{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"REBEKAH SKOWRONSKI","gend":1,"add":"21516 MEMORIAL AVENUE","city":"S CHESTERFIELD","state":"VA","zip":"23803-8075","dob":"1991-06-12","age":"","mstatus":"","insh":10100268,"cliId":"","pno":8048969260,"cno":8048969260,"email":"","ename":"","eno":"","pphy":"QUARSHIE, GEORGE","ppno":8045263500,"pcpadd":"20901 Chesterfield Ave, ","pcpcity":"Petersburg","pcpstate":"VA","pcpzip":238031903,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"CO. CARL KEENE","add3":"","madd1":"21516 MEMORIAL AVENUE","madd2":"CO. CARL KEENE","madd3":"","mcity":"S CHESTERFIELD","mstate":"VA","mzip":"23803-8075","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O26.93","W18.30XA","Y92.480","Y93.01","Z3A.34","R52","W10.1XXA","N28.1","K83.8","R10.10","R50.9","R10.2","R23.2","Z32.02","Z11.3","N89.8","L55.0","M79.10","L55.9","E86.0","D72.829","R00.0","J20.9","R05","O99.213","Z68.41","Z30.2","S30.861A","R09.81","R42","W57.XXXA","R07.9","Z01.419","K80.50","J02.9","K04.7","R51","R10.9","J45.31","J30.89","J30.81","S60.511A","S60.221A","Z3A.32","Z3A.36","R23.8","N92.0","Z68.38","R07.89","B34.9","R19.7","R11.2","R10.11","R11.0","R06.02","E66.01","M54.2","J11.1","I49.8","I21.09","E66.9","Z3A.33","Z3A.37","G89.18","R06.2","R20.0","R20.2","J06.9","Z87.891","Z20.828","Z3A.31","O99.210","Z3A.41","M43.17","M51.36","M41.9","J18.9","Z72.0","R53.83","M19.90","F41.9","F43.10","Z88.0","Z88.1","Z88.8","F41.1","F45.8","Z79.899","M43.06","M54.6","Z98.890","M43.8X5","Z98.1","M43.16","A49.8","F17.200","O32.1XX0","O32.8XX0","O90.2","Z37.0","O82","Z30.09","J01.90","Z82.49","F17.210","Z91.041","R51.9"],"date":["2019-02-20","2019-02-20","2019-02-20","2019-02-20","2019-02-27","2019-02-20","2019-02-20","2019-11-20","2019-11-20","2019-11-20","2020-11-01","2020-05-11","2020-05-11","2020-05-11","2020-05-11","2020-05-11","2020-06-14","2020-06-14","2020-06-14","2020-06-14","2020-06-14","2020-06-14","2020-11-13","2021-04-27","2019-03-13","2019-03-13","2019-03-14","2019-05-08","2019-05-08","2019-08-28","2019-05-08","2020-11-13","2021-01-04","2019-11-17","2020-11-13","2020-06-01","2020-06-01","2021-02-05","2021-05-21","2021-05-21","2021-05-21","2021-05-21","2021-05-21","2019-02-07","2019-03-06","2019-06-14","2019-06-14","2019-06-14","2020-11-01","2019-11-20","2021-02-05","2019-11-20","2021-02-05","2020-01-03","2021-04-28","2019-03-06","2019-06-25","2020-02-16","2020-11-01","2020-11-01","2019-02-27","2019-02-13","2019-03-14","2019-03-14","2019-08-28","2019-08-28","2019-08-28","2019-10-17","2021-04-28","2021-04-27","2019-01-31","2019-02-13","2019-03-13","2020-10-09","2020-10-09","2020-10-09","2020-11-01","2020-10-30","2020-10-30","2021-04-28","2021-02-05","2021-02-05","2021-02-05","2021-02-05","2021-02-05","2021-04-28","2021-04-28","2021-04-28","2019-05-21","2019-05-21","2019-05-21","2019-05-21","2019-05-21","2019-05-21","2020-05-11","2020-11-01","2019-03-14","2019-03-14","2019-03-14","2019-03-14","2019-03-14","2019-03-14","2020-11-13","2020-11-13","2020-11-13","2020-11-13","2021-04-28"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","68382070718","DOXYCYC ","CAP 100MG","20","Select","Select",""],["","67877057305","BENZONATATE ","CAP 100MG","15","Select","Select",""],["","51660093930","CETIRIZINE ","TAB 10MG","30","Select","Select",""],["","00185067405","HYDROXYZ ","CAP 25MG","12","Select","Select",""],["","65862044890","VALACYCLOVIR ","TAB 500MG","60","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","24","Select","Select",""],["","13811071910","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","57237007710","ONDANSETRON ","TAB 4MG ODT","15","Select","Select",""],["","00591079501","DICYCLOMINE ","TAB 20MG","20","Select","Select",""],["","63824005632","MUCINEX ","TAB 30-600ER","20","Select","Select",""],["","00456074613","AERCHMBR ","MIS LRG MASK","1","Select","Select",""],["","64380080707","IBUPROFEN ","TAB 800MG","20","Select","Select",""],["","00591544305","PREDNISONE ","TAB 20MG","12","Select","Select",""],["","42571025201","CLINDAMYCIN ","CAP 300MG","21","Select","Select",""],["","59746012206","MECLIZINE ","TAB 12.5MG","30","Select","Select",""],["","00781707787","METRONIDAZOL ","GEL 0.75%VAG","70","Select","Select",""],["","55111068305","IBU ","TAB 600MG","21","Select","Select",""],["","70010075401","METHOCARBAM ","TAB 500MG","30","Select","Select",""],["","50383070016","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","62559049001","DIPHEN\/ATROP ","TAB 2.5MG","15","Select","Select",""],["","00186091706","PULMICORT ","INH 90MCG","1","Select","Select",""],["","33342002208","LEVOFLOXACIN ","500MG","10","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}