{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"M   AYEKATREKATIHW ","gend":1,"add":"YLEVE 215314 TPA RD N","city":"CHESTER","state":"VA","zip":"23831-9998","dob":"2000-07-29","age":"","mstatus":"","insh":"7573610*32","cliId":"","pno":"84\/4089550-1","cno":"804\/668-6207","email":"","ename":"","eno":"","pphy":"ARIAS, ALBERTO MD","ppno":"804\/748-9071","pcpadd":"12801 IRON BRIDGE RD STE 200","pcpcity":"CHESTER","pcpstate":"VA","pcpzip":23831,"pcpcounty":"","pcpid":"","pcpname":"SOUTHSIDE PHYSICIANS NETWORK - FAMILY MEDICINE","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":["F33.9","F33.3","F90.0","Z30.431","B37.3","N76.0","B96.89","A56.02","Z11.3","Z01.419","Z30.430","N93.9","Z30.432","Z32.02","Z30.09","R07.0","J40.","Z20.822","Z72.51","E66.9","F17.200","Z68.41","N39.0","R07.9","R07.89","R45.89","A49.3","N76.4","R30.0","M54.5","M25.569","A60.00","F41.8","F33.1","F41.9","M25.562","G89.29","Z00.00","Z01.10","Z01.00","J06.9","R05.","A60.04","Z68.42","J02.9","F90.2"],"date":["2020-10-12","2020-06-25","2020-06-25","2020-06-24","2020-09-18","2021-07-22","2021-07-22","2021-01-22","2021-09-14","2020-01-21","2020-01-21","2020-12-10","2020-12-10","2021-06-17","2021-06-17","2021-05-31","2021-05-31","2021-09-21","2021-09-14","2021-06-17","2021-06-17","2021-06-17","2021-09-21","2021-09-21","2021-09-21","2020-02-24","2020-06-24","2021-03-05","2020-12-04","2020-12-04","2020-12-04","2021-03-26","2021-03-26","2019-02-07","2019-02-01","2019-01-15","2019-01-15","2019-10-28","2019-10-28","2019-10-28","2019-03-04","2019-01-13","2019-04-25","2019-03-04","2019-03-04","2019-02-01"],"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":[["","","AZITHROMYCIN","TAB 500MG","","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","15","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","00185012201","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","","METRONIDAZOL","TAB 500MG","","Select","Select",""],["","65862069730","VENLAFAXINE","CAP 150MG ER","30","Select","Select",""],["","54092038701","ADDERALL","CAP 20MG","30","Select","Select",""],["","55111025760","ZIPRASIDONE","CAP 40MG","60","Select","Select",""],["","","NYSTATIN","CRE 100000","","Select","Select",""],["","","TRIAMCINOLON","OIN 0.005","","Select","Select",""],["","","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","","SMZ\/TMP","TAB 800-160","","Select","Select",""],["","","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","","ONDANSETRON","TAB 4MG ODT","","Select","Select",""],["","65862044890","VALACYCLOVIR","TAB 500MG","6","Select","Select",""],["","66993059702","AMPHET\/DEXTR","CAP 20MG ER","30","Select","Select",""],["","","DOXYCYC","TAB 100MG","","Select","Select",""],["","","TERCONAZOLE","CRE 0.008","","Select","Select",""],["","64380071306","BENZONATATE","CAP 200MG","20","Select","Select",""],["","45802088014","NYSTAT\/TRIAM","CRE ","15","Select","Select",""],["","00591271601","METHYLPHENID","TAB 27MG ER","30","Select","Select",""],["","68382013805","TOPIRAMATE","TAB 25MG","60","Select","Select",""],["","69238110305","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","30","Select","Select",""],["","31722063231","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","50383077504","LIDOCAINE","SOL 2% VISC","360","Select","Select",""],["","00052027303","NUVARING","MIS ","1","Select","Select",""],["","60432060416","PROMETHAZINE","SYP DM","120","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","20","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":""}]}]}