{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JERRICA   D LIMERICK","gend":1,"add":"1009 HERITAGE PL UNIT# 201","city":"FREDERICKSBURG","state":"VA","zip":"22401-9998","dob":"1990-07-14","age":"","mstatus":"","insh":"900036033*01","cliId":"","pno":"540\/498-5104","cno":"","email":"","ename":"","eno":"","pphy":"KIN JR, JOHN W MD","ppno":"540\/361-2040","pcpadd":"1451 HOSPITAL DR STE 201","pcpcity":"FREDERICKSBURG","pcpstate":"VA","pcpzip":22401,"pcpcounty":"","pcpid":"","pcpname":"RICHMOND MULTI-SPECIALTY LLC","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/361-2058","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N92.6","M54.5","M47.816","M54.30","M48.061","Z20.828","E03.9","R11.0","R10.9","R23.2","S76.011A","Z23.","Z30.42","M54.2","F31.9","G43.901","F17.210","E07.9","E28.2","Z83.79","Z79.84","Z79.1","Z79.890","Z79.52","Z88.8","Z91.018","R05.","Z11.3","R39.9","G89.29","R74.01","M54.42","M54.41","M54.6","Z20.822","M51.27","M54.17","M46.1","G43.909","Z01.818","R07.0","F17.200","M51.37","S76.012A","R20.2","M54.16","M51.26","J01.00","J02.9","Z01.419","B97.7","J03.91","R51.","G40.909","N93.9","B35.4","R19.7","M25.559","I10.","E78.5","J30.9","E04.2","N92.1","E66.01","F41.9","L63.9","R73.03","M54.9","R50.9","N92.0","H92.01","R51.9"],"date":["2020-01-30","2021-02-22","2021-07-19","2020-06-18","2021-07-19","2021-09-13","2021-07-22","2021-12-01","2020-12-08","2020-12-08","2021-05-26","2021-07-26","2021-10-06","2019-09-30","2020-05-04","2020-05-04","2020-02-04","2020-02-04","2020-02-04","2020-02-04","2020-02-04","2020-02-04","2020-02-04","2020-02-04","2020-02-04","2020-02-04","2021-01-03","2021-03-16","2020-05-04","2021-11-09","2021-02-22","2021-11-09","2021-11-09","2021-05-26","2021-12-01","2021-11-09","2021-11-09","2021-11-09","2019-10-13","2020-01-28","2020-11-12","2021-05-26","2021-05-26","2021-05-26","2021-05-26","2021-11-09","2021-11-09","2020-07-22","2020-10-28","2021-03-16","2021-04-19","2021-09-05","2019-09-07","2019-09-07","2019-12-26","2020-10-12","2021-01-03","2021-05-26","2021-09-21","2021-09-21","2021-09-21","2021-09-21","2020-01-30","2020-01-30","2020-01-30","2020-12-10","2021-07-22","2019-10-13","2019-10-13","2020-01-30","2021-12-01","2021-12-01"],"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":[["","00548570100","MEDROXYPROGESTERONE ACETATE                                           ","150MG\/ML","-1","Select","Select",""],["","00781518892","LEVOTHYROXINE SODIUM                                                  ","175MCG","30","Select","Select",""],["","16729017001","ESCITALOPRAM OXALATE                                                  ","20MG","30","Select","Select",""],["","42858010201","OXYCODONE\/ACETAMINOPHEN                                               ","5-325MG","10","Select","Select",""],["","31722063231","OSELTAMIVIR PHOSPHATE                                                 ","75MG","14","Select","Select",""],["","68645056259","IBUPROFEN                                                             ","600MG","20","Select","Select",""],["","10702000709","CYCLOBENZAPRINE HYDROCHLORIDE                                         ","10MG","21","Select","Select",""],["","00093831118","ELETRIPTAN HYDROBROMIDE                                               ","40MG","-10","Select","Select",""],["","00093005405","BUSPIRONE HYDROCHLORIDE                                               ","10MG","90","Select","Select",""],["","66993096045","METRONIDAZOLE                                                         ","0.75%","45","Select","Select",""],["","16571020210","DICLOFENAC SODIUM DR                                                  ","50MG DR","60","Select","Select",""],["","72305017530","EUTHYROX                                                              ","175MCG","90","Select","Select",""],["","00456315467","AEROCHAMBER PLUS FLOW-VU                                              ","PLUS","1","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA                                                 ","HFA","-18","Select","Select",""],["","00832105415","BACLOFEN                                                              ","10MG","60","Select","Select",""],["","00143924920","AMOXICILLIN\/CLAVULANATE POTASSIUM                                     ","875-125","14","Select","Select",""],["","42806071401","BENZONATATE                                                           ","100MG","30","Select","Select",""],["","00187526001","OCEAN NASAL SPRAY                                                     ","0.65%","15","Select","Select",""],["","00472024260","PERMETHRIN                                                            ","5%","60","Select","Select",""],["","00472016630","NYSTATIN                                                              ","100000","60","Select","Select",""],["","65862086099","FAMOTIDINE                                                            ","40MG","30","Select","Select",""],["","70710113803","FLUCONAZOLE                                                           ","100MG","4","Select","Select",""],["","68462029817","CLOTRIMAZOLE\/BETAMETHASONE DIPROPIONATE                               ","DIPROP","-30","Select","Select",""],["","65162083366","DICLOFENAC SODIUM                                                     ","1%","500","Select","Select",""],["","00781261305","AMOXICILLIN                                                           ","500MG","21","Select","Select",""],["","57237004101","PENICILLIN V POTASSIUM                                                ","500MG","20","Select","Select",""],["","68382005105","MELOXICAM                                                             ","15MG","15","Select","Select",""],["","62332014131","CELECOXIB                                                             ","100MG","60","Select","Select",""],["","57237007810","ONDANSETRON ODT                                                       ","8MG ODT","6","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":""}]}]}