{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"M   AMSABNADAMAR ","gend":1,"add":"SAMOHT 2522RD YENNEK ","city":"GLEN ALLEN","state":"VA","zip":"23060-9998","dob":"1986-10-02","age":"","mstatus":"","insh":"8567110*09","cliId":"","pno":"74\/4083086-7","cno":"804\/641-7315","email":"","ename":"","eno":"","pphy":"WINGARD, JENNA M PA","ppno":"804\/968-5700","pcpadd":"SUITE 100 5000 COX ROAD","pcpcity":"GLEN ALLEN","pcpstate":"VA","pcpzip":23060,"pcpcounty":"","pcpid":"","pcpname":"PATIENT FIRST RICHMOND MEDICAL GROUP PLLC","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":["M72.2","E03.9","Z12.11","Z80.0","Z86.010","K63.5","R10.2","Z11.8","Z11.3","R39.9","R30.9","N39.0","N94.6","N92.0","R30.0","E04.1","D12.2","M79.609","R14.0","R20.8","N94.10","R35.0","N89.8","J06.9","D25.9","K62.89","K64.4","Z01.419","E28.2","Z11.51","Z91.89","M77.31","M21.6X1","M79.671","E55.9","Z23.","Z68.35","R53.83","E66.01","I83.811","N76.0","R52.","I83.11","M24.574","R07.9"],"date":["2019-11-22","2020-12-18","2020-12-21","2020-12-21","2020-12-21","2020-12-21","2021-06-09","2021-06-09","2021-06-09","2021-06-09","2021-06-09","2021-06-09","2021-09-10","2021-09-10","2021-01-04","2021-06-18","2020-12-21","2021-08-17","2021-02-04","2021-02-04","2021-02-04","2021-02-04","2021-02-04","2021-07-24","2021-09-10","2019-05-23","2019-05-23","2021-02-19","2021-02-19","2020-01-09","2021-08-17","2019-11-22","2019-11-22","2019-11-22","2020-08-13","2019-09-09","2019-09-09","2019-09-09","2019-09-09","2019-05-10","2020-07-21","2020-07-21","2019-05-10","2019-11-22","2021-07-24"],"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":[["","","APRI"," APRI ","28","Select","Select",""],["","","TAMIFLU"," TAMIFLU ","10","Select","Select",""],["","","OSELTAMIVIR"," OSELTAMIVIR ","10","Select","Select",""],["","","BENZONATATE"," BENZONATATE ","15","Select","Select",""],["","","PROAIR"," PROAIR ","8","Select","Select",""],["","","METHYLPRED"," METHYLPRED ","21","Select","Select",""],["","","NEO\/POLY\/HC"," NEO\/POLY\/HC ","10","Select","Select",""],["","","HYDROCO\/APAP"," HYDROCO\/APAP ","10","Select","Select",""],["","","CIPROFLOXACN"," CIPROFLOXACN ","20","Select","Select",""],["","","DICLOFENAC"," DICLOFENAC ","14","Select","Select",""],["","","CIPRODEX"," CIPRODEX ","8","Select","Select",""],["","","NITROFURANTN"," NITROFURANTN ","14","Select","Select",""],["","","PHENAZOPYRID"," PHENAZOPYRID ","6","Select","Select",""],["","","CEPHALEXIN"," CEPHALEXIN ","14","Select","Select",""],["","","SMZ\/TMP"," SMZ\/TMP ","6","Select","Select",""],["","","MELOXICAM"," MELOXICAM ","30","Select","Select",""],["","","APAP\/CODEINE"," APAP\/CODEINE ","21","Select","Select",""],["","","IPRATROPIUM"," IPRATROPIUM ","30","Select","Select",""],["","","VITAMIN","CAP 50000UNT","","Select","Select",""],["","","AMOXICILLIN","TAB 875MG","","Select","Select",""],["","","METRONIDAZOL","TAB 500MG","","Select","Select",""],["","","JUNEL","TAB 1.5\/30","","Select","Select",""],["","","CYCLOBENZAPR","TAB 10MG","","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":""}]}]}