{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"G   AJNOTTHGIEPS ","gend":1,"add":" EICNUM 70923434 TPA DR","city":"RICHMOND","state":"VA","zip":"23223-9998","dob":"1972-11-05","age":"","mstatus":"","insh":"8961210*97","cliId":"","pno":"03\/4088703-3","cno":"804\/303-3078","email":"","ename":"","eno":"","pphy":"JACKSON, RICHARD A MD","ppno":"804\/225-7148","pcpadd":"304 E LEIGH ST","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23219,"pcpcounty":"","pcpid":"","pcpname":"Dominion Medical Associates, INC.","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":["Z47.89","M43.16","M43.26","I10.","M19.90","F41.9","M96.1","F17.210","E66.9","M54.9","R53.83","G89.29","R51.9","R06.02","N18.2","E03.9","E87.2","NO DATA","I49.9","F17.200","R29.6","M54.16","Z68.34","Z88.8","Z88.6","Z90.710","Z90.49","Z82.49","Z98.890","R20.2","H91.90","Z12.11","Z23.","M79.89","M54.5","Z80.0","K64.8","G47.30","M53.2X6","Z98.1","R79.89","R76.8","D80.2","Z87.39","Z68.36","Z01.812","Z20.822"],"date":["2020-03-10","2020-03-10","2020-03-10","2022-02-25","2020-03-10","2020-03-10","2020-04-03","2020-03-03","2020-04-03","2021-01-05","2021-01-05","2021-01-05","2021-01-05","2021-01-05","2021-09-22","2021-09-22","2021-09-22","2020-02-10","2020-02-10","2020-02-10","2020-02-10","2020-02-10","2020-02-10","2020-02-10","2020-02-10","2020-02-10","2020-02-10","2020-02-10","2020-02-10","2021-10-19","2021-10-19","2022-02-25","2021-03-27","2020-02-14","2021-05-26","2022-02-25","2022-02-25","2022-02-25","2020-02-10","2020-02-10","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2022-02-21","2022-02-21"],"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":[["","00169280015","SAXENDA","INJ 18MG\/3ML","15","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","00591024105","LORAZEPAM","TAB 1MG","60","Select","Select",""],["","65162062710","TRAMADOL","TAB 50MG","56","Select","Select",""],["","64980033912","MAGNESIUM-OX","TAB 400MG","30","Select","Select",""],["","00378181377","LEVOTHYROXIN","TAB 125MCG","30","Select","Select",""],["","69842090001","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","70377002711","ATORVASTATIN","TAB 10MG","30","Select","Select",""],["","00536589588","NICOTINE","DIS 14MG\/24H","28","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","10702000650","CYCLOBENZAPR","TAB 5MG","80","Select","Select",""],["","68382002210","ATENOLOL","TAB 25MG","60","Select","Select",""],["","50111043401","TRAZODONE","TAB 100MG","45","Select","Select",""],["","00169185189","NOVOFINE","MIS 32GX6MM","100","Select","Select",""],["","00527130101","PRIMIDONE","TAB 50MG","30","Select","Select",""],["","69618002302","MAG","TAB 400MG","30","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","59779044870","CVS","DIS 21MG\/24H","28","Select","Select",""],["","10702005601","OXYCODONE","TAB 10MG","28","Select","Select",""],["","31722053401","METHOCARBAM","TAB 750MG","90","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","59011041010","OXYCONTIN","TAB 10MG CR","28","Select","Select",""],["","60505264907","TIZANIDINE","CAP 4MG","90","Select","Select",""],["","00172392660","DIAZEPAM","TAB 5MG","42","Select","Select",""],["","00378912198","FENTANYL","DIS 25MCG\/HR","10","Select","Select",""],["","00406051205","OXYCOD\/APAP","TAB 5-325MG","105","Select","Select",""],["","69557011130","ZTLIDO","PAD 0.018","30","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","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":""}]}]}