{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" YMMATSNAVE","gend":1,"add":"L SLEAHCIM TNIAS 6031TNEMTRAPA EGARAG DNA","city":"HENRICO","state":"VA","zip":"23229-9998","dob":"1963-06-23","age":"","mstatus":"","insh":"07200210*38","cliId":"","pno":"7340896297","cno":8043779269,"email":"","ename":"","eno":"","pphy":"RAZA, ZAHRA MD","ppno":8045274540,"pcpadd":"3470 MAYLAND COURT","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":"23233-9998","pcpcounty":"","pcpid":"","pcpname":"","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":["F31.9","R55.","I65.23","E11.59","I10.","I49.3","I35.8","I87.2","Z68.38","F43.12","F41.9","F41.1","K11.20","F31.81","I51.7","R94.31","Z86.79","R30.0","F32.9","E78.5","L90.5","Z01.818","M54.2","NO DATA","M24.112","M47.816","R49.0","K11.8","E11.51","E66.01","I48.91","M62.838","M54.6","E11.9","E27.8","C73.","G47.33","M40.204","G47.00","G89.29","M62.81","Z68.39","S61.213A","R91.8","R91.1","R59.0","K21.9","M40.294","S29.019A","D22.5","D48.5","M20.22","R29.898","R87.622","R87.612","D18.01","L30.4","L81.4","M79.672","M19.072","M72.2","M79.602","R07.89","R10.84","V89.2XXA","Y92.410","Y93.89","S06.0X0A","E89.0","E78.2","J01.00","Z20.828","E03.9","J45.909","M19.90","E66.9","Z85.850","Z87.891","Z79.84","Z79.899","R22.1","Z01.411","Z12.39","Z77.9","Z12.12","J18.9","H11.31","R06.02","R00.2","R53.83","R68.89","Z01.84","Z11.59","G44.89","D31.31","E11.319","M43.8X9","Z79.890","H40.1111","H43.813","I25.10","M72.0","R22.33","Z11.51","J02.9","H40.013","H43.819","J30.9","F17.200","B37.89","H40.003","Z96.1","W26.0XXA","R07.2","H40.1131","F17.210"],"date":["2023-04-24","2022-01-28","2022-01-28","2023-03-29","2023-03-29","2022-01-28","2023-03-29","2023-03-29","2023-03-29","2023-03-02","2021-05-10","2022-08-02","2022-02-10","2023-03-02","2023-03-14","2022-09-13","2021-03-31","2021-01-05","2021-03-31","2022-05-30","2021-03-11","2021-07-28","2021-11-18","2022-01-14","2021-12-10","2021-12-10","2022-10-17","2022-05-26","2023-03-02","2023-03-14","2023-03-14","2023-03-14","2023-03-20","2023-03-14","2023-03-14","2023-03-14","2023-03-14","2023-03-14","2023-03-14","2023-03-20","2022-01-14","2022-04-21","2022-05-30","2022-10-12","2022-10-12","2022-10-12","2023-01-03","2023-03-20","2023-03-20","2021-02-17","2021-02-17","2021-08-13","2022-01-14","2022-12-06","2022-12-06","2023-01-17","2023-01-17","2023-01-17","2021-08-10","2021-08-10","2021-07-19","2021-09-10","2021-09-10","2021-09-10","2021-09-10","2021-09-10","2021-09-10","2021-11-18","2022-04-21","2023-03-29","2021-12-10","2021-12-10","2021-12-25","2021-12-25","2021-12-25","2021-12-25","2022-09-07","2021-12-25","2022-04-21","2022-04-21","2021-12-25","2022-04-04","2022-04-04","2022-04-04","2022-04-04","2022-07-08","2022-08-10","2022-09-13","2023-03-29","2022-09-13","2022-09-13","2022-09-13","2022-09-13","2021-09-29","2022-10-13","2021-10-20","2021-12-10","2022-04-21","2023-01-05","2022-10-13","2023-03-29","2021-10-08","2021-10-08","2021-08-02","2021-08-02","2022-02-01","2022-02-01","2022-04-11","2022-09-07","2022-04-11","2022-04-12","2022-04-12","2022-05-30","2022-10-03","2023-03-02","2022-09-07"],"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":[["","00378395205","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","00904546052","OYST SHELL\/D","TAB 500MG","30","Select","Select",""],["","72578003601","METFORMIN","TAB 750MG