{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ACISSEJZTRAWHCS","gend":1,"add":"TSIOLC 1319A TPA E SRE","city":"HENRICO","state":"VA","zip":"23229-9998","dob":"1972-09-09","age":"","mstatus":"","insh":"8376110*94","cliId":"","pno":"42\/1755227-3","cno":"571\/243-7225","email":"","ename":"","eno":"","pphy":"YOUNG, WILLIAM H MD","ppno":"804\/355-5550","pcpadd":"STE 301 110 N ROBINSON ST","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23220,"pcpcounty":"","pcpid":"","pcpname":"","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":["Z00.01","F41.9","F41.0","J45.909","I47.2","R94.31","NO DATA","M25.50","M25.531","R53.83","M25.532","J30.9","F41.8","J45.901","Z20.828","F10.239","I46.2","I49.01","F33.1","D69.6","D72.829","F17.200","H57.04","R56.9","Z72.89","Z88.0","F10.231","D72.828","E87.6","V72.85","F41.1","F10.99","J45.41","N92.4","K29.70","R05.","J18.9","R42.","I49.1","R00.1","F10.10","I21.4","I46.8","I45.81","Z62.820","H91.13","Z20.822","J01.20","R06.02","J01.90","Z00.00","H66.93","J45.22","Z79.51","Z79.899"],"date":["2020-07-21","2022-09-30","2020-07-21","2021-01-11","2020-10-05","2021-08-19","2022-11-09","2022-01-24","2022-01-24","2022-01-24","2022-01-24","2022-04-05","2022-06-30","2021-08-06","2020-06-03","2020-10-05","2020-09-25","2020-09-25","2022-02-04","2020-10-05","2020-10-05","2021-08-23","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2021-09-30","2020-10-01","2021-08-23","2021-08-19","2021-08-19","2021-08-19","2021-10-05","2022-08-25","2020-09-25","2020-09-25","2020-10-01","2020-10-01","2020-10-01","2020-10-01","2021-08-11","2022-08-25","2021-08-23","2020-08-04","2021-08-23","2022-08-05","2022-11-10","2022-02-04","2021-07-28","2021-08-23","2021-08-23"],"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":[["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","24208063110","NEO\/POLY\/HC","SOL 1% OTIC","10","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00378932132","WIXELA","AER 250\/50","60","Select","Select",""],["","10006073020","VITAMIN","TAB 100MG","30","Select","Select",""],["","16729013700","CLONAZEPAM","TAB 1MG","120","Select","Select",""],["","50111045001","TRAZODONE","TAB 150MG","30","Select","Select",""],["","57237016250","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","00173069600","ADVAIR","AER 250\/50","60","Select","Select",""],["","68645056054","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","50383090110","HC\/ACET","SOL OTIC","10","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","28","Select","Select",""],["","69315090405","LORAZEPAM","TAB 0.5MG","3","Select","Select",""],["","76204020025","ALBUTEROL","NEB 0.00083","150","Select","Select",""],["","60505083305","AZELASTINE","SPR 0.001","30","Select","Select",""],["","65862017760","CEFDINIR","CAP 300MG","20","Select","Select",""],["","82607066026","FLOWFLEX","KIT TEST","8","Select","Select",""],["","00487020103","IPRATROPIUM\/","SOL ALBUTER","90","Select","Select",""],["","00536354710","DAILY-VITE","TAB ","30","Select","Select",""],["","80681002000","MULTIVITAMIN","TAB ","30","Select","Select",""],["","00761036120","MULTI","TAB D-3","30","Select","Select",""],["","27808023302","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","30","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","66993058597","FLUTIC\/SALME","AER 250\/50","60","Select","Select",""],["","51224012230","AZITHROMYCIN","TAB 500MG","3","Select","Select",""],["","55111028050","LEVOFLOXACIN","TAB 500MG","10","Select","Select",""],["","70000018701","COUGH","SUS 30MG\/5ML","89","Select","Select",""],["","00054418425","DEXAMETHASON","TAB 4MG","2","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","13668001005","CITALOPRAM","TAB 20MG","90","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","10135013210","THIAMINE","TAB 100MG","30","Select","Select",""],["","69315012710","FOLIC","TAB 1000MCG","30","Select","Select",""],["","31604001269","MAGNESIUM","TAB 250MG","30","Select","Select",""],["","00245531915","KLOR-CON","TAB 20MEQ ER","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}