{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  LATSYRCSNOYL E ","gend":1,"add":" NOJ 9035TS YAW S","city":"PETERSBURG","state":"VA","zip":"23803-9998","dob":"1982-01-19","age":"","mstatus":"","insh":"6071110*97","cliId":"","pno":"38\/4089500-6","cno":"","email":"","ename":"","eno":"","pphy":"SARAIYA, BHAVNA MD","ppno":"","pcpadd":"50 MEDICAL PARK BLVD SUITE C","pcpcity":"PETERSBURG","pcpstate":"VA","pcpzip":23805,"pcpcounty":"","pcpid":"","pcpname":"SOUTHSIDE PHYSICIANS NETWORK - INTERNAL MEDICINE","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":["Z39.1","Z34.93","Z3A.39","O36.8131","O80.","Z37.0","J06.9","R50.9","R60.0","M79.604","M79.605","O36.8130","O70.0","L50.0","N76.0","B96.89","R05.","R63.4","R45.86","R53.83","E55.9","R20.0","F32.9","R21.","Z82.69","Z81.8","R20.2","Z68.30","L82.1","L53.8","N89.8","L91.0","N62.","Z87.440","Z68.31","B97.89","Z32.01","Z20.822","K21.9","E66.3","R51.9","Z3A.37","Z39.2","Z23.","Z3A.27","Z3A.40","R10.9","Z79.899","R19.7","M51.16","R10.2","R51.","M54.5","J45.909","E66.9","Z68.34","Z11.3","R11.0","Z3A.01","M79.671","V58.89","R10.84","Z30.011","K59.00","R10.13","L30.9","L29.8","Z32.02","S93.401A","W10.8XXA","S93.409A","G89.29","Y92.008"],"date":["2020-07-22","2020-09-17","2020-08-18","2020-08-18","2020-08-18","2020-08-18","2021-12-02","2021-06-23","2020-07-05","2020-07-05","2020-07-05","2020-08-17","2020-08-17","2020-12-30","2021-11-08","2021-08-03","2021-08-04","2021-08-04","2021-09-15","2021-08-04","2021-09-15","2021-08-04","2021-09-15","2021-08-04","2021-08-04","2021-08-04","2021-08-04","2021-08-04","2020-11-03","2020-11-03","2020-02-10","2020-10-12","2021-09-15","2021-09-15","2021-12-02","2021-12-02","2021-12-02","2021-12-02","2021-12-02","2021-12-02","2021-12-02","2020-07-17","2020-10-17","2020-05-27","2020-05-27","2020-09-17","2021-09-02","2021-09-02","2021-09-02","2019-10-11","2019-06-05","2019-01-25","2019-01-25","2019-01-25","2019-01-25","2019-01-25","2019-10-14","2019-12-27","2019-12-27","2019-05-31","2019-05-31","2019-06-05","2019-06-05","2019-01-30","2019-02-27","2019-06-05","2019-06-05","2019-02-06","2019-05-19","2019-05-24","2019-05-24","2019-05-24","2019-05-24"],"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":[["","50428042799","ALLRGY","TAB 10-240MG","14","Select","Select",""],["","00591565810","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","60","Select","Select",""],["","13668013601","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","27437005101","SOLOSEC","GRA 2GM","1","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","14","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","65162068090","PROMETHAZINE","SOL DM","120","Select","Select",""],["","00085113204","PROVENTIL","AER HFA","7","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","21","Select","Select",""],["","","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","57664037718","TRAMADOL","TAB 50MG","5","Select","Select",""],["","64380071207","BENZONATATE","CAP 100MG","21","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","00536408501","PRENATAL","TAB 28-0.8MG","90","Select","Select",""],["","","HYDROXYZ","TAB 25MG","","Select","Select",""],["","65862086001","FAMOTIDINE","TAB 40MG","60","Select","Select",""],["","","AYR","DRO 0.0065","","Select","Select",""],["","","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","00378064110","PREDNISONE","TAB 10MG","36","Select","Select",""],["","00143314205","DOXYCYCL","CAP 100MG","14","Select","Select",""],["","59651000305","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","00555902658","JUNEL","TAB 44581","28","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","21","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","51672130406","TERCONAZOLE","CRE 0.004","45","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":""}]}]}