{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"N   REBMAGREBLOH ","gend":1,"add":" NEB 2628RD SIVEN","city":"RICHMOND","state":"VA","zip":"23235-9998","dob":"1997-06-13","age":"","mstatus":"","insh":"7274110*65","cliId":"","pno":"39\/4080256-1","cno":"804\/931-6520","email":"","ename":"","eno":"","pphy":"MALHOTRA, SHAILAJA V MD","ppno":"804\/739-0910","pcpadd":"13861 HULL STREET RD","pcpcity":"MIDLOTHIAN","pcpstate":"VA","pcpzip":23112,"pcpcounty":"","pcpid":"","pcpname":"Primary Health Group - Village Green","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":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K52.9","R93.3","R31.9","R79.89","R10.0","R11.2","K52.89","R06.02","R10.30","S55.102A","J45.901","J40.","R07.9","R20.2","Z68.41","G89.29","R42.","R53.83","R00.0","N10.","Z20.822","R10.13","K82.8","M54.9","R10.9","F43.12","F41.0","F34.1","M70.71","L30.4","M79.605","U07.1","J45.909","Z87.891","R05.9","A41.9","R65.21","R40.2213","A09.","E28.2","E66.01","Z88.0","F41.9","K21.9","Z87.440","Z87.442","Z88.6","Z79.51","V72.85","NO DATA","K92.0","R39.9","I70.208","Z71.3","R05.","F41.8","Z92.89","Z68.39","G47.00","K59.00","K76.0","Z79.01","Z87.11","E66.9","Z72.89","Z82.49","Z88.1","Z88.8","J01.90","H66.90","R06.83","E78.1","G43.819","E34.8","G60.3","G47.33","K29.70","R19.7","R10.11","S69.81XA","M25.531","M79.602","J96.01","J18.9","Z20.828","J45.21","Z68.38","B97.29","I47.1","Z01.810","M72.2","Z01.419","B37.2","Z23.","J10.01","R07.1","R51.9","R94.31","F41.1","R11.0","R13.10","L73.9","Z03.818","Z88.9","R10.2","R94.8","G62.9","Z84.0","H04.123","H43.393","R10.84","I30.0","D72.829","I51.7","N39.0","B34.9","M25.50","M25.551","M47.816","R06.00","M79.7","Z68.43","E55.9","R07.2","J10.1","R05.8","J20.9","Z78.9","Z00.8","J33.9","J30.9","M79.603","R68.83","Z53.20","R10.31","E04.1","H53.8","H01.001","M25.559","L98.9","R93.89","M77.8"],"date":["2021-09-03","2020-02-02","2020-02-02","2021-08-02","2020-01-31","2022-03-17","2020-01-31","2020-10-30","2020-02-06","2020-02-12","2022-04-12","2022-04-14","2021-09-14","2021-02-04","2022-04-14","2021-06-25","2021-06-25","2021-06-25","2022-07-14","2021-08-24","2022-07-08","2021-08-28","2022-03-17","2021-09-03","2021-09-03","2022-10-25","2022-10-25","2022-10-25","2022-04-01","2022-04-01","2022-04-14","2022-07-14","2022-07-14","2022-07-14","2022-07-14","2020-01-24","2020-01-24","2020-01-24","2020-01-24","2021-03-29","2020-05-18","2021-08-27","2020-05-06","2022-07-14","2020-01-24","2020-01-24","2020-01-24","2022-03-14","2020-01-24","2021-01-28","2020-02-19","2020-02-02","2020-05-18","2020-05-18","2020-05-06","2020-05-12","2020-05-12","2022-03-17","2020-05-12","2021-08-27","2021-08-27","2021-08-27","2021-08-27","2021-08-27","2021-08-27","2021-08-27","2021-08-27","2021-08-27","2021-12-09","2021-12-09","2021-11-12","2021-11-12","2022-01-07","2022-01-07","2022-01-07","2022-01-07","2022-03-14","2022-03-17","2022-04-14","2022-05-06","2022-05-06","2020-02-11","2020-05-08","2020-05-08","2022-01-13","2021-02-23","2020-05-06","2020-05-07","2021-09-14","2020-10-30","2020-11-09","2021-03-29","2021-03-29","2021-03-29","2021-11-27","2022-07-14","2022-07-14","2022-07-14","2020-10-16","2020-10-21","2020-10-21","2021-04-15","2022-04-12","2020-01-27","2020-02-19","2020-02-19","2020-06-01","2020-07-02","2021-04-02","2021-04-02","2021-09-01","2021-09-14","2020-01-24","2020-01-26","2021-01-11","2021-01-14","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-08-02","2021-10-23","2021-11-27","2022-04-12","2022-04-12","2022-09-08","2022-09-08","2022-09-08","2022-09-08","2020-02-06","2020-02-06","2020-02-06","2020-08-23","2020-10-30","2021-03-31","2021-03-31","2022-01-10","2022-01-10","2020-05-08","2022-05-20"],"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":[]},{"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":[["","31722071390","PANTOPRAZOLE","TAB 