{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  REBMETPESLLADOOG A ","gend":1,"add":"EMAJ 38201DAOR NWOTS","city":"ASHLAND","state":"VA","zip":"23005-9998","dob":"1981-09-29","age":"","mstatus":"","insh":"97200210*48","cliId":"","pno":"86\/4080708-3","cno":"","email":"","ename":"","eno":"","pphy":"TIEDEMANN, MARIE THERESE MD","ppno":"804\/798-9208","pcpadd":"306 ASHCAKE RD STE C","pcpcity":"ASHLAND","pcpstate":"VA","pcpzip":23005,"pcpcounty":"","pcpid":"","pcpname":"BON SECOURS MEDICAL GROUP RICHMOND PRIMARY CARE LLC","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":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F14.20","F33.1","H66.012","F41.1","N76.1","H60.93","L30.9","Z20.822","F31.30","F14.90","H60.392","J20.9","H66.90","V62.84","X83.8XXA","H60.509","F31.75","Z20.828","R50.9","F68.8","R35.0","N76.0","M54.9","S43.014A","M54.32","B37.3","F41.9","Z68.28","M79.7","I10.","Z92.29","H93.299","H53.8","R06.02","I11.9","R94.31"],"date":["2020-08-27","2021-01-28","2021-01-12","2021-01-12","2020-08-19","2020-08-19","2020-08-19","2021-04-05","2021-01-01","2021-01-01","2021-04-05","2021-04-05","2020-12-30","2020-12-30","2020-12-30","2021-01-27","2021-04-08","2020-11-07","2020-11-07","2020-12-29","2021-06-28","2021-06-28","2019-07-22","2019-10-05","2019-07-22","2019-07-22","2019-12-09","2019-12-09","2019-12-09","2019-12-09","2019-12-09","2019-12-09","2019-12-09","2019-12-09","2019-12-09","2019-12-09"],"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":[["","65862001105","SERTRALINE","TAB 25MG","30","Select","Select",""],["","43598032675","CIPRO\/DEXA","SUS 0.3-0.1%","8","Select","Select",""],["","00093227434","AMOX\/K","TAB 500-125","20","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","59762219807","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","","NEO\/POLY\/HC","SUS 1% OTIC","","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","00299382060","METROGEL","GEL 0.01","60","Select","Select",""],["","00065853302","CIPRODEX","SUS 0.3-0.1%","8","Select","Select",""],["","00781707787","METRONIDAZOL","GEL 0.75%VAG","70","Select","Select",""],["","00713022580","TRIAMCINOLON","CRE 0.001","80","Select","Select",""],["","00115165901","PROPRANOLOL","TAB 10MG","60","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","21","Select","Select",""],["","68180044701","QUETIAPINE","TAB 100MG","30","Select","Select",""],["","00093506201","HYDROXYZ","TAB 50MG","90","Select","Select",""],["","43547040650","CLONAZEPAM","TAB 0.5MG","20","Select","Select",""],["","","VITAMIN","CAP 50000UNT","","Select","Select",""],["","27241009803","DULOXETINE","CAP 30MG","14","Select","Select",""],["","65862022660","CLARITHROMYC","TAB 500MG","20","Select","Select",""],["","13107003134","MIRTAZAPINE","TAB 15MG","14","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","00004080085","TAMIFLU","CAP 75MG","10","Select","Select",""],["","00904660744","DAY","CAP COLD\/FLU","32","Select","Select",""],["","31722063231","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","24385003662","GNP","CAP COLD\/FLU","48","Select","Select",""],["","43547034050","RISPERIDONE","TAB 0.5MG","30","Select","Select",""],["","33342006807","OLANZAPINE","TAB 5MG","30","Select","Select",""],["","43386066024","TRIMETHOBENZ","CAP 300MG","1","Select","Select",""],["","63824000850","MUCINEX","TAB 600MG ER","10","Select","Select",""],["","59746017310","PREDNISONE","TAB 10MG","9","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","15","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":""}]}]}