{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JANICE   A WHITE","gend":1,"add":"3901 PRICE CLUB BLVD APT 125","city":"MIDLOTHIAN","state":"VA","zip":"23112-9998","dob":"1944-10-12","age":"","mstatus":"","insh":"900035613*01","cliId":"","pno":"804\/370-7964","cno":"","email":"","ename":"","eno":"","pphy":"MADISON, ASENA L MD","ppno":"804\/362-7372","pcpadd":"9549 AMBERDALE DRIVE","pcpcity":"NORTH CHESTERFIELD","pcpstate":"VA","pcpzip":23236,"pcpcounty":"","pcpid":"","pcpname":"PC THE GARDEN OF EDEN HEALTH CENTER","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"866\/834-5648","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R05.","L02.818","D51.9","I10.","I70.219","Z68.33","Z79.4","Z00.01","Z12.11","L65.9","N95.2","G47.09","Z86.14","R11.0","E11.40","Z13.6","Z12.31","K21.0","Z13.820","R22.0","L98.9","F32.9","K21.9","E11.9","I48.91","Z76.89","I95.1","Z68.31","Q79.60","R07.9","E53.8","M79.673","G47.00","E78.00","K64.9","E11.65","M79.672","K62.5","F43.20","R94.31","J98.01","R26.81","Z76.0","R25.1","R41.3","F34.1","R45.851","R58.","Q79.61","K30.","D50.9","D72.829","D51.8","R10.9","E61.1","R06.02","R52.","R07.2","R42.","Z68.32","L50.0","G47.33"],"date":["2020-02-12","2019-10-22","2019-10-22","2021-12-03","2020-07-22","2020-11-30","2021-12-06","2020-03-26","2020-03-26","2020-04-30","2020-02-27","2019-09-22","2019-09-22","2021-11-11","2019-09-22","2020-03-26","2020-03-26","2020-03-26","2020-03-26","2020-08-21","2021-12-03","2021-07-26","2021-07-12","2021-07-12","2021-07-12","2020-02-27","2020-08-05","2020-08-26","2021-04-05","2019-12-18","2020-04-09","2020-02-27","2020-02-27","2021-04-19","2021-04-19","2021-04-19","2021-07-26","2021-12-03","2021-07-26","2019-11-06","2020-04-09","2020-06-15","2020-06-15","2020-06-15","2021-08-12","2021-08-12","2021-08-12","2021-12-03","2021-12-03","2021-12-03","2020-02-12","2020-02-12","2020-02-12","2020-02-12","2020-02-12","2020-02-12","2020-02-12","2020-11-30","2020-05-28","2020-07-22","2020-09-01","2020-02-13"],"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":[]}]},{"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":[["","00169633910","NOVOLOG FLEXPEN                                                       ","FLEXPEN","-54","Select","Select",""],["","57237007530","ONDANSETRON HYDROCHLORIDE                                             ","4MG","-30","Select","Select",""],["","65862056099","PANTOPRAZOLE SODIUM                                                   ","40MG","30","Select","Select",""],["","00113044164","SLEEP AID                                                             ","25MG","30","Select","Select",""],["","00093719801","FLUOXETINE HYDROCHLORIDE                                              ","40MG","30","Select","Select",""],["","29300013510","CLONIDINE HCL                                                         ","0.1MG","30","Select","Select",""],["","68462015713","ONDANSETRON ODT                                                       ","4MG ODT","-25","Select","Select",""],["","00093354143","ESTRADIOL                                                             ","0.01%","42","Select","Select",""],["","11917009899","5-HTP                                                                 ","100MG","60","Select","Select",""],["","29300012810","HYDROCHLOROTHIAZIDE                                                   ","25MG","90","Select","Select",""],["","74312052805","VITAMIN B-12                                                          ","1000MCG","200","Select","Select",""],["","65702040810","ACCU-CHEK AVIVA PLUS                                                  ","AVIVA PL","-400","Select","Select",""],["","67877041890","VALSARTAN                                                             ","320MG","30","Select","Select",""],["","00093101042","MUPIROCIN                                                             ","2%","22","Select","Select",""],["","68180072003","AMLODIPINE BESYLATE                                                   ","5MG","30","Select","Select",""],["","52041004533","IROFOL                                                                ","","60","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA                                                 ","HFA","-8","Select","Select",""],["","00143961910","CYANOCOBALAMIN                                                        ","1000MCG","30","Select","Select",""],["","08290309581","BD 3ML LUER-LOK SYRINGE\/25G X 1\"                                      ","25GX1\"","100","Select","Select",""],["","08627005303","DEXCOM G6 SENSOR                                                      ","SENSOR","3","Select","Select",""],["","45802005535","TRIAMCINOLONE ACETONIDE                                               ","0.10%","15","Select","Select",""],["","08290305787","BD ECLIPSE SYRINGE LUER-LOK\/3ML\/25G X 1\"                              ","25GX1\"","100","Select","Select",""],["","73070010315","INSULIN ASPART FLEXPEN                                                ","FLEXPEN","12","Select","Select",""],["","65862020299","LOSARTAN POTASSIUM                                                    ","50MG","30","Select","Select",""],["","00430375414","ESTRACE                                                               ","0.01%","42","Select","Select",""],["","23155050105","HYDROXYZINE HYDROCHLORIDE                                             ","25MG","30","Select","Select",""],["","29300013510","CLONIDINE HYDROCHLORIDE                                               ","0.1MG","30","Select","Select",""],["","65862001705","AMOXICILLIN                                                           ","500MG","21","Select","Select",""],["","00088221905","LANTUS SOLOSTAR                                                       ","100\/ML","6","Select","Select",""],["","65862047090","LOSARTAN POTASSIUM\/HYDROCHLOROTHIAZIDE                                ","100-25","5","Select","Select",""],["","00169413212","OZEMPIC                                                               ","2\/1.5ML","2","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":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"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":""}]}]}