ER","30","Select","Select",""],["","13668059502","NYSTATIN","100000\/G","30","Select","Select",""],["","00713022515","TRIAMCINOLON","CRE 0.001","15","Select","Select",""],["","69238183901","LEVOTHYROXIN","TAB 175MCG","30","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","200","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","100","Select","Select",""],["","00310653004","BYDUREON PEN","INJ 2MG","4","Select","Select",""],["","43598081115","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","48","Select","Select",""],["","27241009706","DULOXETINE","CAP 20MG","30","Select","Select",""],["","68462013801","OXCARBAZEPIN","TAB 300MG","270","Select","Select",""],["","45963067611","METOPROLOL","TAB 50MG ER","90","Select","Select",""],["","00002143480","TRULICITY","1.5 MG\/0.5","2","Select","Select",""],["","68180098003","LISINOPRIL","10 MG","180","Select","Select",""],["","00310654004","BYDUREON BC","INJ 2\/0.85ML","3","Select","Select",""],["","11917013861","CALCIUM\/D","TAB 500-200","29","Select","Select",""],["","00536781708","OYSCO 500+D","TAB ","250","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","50","Select","Select",""],["","45963067611","METOPROL SUC","TAB 50MG ER","30","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","00406324301","HYDROMORPHON","TAB 2MG","40","Select","Select",""],["","65862064169","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","10702000350","PROMETHAZINE","TAB 25MG","20","Select","Select",""],["","00781185220","AMOX\/K CLAV","TAB 875-125","14","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","10","Select","Select",""],["","65162019011","NAPROXEN","TAB 500MG","20","Select","Select",""],["","70461032203","FLUCLVX QUAD","INJ 2022-23","0","Select","Select",""],["","33332032101","AFLURIA QUAD","INJ 2021-22","0","Select","Select",""],["","57896010210","ACETAMINOPHE","TAB 325MG","30","Select","Select",""],["","80777027399","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","49502010202","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","68462018135","CLOTRIMAZOLE","CRE 0.01","60","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","00069108530","PAXLOVID","TAB 300-100","30","Select","Select",""],["","80681013700","CALCIUM","500-VIT D3 500 MG-10","180","Select","Select",""],["","00766165675","OS-CAL + D3","TAB 500-200","60","Select","Select",""],["","00904188260","CALCIUM+D3","TAB 250-125","60","Select","Select",""],["","59267030401","PFIZER BIVAL","INJ BA4\/BA5","0","Select","Select",""],["","00536781708","OYSCO","500-VIT D3 500MG-5MCG","10","Select","Select",""],["","68462013801","OXCARBAZEPINE","300 MG","235","Select","Select",""],["","27241009706","DULOXETINE HCL","20 MG","30","Select","Select",""],["","59762033302","LATANOPROST","0.005 %","7.5","Select","Select",""],["","72578003601","METFORMIN HCL ER","750 MG","180","Select","Select",""],["","45963067611","METOPROLOL SUCCINATE","50 MG","30","Select","Select",""],["","69238183901","LEVOTHYROXINE SODIUM","175 MCG","90","Select","Select",""],["","00054418125","DEXAMETHASONE","1 MG","1","Select","Select",""],["","74312053098","MELATONIN","5 MG","30","Select","Select",""],["","43598083205","ATORVASTATIN CALCIUM","40 MG","90","Select","Select",""],["","43598081115","CETIRIZINE HCL","10 MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPRINE HCL","10 MG","60","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":""}]}]}