40MG","60","Select","Select",""],["","00168000615","TRIAMCINOLON","OIN 0.001","15","Select","Select",""],["","55111064501","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","64380073706","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","71143037501","XHANCE","MIS 93MCG","16","Select","Select",""],["","55111015330","ONDANSETRON","TAB 4MG","15","Select","Select",""],["","00527058601","DICYCLOMINE","CAP 10MG","120","Select","Select",""],["","00591544243","PREDNISONE","PAK 10MG","48","Select","Select",""],["","65162027210","SMZ\/TMP","TAB 800-160","10","Select","Select",""],["","51991084716","BROM\/PSE\/DM","SYP ","240","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","7","Select","Select",""],["","51672129801","KETOCONAZOLE","CRE 0.02","15","Select","Select",""],["","00378932132","WIXELA","AER 250\/50","60","Select","Select",""],["","69238110005","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","00173069600","ADVAIR","AER 250\/50","60","Select","Select",""],["","16571020110","DICLOFENAC","TAB 75MG DR","20","Select","Select",""],["","00069108530","PAXLOVID","TAB 300-100","30","Select","Select",""],["","65162046510","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","70710112307","DOXYCYC","TAB 100MG","14","Select","Select",""],["","59310058020","PROAIR","AER ","1","Select","Select",""],["","42806071501","BENZONATATE","CAP 200MG","30","Select","Select",""],["","89076085333","AIRIAL","MIS COMPACT","1","Select","Select",""],["","76385012450","METHOCARBAM","TAB 750MG","40","Select","Select",""],["","65862007701","CIPROFLOXACN","TAB 500MG","20","Select","Select",""],["","65862053820","LEVOFLOXACIN","TAB 750MG","5","Select","Select",""],["","17478007035","ERYTHROMYCIN","OIN 5MG\/GM","4","Select","Select",""],["","00832046515","NYAMYC","POW 100000","15","Select","Select",""],["","16714036603","SETLAKIN","TAB ","91","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","57664037708","TRAMADOL","TAB 50MG","30","Select","Select",""],["","16729017217","AMITRIPTYLIN","TAB 25MG","30","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","20","Select","Select",""],["","65162074510","PROMETHAZINE","TAB 12.5MG","20","Select","Select",""],["","65162071009","COLCHICINE","TAB 0.6MG","60","Select","Select",""],["","62332025118","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","50242087701","XOFLUZA","TAB 80MG","1","Select","Select",""],["","64380079901","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","50383070016","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","60505082601","IPRATROPIUM","SPR 0.0003","30","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","00003089431","ELIQUIS","TAB 5MG","60","Select","Select",""],["","50228018005","GABAPENTIN","CAP 300MG","20","Select","Select",""],["","69543025216","VIRTUSSIN","SOL 100-10\/5","118","Select","Select",""],["","00085720601","DULERA","AER 100-5MCG","13","Select","Select",""],["","60505265301","TRAZODONE","TAB 50MG","60","Select","Select",""],["","16729013616","CLONAZEPAM","TAB 0.5MG","30","Select","Select",""],["","51991070505","ALPRAZOLAM","TAB 0.5MG","45","Select","Select",""],["","76439030210","CHLORD\/CLIDI","CAP 5-2.5MG","15","Select","Select",""],["","00187410010","LIBRAX","CAP 5-2.5MG","15","Select","Select",""],["","67877024201","QUETIAPINE","TAB 25MG","30","Select","Select",""],["","00378803077","LANSOPRAZOLE","CAP 30MG DR","90","Select","Select",""],["","52268001201","SUPREP","SOL PREP KIT","354","Select","Select",""],["","65862090801","CELECOXIB","CAP 100MG","60","Select","Select",""],["","68462040601","INDOMETHACIN","CAP 25MG","30","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":""}]}]}