{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   ELEHCIMNOSKCAJ J","gend":1,"add":"RUTNEC 36522 TPA RD Y","city":"PETERSBURG","state":"VA","zip":"23805-9998","dob":"1989-10-30","age":"","mstatus":"","insh":"4933710*16","cliId":"","pno":"27\/4081169-0","cno":"","email":"","ename":"","eno":"","pphy":"SOMERS, KARA E MD","ppno":"804\/828-2647","pcpadd":"1000 E BROAD 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":["D06.9","O98.72","O34.211","Z3A.39","Z37.0","J06.9","Z21.","Z80.3","Z83.3","Z79.899","R05.","O98.713","O99.013","D50.9","Z87.410","Z3A.36","Z33.1","Z30.46","Z39.0","B02.8","O98.719","Z3A.00","Z87.891","Z23.","R21.","B20.","D64.9","L30.9","L21.9","O99.824","O99.02","Z30.017","R87.612","A51.31","V23.9","O34.219","O98.712","Z3A.25","Z3A.32","Z39.2","Z20.828","Z3A.20","Z3A.33","O91.113","Z3A.34","Z32.01","Z30.431","R00.0","N93.9","R42.","R10.30","L08.9","O03.9","B02.9","M79.672"],"date":["2020-09-21","2021-01-25","2021-01-25","2021-01-25","2021-01-25","2021-08-17","2021-08-17","2021-08-17","2021-08-17","2021-08-17","2021-08-17","2021-01-08","2021-01-05","2021-01-25","2021-01-05","2021-01-08","2021-01-23","2021-01-28","2021-01-28","2020-09-05","2020-09-05","2020-09-05","2020-09-05","2021-08-10","2020-09-05","2021-09-14","2021-01-08","2021-09-14","2021-09-14","2021-01-25","2021-01-25","2021-01-25","2021-07-29","2021-07-29","2020-10-20","2020-12-22","2020-10-20","2020-10-20","2020-12-08","2021-03-10","2021-01-23","2020-08-27","2020-12-16","2020-12-22","2020-12-22","2019-10-09","2019-03-01","2019-02-28","2019-10-29","2019-10-29","2019-10-29","2019-05-26","2019-11-07","2019-05-22","2019-09-08"],"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":[["","68180016206","AZITHROMYCIN","TAB 600MG","8","Select","Select",""],["","65862042001","SMZ\/TMP","TAB 800-160","30","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","10","Select","Select",""],["","00363010412","PAIN","TAB 325MG","120","Select","Select",""],["","45802086801","POLYETH","POW 3350 NF","119","Select","Select",""],["","59676080030","SYMTUZA","TAB ","30","Select","Select",""],["","49702022813","TIVICAY","TAB 50MG","30","Select","Select",""],["","45802005505","TRIAMCINOLON","OIN 0.001","454","Select","Select",""],["","59676056630","PREZISTA","TAB 800MG","30","Select","Select",""],["","65862004824","ZIDOVUDINE","SYP 50MG\/5ML","240","Select","Select",""],["","61958070101","TRUVADA","TAB 200-300","30","Select","Select",""],["","00006022761","ISENTRESS","TAB 400MG","60","Select","Select",""],["","00074333330","NORVIR","TAB 100MG","30","Select","Select",""],["","00536105224","PEG3350","POW ","238","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","64380080807","IBUPROFEN","TAB 600MG","120","Select","Select",""],["","00087086644","D-VI-SOL","LIQ 400UNIT","50","Select","Select",""],["","00904759160","FEROSUL","TAB 325MG","30","Select","Select",""],["","00536100901","FERROUS","TAB 325MG","30","Select","Select",""],["","66689000816","NYSTATIN","SUS 100000","112","Select","Select",""],["","54838000650","VITAMIN","DRO 10MCG\/ML","50","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":""}]}]}