{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   ATIUQRAMSDLONYER Y","gend":1,"add":"VA YELNEP 114492 XOB OP E","city":"HENRICO","state":"VA","zip":"23075-9998","dob":"1983-09-25","age":"","mstatus":"","insh":"69300210*10","cliId":"","pno":"42\/4089025-7","cno":"","email":"","ename":"","eno":"","pphy":"CZAJKOWSKI, STANLEY B DO","ppno":"804\/764-1253","pcpadd":"8200 MEADOWBRIDGE ROAD SUITE 306","pcpcity":"MECHANICSVILLE","pcpstate":"VA","pcpzip":23116,"pcpcounty":"","pcpid":"","pcpname":"MEMORIAL MEDICAL CENTER","plan":"OHP","program":"MEDICAID","lob":"OHCC","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":["R07.9","E89.0","N64.4","R00.2","B37.3","R07.1","Z20.828","N32.89","J30.1","M05.79","G43.009","M94.0","J45.20","E03.9","R90.82","G43.709","Z68.32","Z79.899","G56.03","M62.838","I45.19","M54.5","M62.830","M53.80","R07.81","R11.0","R93.0","Z01.419","Z11.51","H00.015","R42.","Z20.822","E55.9","R09.1","R05.","G43.909","M54.2","G81.94","R25.2","J45.909","J16.8","R10.84","R07.89","J18.1","Z68.30","R29.818","E88.09","D63.8","R20.0","Z68.31","N30.90","F32.2","H02.843","R51.9","K29.70","R13.10","K21.9","R21.","G35.","M25.551","M25.552","L30.9","J40.","B35.4","NO DATA","R22.0","Z79.890","Z01.812","H57.12","H05.223","M06.9","R23.4","M16.0","M84.377A"],"date":["2021-11-01","2021-02-05","2021-03-15","2021-03-12","2020-02-24","2020-11-01","2022-03-13","2021-07-30","2021-07-30","2022-07-13","2022-05-10","2021-11-22","2021-11-22","2022-01-01","2021-11-22","2021-11-22","2022-07-13","2022-01-03","2020-10-14","2020-03-08","2020-11-01","2020-05-12","2020-05-12","2020-05-12","2020-08-03","2022-07-13","2021-04-23","2020-09-29","2020-09-29","2020-05-05","2021-03-12","2022-08-06","2020-07-23","2020-11-01","2019-07-26","2019-07-17","2019-07-17","2019-03-22","2019-03-22","2022-01-01","2019-02-07","2019-02-07","2022-02-21","2019-04-05","2019-09-18","2019-05-01","2019-11-18","2019-11-18","2019-05-06","2019-11-18","2021-07-22","2022-11-17","2022-01-01","2022-05-24","2022-02-21","2022-02-21","2022-02-21","2022-03-22","2022-05-10","2022-02-01","2022-02-01","2022-05-06","2022-03-13","2022-03-13","2022-01-01","2022-01-01","2022-01-01","2022-02-17","2022-06-03","2022-07-01","2022-07-01","2022-03-28","2022-07-13","2022-11-21"],"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":[["","","RASUVO","INJ 25MG","","Select","Select",""],["","","EMGALITY"," EMGALITY ","1","Select","Select",""],["","24208091055","ERYTHROMYCIN","OIN 5MG\/GM","4","Select","Select",""],["","","LEVOTHYROXIN"," LEVOTHYROXIN ","30","Select","Select",""],["","","ONDANSETRON","TAB 4MG ODT","","Select","Select",""],["","62175061846","PANTOPRAZOLE","TAB 20MG","60","Select","Select",""],["","00603533815","PREDNISONE","PAK 10MG","21","Select","Select",""],["","00168009915","KETOCONAZOLE","CRE 0.02","15","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","45802027603","HYDROCORT","OIN 0.01","28","Select","Select",""],["","72647033104","METHYLPRED","TAB 4MG","21","Select","Select",""],["","69315012710","FOLIC","TAB 1000MCG","90","Select","Select",""],["","50742018130","LEUCOVOR","TAB 5MG","4","Select","Select",""],["","","VALACYCLOVIR","TAB 500MG","","Select","Select",""],["","","DICLOFENAC","TAB 75MG DR","","Select","Select",""],["","","VITAMIN","CAP 50000UNT","","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","65162068090","PROMETHAZINE","SOL DM","118","Select","Select",""],["","47781030801","NITROFUR","CAP 100MG","10","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","20","Select","Select",""],["","","TERCONAZOLE","SUP 80MG","","Select","Select",""],["","","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","","TIZANIDINE","TAB 4MG","","Select","Select",""],["","","MAG","TAB 400MG","","Select","Select",""],["","","RIBOFLAVIN","TAB 400MG","","Select","Select",""],["","","NAPROXEN","TAB 500MG","","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":""}]}]}