{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AUQINOJYESROD ","gend":1,"add":"YBSOM 427F TPA TS ","city":"RICHMOND","state":"VA","zip":"23223-9998","dob":"1991-02-11","age":"","mstatus":"","insh":"8803210*97","cliId":"","pno":"78\/4082862-8","cno":"","email":"","ename":"","eno":"","pphy":"WHITEHURST COOK, MICHELLE MD","ppno":"804\/828-5883","pcpadd":"401 N 11TH ST","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23298,"pcpcounty":"","pcpid":"","pcpname":"MCV ASSOCIATED PHYSICIANS","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":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.5","R46.2","T50.905A","F11.23","F33.1","J39.0","F11.20","F14.20","F43.10","S50.02XA","T22.212A","X15.0XXA","J02.9","F19.10","F41.9","F31.81","F33.9","R10.84","W01.10XA","Z00.01","B36.0","F32.9","G56.03","M25.559","B99.9","R07.0","Z20.828","R21.","T78.40XA","L29.9","R06.02","R05.","R07.9"],"date":["2020-07-20","2021-01-11","2021-01-11","2021-01-11","2021-08-31","2021-06-26","2021-10-19","2021-08-31","2021-08-31","2021-11-03","2021-11-03","2021-11-03","2021-06-27","2021-06-27","2021-05-12","2021-05-12","2021-05-12","2021-12-07","2021-11-03","2020-12-30","2020-12-30","2020-12-30","2020-12-30","2021-05-25","2021-06-26","2021-06-26","2021-06-26","2020-10-31","2020-10-31","2020-11-09","2021-02-17","2021-02-17","2021-02-17"],"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":[["","","MIRTAZAPINE","TAB 15MG","","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","20","Select","Select",""],["","","CLINDAMYCIN","CAP 300MG","","Select","Select",""],["","60505083001","MOMETASONE","SPR 50MCG","17","Select","Select",""],["","70010077001","METHOCARBAM","TAB 750MG","56","Select","Select",""],["","","QUETIAPINE","TAB 50MG","","Select","Select",""],["","43199001101","HYOSCYAMINE","SUB 0.125MG","20","Select","Select",""],["","57237007810","ONDANSETRON","TAB 8MG ODT","12","Select","Select",""],["","","SUBOXONE","MIS 4-1MG","","Select","Select",""],["","","PREDNISONE","TAB 20MG","","Select","Select",""],["","","HYDROCORT","CRE 0.01","","Select","Select",""],["","","PERMETHRIN","CRE 0.05","","Select","Select",""],["","","HYDROXYZ","CAP 25MG","","Select","Select",""],["","","PROAIR","AER ","","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","","CLONIDINE","TAB 0.1MG","","Select","Select",""],["","","DICLOFENAC","TAB 50MG DR","","Select","Select",""],["","","DIPHENHYDRAM","CAP 25MG","","Select","Select",""],["","","BANOPHEN","CAP 25MG","","Select","Select",""],["","","WAL-DRYL","CAP 25MG","","Select","Select",""],["","","CITALOPRAM","TAB 20MG","","Select","Select",""],["","","METHADONE","TAB 5MG","","Select","Select",""],["","","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","","CHLORHEX","SOL 0.0012","","Select","Select",""],["","","IBUPROFEN","TAB 600MG","","Select","Select",""],["","","NITROFURANTN","CAP 100MG","","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":""}]}]}