{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"L   YMMATLLAHSRAM ","gend":1,"add":"SRAM 22NL LLAH","city":"COLUMBIA","state":"VA","zip":"23038-9998","dob":"1967-09-15","age":"","mstatus":"","insh":"95500210*85","cliId":"","pno":"84\/4082796-9","cno":"804\/489-6972","email":"","ename":"","eno":"","pphy":"KLIM, MADELINE NP","ppno":"804\/285-6050","pcpadd":"3452 ANDERSON HWY STE D","pcpcity":"POWHATAN","pcpstate":"VA","pcpzip":23139,"pcpcounty":"","pcpid":"","pcpname":"POWHATAN MEDICAL ASSOCIATES","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":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.42","J44.9","K21.9","R91.8","Z71.9","Z01.810","E11.9","M48.02","Z68.24","F33.2","F43.12","F41.1","L82.1","D22.61","C44.622","B07.8","M32.9","M35.00","M79.7","M54.2","M25.511","Z79.899","D48.5","B07.9","L57.8","Z86.007","L98.9","B07.0","M54.12","F33.1","L90.5","J44.1","R68.89","R11.0","M79.604","M79.605","F43.23","G43.709","R53.1","W19.XXXA","Z91.89","M51.36","Z68.23","N89.8","R30.0","Z68.22","N28.89","E53.8","E55.9","E78.00","M62.838","Z91.81","R29.898","NO DATA","R53.83","G47.9","Z72.0","H43.813","H25.13","H52.03","D04.62","Z01.818","Z91.09","B35.1","F43.9","F43.21","Z88.9","Z98.1","L57.0","M54.16","F33.9","D22.9","B08.1","Z12.83","Z47.89","Z48.89","Z86.008"],"date":["2020-05-20","2022-06-14","2022-06-14","2022-02-11","2022-02-11","2020-07-14","2022-02-25","2022-07-14","2020-10-26","2022-08-25","2022-08-25","2022-08-25","2022-02-24","2021-08-12","2021-08-12","2022-02-24","2022-07-07","2022-07-07","2022-07-07","2022-07-07","2022-07-07","2022-07-07","2022-02-24","2022-02-24","2022-02-24","2022-02-24","2022-02-24","2022-02-24","2022-07-14","2022-08-25","2020-09-25","2022-01-13","2020-12-09","2020-12-09","2020-12-09","2020-12-09","2022-08-31","2021-04-13","2021-04-29","2021-04-13","2021-04-13","2021-04-13","2021-04-13","2021-10-27","2021-10-27","2021-10-27","2022-02-25","2022-02-25","2022-02-25","2022-02-25","2022-02-25","2022-02-25","2022-02-25","2022-02-25","2022-02-25","2022-02-25","2022-01-13","2022-02-23","2022-02-23","2022-02-23","2020-05-08","2020-07-08","2020-10-26","2020-10-26","2021-03-03","2021-03-03","2020-02-11","2020-10-16","2021-02-25","2022-07-14","2020-02-25","2020-06-25","2020-06-25","2020-06-25","2020-10-16","2020-02-21","2020-02-21"],"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":[["","67877022310","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","10702000709","CYCLOBENZAPR","TAB 10MG","60","Select","Select",""],["","31722072250","LEVOFLOXACIN","TAB 500MG","7","Select","Select",""],["","13668021830","ARIPIPRAZOLE","TAB 10MG","30","Select","Select",""],["","70069000510","CYANOCOBALAM","INJ 1000MCG","1","Select","Select",""],["","59746017310","PREDNISONE","TAB 10MG","25","Select","Select",""],["","60505016907","PRAVASTATIN","TAB 20MG","30","Select","Select",""],["","62756014202","METFORMIN","TAB 500MG ER","30","Select","Select",""],["","64380073706","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","70436001102","BUPROPN","TAB 300MG XL","30","Select","Select",""],["","08290305269","3ML","MIS 25GX5\/8\"","1","Select","Select",""],["","16729017501","AMITRIPTYLIN","TAB 100MG","45","Select","Select",""],["","00527169501","BUT\/APAP\/CAF","TAB ","90","Select","Select",""],["","68645014059","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","69238154401","HYDROXYCHLOR","TAB 200MG","30","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","50111078810","AZITHROMYCIN","TAB 500MG","12","Select","Select",""],["","69452014430","BENZONATATE","CAP 200MG","60","Select","Select",""],["","57237001930","DULOXETINE","CAP 60MG","60","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","90","Select","Select",""],["","00228202950","ALPRAZOLAM","TAB 0.5MG","30","Select","Select",""],["","00002143601","EMGALITY","INJ 120MG\/ML","1","Select","Select",""],["","60219107601","AZATHIOPRINE","TAB 50MG","30","Select","Select",""],["","16714008210","HYDROXYZ","TAB 25MG","60","Select","Select",""],["","63304061650","DOXYCYC","CAP 100MG","28","Select","Select",""],["","49035028458","EQ","TAB 1200MG","60","Select","Select",""],["","08290329622","INSULIN","MIS 1ML\/25G","3","Select","Select",""],["","45802032530","GUAIFENESIN","TAB 1200 ER","60","Select","Select",""],["","00173086910","ANORO","AER 62.5-25","60","Select","Select",""],["","49281042050","FLUZONE","INJ 2020-21","0","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","00472016615","NYSTATIN","OIN 100000","15","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","17772010330","TROKENDI","CAP 100MG","30","Select","Select",""],["","00527143501","METAXALONE","TAB 800MG","60","Select","Select",""],["","00456120130","LINZESS","CAP 145MCG","90","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","08290305901","BD  NEEDLES","MIS 25GX5\/8\"","3","Select","Select",""],["","49035000206","STOOL","TAB 8.6-50MG","60","Select","Select",""],["","67618010660","PERI-COLACE","TAB 8.6-50MG","60","Select","Select",""],["","00173088710","TRELEGY","AER ELLIPTA","60","Select","Select",""],["","49035008530","SENNA-S","TAB 8.6-50MG","60","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","42858000101","OXYCODONE","TAB 5MG","42","Select","Select",""],["","60505083001","MOMETASONE","SPR 50MCG","17","Select","Select",""],["","00574206130","CICLOPIROX","GEL 0.0077","30","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","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":""}]}]}