{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ELLEINADSLLIH S  ","gend":1,"add":" LLERRET 22 TPA STC","city":"PETERSBURG","state":"VA","zip":"23803-9998","dob":"1987-03-06","age":"","mstatus":"","insh":"4440510*08","cliId":"","pno":"98\/4083203-2","cno":"","email":"","ename":"","eno":"","pphy":"TASSELL, GAYLEN QUESINBERRY NP","ppno":"804\/287-4550","pcpadd":"12340 BERMUDA CROSSROADS LN","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23223,"pcpcounty":"","pcpid":"","pcpname":"IRONBRIDGE FAMILY PRACTICE","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":["G44.309","S06.0X9S","M54.81","S16.1XXS","G47.9","J03.90","F43.10","V58.89","F32.1","F41.1","Z68.33","F33.3","S00.83XA","F07.81","Z20.828","V54.16","F33.2","M25.572","M79.672","S92.355A","S93.492A","S93.412A","S93.402A","N39.0","R51.","R22.0","V89.2XXA","M25.512","Z71.89","Z71.3","S92.254B","M25.571","M84.374A","R03.0","R60.0","N92.0","M54.2","M62.838","S92.201A","M76.821","G89.29"],"date":["2020-08-21","2020-08-21","2020-08-21","2020-08-21","2020-08-21","2020-12-19","2021-03-03","2021-09-30","2021-03-03","2021-03-03","2021-03-03","2021-12-26","2020-05-18","2020-10-21","2021-12-17","2021-09-30","2020-12-27","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2021-09-04","2021-09-04","2020-06-01","2020-06-01","2020-06-01","2019-06-17","2019-06-17","2019-06-17","2019-09-20","2019-11-18","2019-09-20","2019-05-30","2019-05-30","2019-05-30","2019-03-11","2019-03-11","2019-08-14","2019-11-18","2019-11-18"],"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":[["","","TRAMADOL","TAB 50MG","","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","21","Select","Select",""],["","69367016304","PHENAZOPYRID","TAB 200MG","6","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","68001018008","QUETIAPINE","TAB 50MG","30","Select","Select",""],["","69584009310","BUSPIRONE","TAB 15MG","68","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","00591544301","PREDNISONE","TAB 20MG","7","Select","Select",""],["","","PROVENTIL","AER HFA","","Select","Select",""],["","","AMITRIPTYLIN","TAB 25MG","","Select","Select",""],["","","VENTOLIN","AER ","","Select","Select",""],["","","BENZONATATE","CAP 200MG","","Select","Select",""],["","","PROAIR","AER ","","Select","Select",""],["","68001028108","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","","RIZATRIPTAN","TAB 5MG ODT","","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","20","Select","Select",""],["","","VOLTAREN","GEL 0.01","","Select","Select",""],["","","MIRTAZAPINE","TAB 15MG","","Select","Select",""],["","","CLARITHROMYC","TAB 500MG","","Select","Select",""],["","","ACETAMINOPHE","TAB 325MG","","Select","Select",""],["","00245010811","FERROUS","TAB 325MG EC","30","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","30","Select","Select",""],["","50228018005","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","00054429731","FUROSEMIDE","TAB 20MG","3","Select","Select",""],["","00591565810","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","13107005999","APAP\/CODEINE","TAB 300-30MG","15","Select","Select",""],["","57664012688","HYDROCO\/APAP","TAB 5-325MG","20","Select","Select",""],["","59762444002","METHYLPRED","TAB 4MG","21","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":""}]}]}