{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RAELISSA   V AMBROSE","gend":1,"add":"6831 WILLIAMS LANE","city":"SPOTSYLVANIA","state":"VA","zip":"22551-6605","dob":"1981-04-28","age":"","mstatus":"","insh":7072656,"cliId":"","pno":5402057362,"cno":5402057362,"email":"","ename":"","eno":"","pphy":"QURESHI, SHABANA N","ppno":5716599387,"pcpadd":"231 Garrisonville Rd, Ste 101","pcpcity":"Stafford","pcpstate":"VA","pcpzip":225541604,"pcpcounty":"","pcpid":"","pcpname":"EASY CARE URGENT CARE","ano":5408507108,"add2":"                                                            ","add3":"","madd1":"6831 WILLIAMS LANE","madd2":"                                                            ","madd3":"","mcity":"SPOTSYLVANIA","mstate":"VA","mzip":"22551-6605","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N30.01","R10.84","K04.7","K02.9","E11.9","F17.210","Z79.4","E11.10","R11.2","E87.0","N17.9","E83.39","E86.0","E87.6","F17.200","I10","Z91.19","J98.4","D50.0","K72.90","M54.5","N20.0","D72.829","N39.0","E11.8","N12","K70.10","F10.21","M54.89","R51","Z79.52","F39","E13.9","K74.69","B37.3","R30.0","Z51.89","Z87.19","Z72.89","Z23","N19","R53.1","R00.0","N76.0","F43.20","Z01.419","Z12.31","L73.9","Z80.3","E11.65","R11.11"],"date":["2019-05-01","2019-05-01","2019-10-20","2019-10-20","2021-02-23","2019-10-20","2020-07-13","2020-07-15","2020-07-15","2020-07-13","2020-07-14","2020-07-15","2020-07-14","2020-07-15","2020-07-13","2020-07-13","2020-07-13","2020-07-13","2019-06-27","2019-06-27","2020-07-12","2020-07-12","2020-07-15","2020-07-12","2020-07-12","2020-07-12","2019-08-09","2019-02-27","2019-06-20","2019-10-20","2019-10-20","2020-06-18","2020-08-19","2020-07-15","2019-05-08","2019-08-01","2019-08-09","2019-08-09","2019-08-09","2019-08-09","2020-07-13","2020-07-13","2020-07-14","2019-05-29","2020-07-15","2019-04-09","2019-04-09","2019-04-09","2019-04-09","2020-07-13","2020-07-13"],"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":[["","00781261305","AMOXICILLIN ","CAP 500MG","21","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","00088250205","APIDRA ","INJ SOLOSTAR","9","Select","Select",""],["","65862001305","SERTRALINE ","TAB 100MG","30","Select","Select",""],["","68180032002","BUPROPN ","TAB 300MG XL","30","Select","Select",""],["","33342005507","PIOGLITAZONE ","TAB 30MG","90","Select","Select",""],["","00088221905","LANTUS ","INJ 100\/ML","15","Select","Select",""],["","08290320122","BD  PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","65162062711","TRAMADOL ","TAB 50MG","9","Select","Select",""],["","69315012701","FOLIC ","TAB 1000MCG","30","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","29300011201","LAMOTRIGINE ","TAB 100MG","30","Select","Select",""],["","64380080707","IBUPROFEN ","TAB 800MG","21","Select","Select",""],["","57237004105","PENICILLN ","TAB 500MG","28","Select","Select",""],["","68382004001","PROMETHAZINE ","TAB 12.5MG","15","Select","Select",""],["","55111012701","CIPROFLOXACN ","TAB 500MG","14","Select","Select",""],["","00093031401","KETOROLAC ","TAB 10MG","15","Select","Select",""],["","55111014512","FLUCONAZOLE ","TAB 150MG","3","Select","Select",""],["","67253090150","ALPRAZOLAM ","TAB 0.5MG","60","Select","Select",""],["","00093101042","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","00193731221","CONTOUR ","TES NEXT","100","Select","Select",""],["","23155050105","HYDROXYZ ","TAB 25MG","120","Select","Select",""],["","53489014305","SPIRONOLACT ","TAB 25MG","30","Select","Select",""],["","50111033402","METRONIDAZOL ","TAB 500MG","14","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","10","Select","Select",""],["","43547028910","BUPROPION ","TAB 150MG ER","30","Select","Select",""],["","68585000612","MAGNESIUM-OX ","TAB 400MG","30","Select","Select",""],["","50383077916","LACTULOSE ","SOL 10GM\/15","600","Select","Select",""],["","00069047103","CHANTIX ","PAK 0.5& 1MG","53","Select","Select",""],["","51672130406","TERCONAZOLE ","CRE 0.004","45","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}