{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NASREEN JAN","gend":1,"add":"3725 COGBILL ROAD","city":"NORTH CHESTERFIEL             ","state":"VA","zip":"23234-4834","dob":"1977-01-01","age":"","mstatus":"","insh":4779738,"cliId":"","pno":8045023240,"cno":8044050953,"email":"","ename":"","eno":"","pphy":"BROOKS-WILLIAMS, MALINDA","ppno":8047800840,"pcpadd":"4730 N Southside Plaza St,","pcpcity":"Richmond                      ","pcpstate":"VA","pcpzip":232241742,"pcpcounty":"","pcpid":"","pcpname":"BERMUDA DISTRICT MEDICAL CENTER","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"3725 COGBILL ROAD","madd2":"","madd3":"","mcity":"NORTH CHESTERFIEL             ","mstate":"VA","mzip":"23234-4834","pcpfaxno":"(804) 249-1080","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z12.31","N64.4","N63.22","R92.8","N63.20","R07.89","Z85.3","R07.9","C50.212","C50.912","Z17.0","C50.112","C50.312","Z51.0","Z15.09","R92.1","N63.11","R91.8","E55.9","E78.5","G43.709","R42","M62.89","R51.9","Z01.812","Z20.822","Z79.899","Z45.2","Z90.12","Z48.817","Z68.24","Z51.11","Z01.818","R91.1","C50.919","C50.911","M79.609","M79.89","M79.604","M79.605","Z98.890","L90.5","Z42.1","D64.9","Z92.21","R59.0","K42.9"],"date":["2021-01-28","2021-11-10","2021-02-16","2021-03-10","2021-02-16","2021-02-15","2021-08-24","2021-02-15","2021-05-10","2021-10-25","2021-05-10","2021-02-23","2021-10-29","2021-02-23","2021-02-26","2021-03-05","2021-03-05","2021-10-25","2021-10-20","2021-10-20","2021-10-20","2021-10-29","2021-04-09","2021-04-09","2021-08-21","2021-08-21","2021-08-24","2021-08-24","2021-08-24","2021-05-27","2021-05-10","2021-07-21","2021-06-29","2021-10-25","2021-08-11","2021-08-13","2021-08-17","2021-08-17","2021-08-17","2021-08-17","2021-08-19","2021-08-24","2021-08-24","2021-08-24","2021-08-24","2021-10-20","2021-10-25"],"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":[["","59651030030","TAMOXIFEN","TAB 20MG","30","Select","Select",""],["","59267102504","PFIZER","INJ ADLT RTU","0.3","Select","Select",""],["","42806054701","VITAMIN","CAP 1.25MG","12","Select","Select",""],["","52268001201","SUPREP","SOL PREP KIT","354","Select","Select",""],["","00054418425","DEXAMETHASON","TAB 4MG","32","Select","Select",""],["","59746011506","PROCHLORPER","TAB 10MG","30","Select","Select",""],["","49035037508","ANTI-DIARRHE","TAB 2MG","24","Select","Select",""],["","00172392670","DIAZEPAM","TAB 5MG","2","Select","Select",""],["","52565000730","LIDO\/PRILOCN","CRE 2.5-2.5%","30","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","29300011616","TOPIRAMATE","TAB 50MG","30","Select","Select",""],["","72205000390","ROSUVASTATIN","TAB 10MG","90","Select","Select",""],["","49281042150","FLUZONE","INJ 2021-22","0.5","Select","Select",""],["","00228202750","ALPRAZOLAM","TAB 0.25MG","30","Select","Select",""],["","00904699880","DOCUSATE","CAP 100MG","14","Select","Select",""],["","49483034010","ACETAMIN","TAB 325MG","84","Select","Select",""],["","67877032005","IBUPROFEN","TAB 600MG","21","Select","Select",""],["","42858000101","OXYCODONE","TAB 5MG","21","Select","Select",""],["","70010010810","GABAPENTIN","CAP 100MG","21","Select","Select",""],["","49483008010","SENNA-TIME","TAB 8.6MG","14","Select","Select",""],["","55111029209","SUMATRIPTAN","TAB 50MG","9","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","00093405953","CEFADROXIL","TAB 1GM","28","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}