{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ACISSEJSENOJ ","gend":1,"add":"DISELGNE 811B2 TPA TC E","city":"RICHMOND","state":"VA","zip":"23222-9998","dob":"1987-02-04","age":"","mstatus":"","insh":"4317510*21","cliId":"","pno":"04\/4084673-5","cno":"","email":"","ename":"","eno":"","pphy":"BIGGS, ANGELA GAIL FNP","ppno":"804\/780-0840","pcpadd":"1500 N LOMBARDY STREET","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23220,"pcpcounty":"","pcpid":"","pcpname":"VERNON J HARRIS EAST END COMMUNITY HEALTH CENTER","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":["F25.1","F31.9","F41.0","F25.0","F43.10","R20.0","R20.2","F32.3","M79.672","L84.","R20.8","I10.","F17.210","Z86.69","Z79.899","Z88.6","Z88.5","Z82.49","Z82.61","Z83.3","R00.0","T43.592A","G92.","J96.01","J69.0","E72.20","D86.9","F20.9","E87.6","Z20.822","R56.9","R50.9","Z23.","G25.9","G93.40","R94.01","R41.82","T42.6X1A","J96.00","E87.5","G93.41","J96.90","F20.0","U07.1","V62.84","F25.9","F32.9","A59.01","F33.1","F33.3","G93.2","G93.5","G56.01","R94.31","I51.7","T14.91XA","T50.904A","F22.","Z91.5","Z63.4","I49.9","F39.","T43.594A","M77.42","F31.4","R11.0","R19.7","G56.03","E55.9","R82.90","R00.1","N89.8","G43.009","N92.0","R41.0","R45.1","R14.0","N92.6","Z01.419","Z32.02","K21.9","E78.2","R80.8","Z71.9","E63.9","Z13.228","Z13.29","R25.2","D86.0","Z11.59","M25.511","I49.5","Z00.00","Z13.1","Z13.0","Z11.4","Z13.21","Z13.220","F17.218","G43.001","F31.5","M79.671","M21.41","M21.42","M21.961","Z01.00","G43.709"],"date":["2021-04-12","2021-11-30","2021-11-30","2022-10-13","2022-05-04","2021-09-30","2021-09-30","2022-05-04","2022-07-21","2022-07-21","2020-11-15","2022-05-03","2021-02-01","2020-11-15","2021-02-05","2020-11-15","2020-11-15","2020-11-15","2020-11-15","2020-11-15","2021-02-03","2021-02-06","2021-02-05","2021-02-01","2021-02-01","2021-02-01","2022-03-01","2021-02-05","2021-03-12","2021-11-22","2022-06-09","2021-02-01","2021-02-01","2021-02-02","2021-02-02","2021-02-02","2021-02-02","2021-02-05","2021-02-04","2021-02-04","2021-02-05","2021-02-05","2021-02-09","2021-04-12","2021-04-27","2021-04-12","2021-04-05","2021-04-12","2020-07-05","2022-04-28","2022-05-13","2022-01-14","2021-11-24","2021-02-07","2021-02-01","2021-02-01","2021-02-01","2021-02-05","2021-02-05","2021-02-05","2021-02-06","2022-01-14","2021-02-05","2020-11-19","2020-12-29","2021-10-27","2021-10-27","2020-01-15","2021-03-12","2021-03-12","2021-04-05","2021-04-07","2022-11-08","2020-11-13","2021-02-03","2021-02-03","2021-08-01","2021-08-06","2021-08-16","2021-08-16","2022-06-03","2019-12-23","2019-12-23","2019-12-23","2019-12-23","2019-12-09","2022-04-20","2019-12-09","2022-06-03","2022-02-25","2022-04-05","2022-04-05","2022-04-20","2022-04-20","2022-04-20","2022-04-20","2022-04-20","2022-04-20","2022-04-20","2022-11-08","2022-11-21","2022-07-21","2022-07-21","2022-07-21","2022-07-21","2022-05-13","2022-11-08"],"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":[["","00310737020","BUDES\/FORMOT","AER 160-4.5","31","Select","Select",""],["","70954002110","PRAZOSIN","CAP 5MG","30","Select","Select",""],["","68462039030","ESOMEPRA","CAP 20MG DR","30","Select","Select",""],["","53191036212","D3-50","CAP 50000UNT","12","Select","Select",""],["","00002143611","EMGALITY","INJ 120MG\/ML","1","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","","QUETIAPINE"," QUETIAPINE ","45","Select","Select",""],["","16729020201","BUSPIRONE","TAB 10MG","60","Select","Select",""],["","13668013601","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","50428037624","VITAMIN","TAB 1000MCG","30","Select","Select",""],["","23155000810","HYDROCHLOROT","TAB 25MG","90","Select","Select",""],["","65162079108","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","62332002791","LOSARTAN","TAB 25MG","90","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","31","Select","Select",""],["","43598044828","NICOTINE","DIS 21MG\/24H","28","Select","Select",""],["","55513084101","AIMOVIG","INJ 70MG\/ML","1","Select","Select",""],["","00228212810","CLONIDINE","TAB 0.2MG","90","Select","Select",""],["","70710122901","AMITRIPTYLIN","TAB 100MG","30","Select","Select",""],["","51991001406","MELATONIN","TAB 3MG","30","Select","Select",""],["","00832712311","DIVALPROEX","TAB 250MG DR","90","Select","Select",""],["","50428027646","CVS","TAB 1000 TR","30","Select","Select",""],["","43547030303","ARIPIPRAZOLE","TAB 5MG","30","Select","Select",""],["","50111056101","TRAZODONE","TAB 100MG","30","Select","Select",""],["","23155050201","HYDROXYZ","TAB 50MG","30","Select","Select",""],["","65862022701","LAMOTRIGINE","TAB 25MG","60","Select","Select",""],["","23155065201","METRONIDAZOL","TAB 500MG","4","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","10","Select","Select",""],["","00093031101","LOPERAMIDE","CAP 2MG","20","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","9","Select","Select",""],["","57664050083","MIRTAZAPINE","TAB 30MG","30","Select","Select",""],["","","HYDROCO\/APAP","TAB 7.5-325","","Select","Select",""],["","","AMOXICILLIN","CAP 500MG","","Select","Select",""],["","","DICLOFENAC","TAB 25MG DR","","Select","Select",""],["","","METHYLPRED","TAB 4MG","","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":""}]}]}