2021-09-03","2021-09-03","2021-09-03","2021-09-03","2020-10-14","2022-01-07","2021-09-10","2021-10-19","2021-10-19","2021-10-19","2021-11-03","2022-01-07","2020-09-06","2020-09-06","2020-09-06","2020-09-06","2021-08-20","2021-08-20","2021-08-20","2020-09-06","2020-09-06","2020-01-09","2021-06-22","2021-06-22","2021-08-23","2021-08-23","2021-08-23","2021-08-23","2022-01-07","2021-08-23","2021-08-23","2021-08-23","2021-08-23","2021-08-23","2021-08-23","2021-08-23","2021-08-23","2020-09-06","2020-09-06","2021-06-21","2021-06-21","2021-06-21","2019-07-03","2019-06-09","2019-07-07","2019-07-07","2019-10-03","2019-10-03","2019-07-07","2019-09-12","2019-09-12","2019-09-12","2019-06-09","2019-06-12","2019-06-09","2019-04-17","2019-04-17","2019-04-17","2019-05-14","2019-05-14","2019-05-14","2019-07-06","2019-01-29","2019-01-29","2019-01-29","2019-02-11","2019-02-11","2019-06-11","2019-06-09","2019-05-07","2022-03-23","2022-03-23","2022-03-23","2022-01-07","2022-09-28","2022-09-28","2022-09-28"],"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":[["","00093506105","HYDROXYZ","TAB 25MG","40","Select","Select",""],["","00135047402","NICORETTE","GUM 2MG MINT","100","Select","Select",""],["","60505265301","TRAZODONE","TAB 50MG","30","Select","Select",""],["","12496120803","SUBOXONE","MIS 8-2MG","30","Select","Select",""],["","00378876793","BUPREN\/NALOX","MIS 8-2MG","35","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","00143993905","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","50111064801","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","43598044674","NICOTINE","DIS 7MG\/24HR","42","Select","Select",""],["","59651036205","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","00904699880","DOCUSATE","CAP 100MG","20","Select","Select",""],["","65862064230","AZITHROMYCIN","TAB 500MG","2","Select","Select",""],["","68382004001","PROMETHAZINE","TAB 12.5MG","20","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","4","Select","Select",""],["","54838000650","VITAMIN","DRO 10MCG\/ML","50","Select","Select",""],["","00536100901","FERROUS","TAB 325MG","30","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","30","Select","Select",""],["","65862001205","SERTRALINE","TAB 50MG","30","Select","Select",""],["","70756020511","AMITRIPTYLIN","TAB 100MG","30","Select","Select",""],["","51672128902","NYSTATIN","CRE 100000","30","Select","Select",""],["","00904672080","ACETAMIN","TAB 500MG","50","Select","Select",""],["","","FAMOTIDINE","TAB 20MG","","Select","Select",""],["","","LOPERAMIDE","CAP 2MG","","Select","Select",""],["","","DICYCLOMINE","CAP 10MG","","Select","Select",""],["","","OYSTER","TAB 500MG","","Select","Select",""],["","","CALCIUM","CHW 500MG","","Select","Select",""],["","","MIRTAZAPINE","TAB 15MG","","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":""}]}]}