{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LINDA   A BLAKE","gend":1,"add":"1439 ROGERS ST","city":"RICHMOND","state":"VA","zip":"23223-9998","dob":"1960-12-31","age":"","mstatus":"","insh":"1811706*01","cliId":"","pno":"804\/222-2221","cno":"804\/222-2221","email":"","ename":"","eno":"","pphy":"DIGGS, ARLEETA MD","ppno":"804\/225-7148","pcpadd":"304 E LEIGH ST","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23219,"pcpcounty":"","pcpid":163814,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"CENTRAL","aligned":"","ano":"804\/301-9852","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/225-7159","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","E66.01","E78.5","R82.998","N89.8","U07.1","H57.13","H52.03","H52.223","H52.4","J01.90","R07.89","M85.851","Z12.31","H00.14","H05.112","J01.10","Z86.16","R51.9","H57.11","Z01.419","Z12.4","Z20.828","R09.89","F41.9","M19.90","K21.9","F41.0","F33.1","F41.1","F43.23","F51.01","F32.9","R30.0","J45.20","E55.9","R35.0","B37.2","L28.2","Z68.41","R06.02","J45.909","Z79.1","Z79.2","Z79.51","Z79.52","Z79.899","Z13.820","Z78.0","M85.80","M06.9","J01.41","T50.905A","G44.221","R05.9","R06.00","R07.9","Z82.49","R00.2","G47.33","I47.1","J38.3","J45.40","I08.0"],"date":["2021-11-09","2020-12-28","2021-10-26","2021-01-11","2021-06-14","2021-01-11","2021-01-22","2021-01-22","2021-01-22","2021-01-22","2021-01-22","2020-07-07","2020-10-12","2021-02-08","2021-02-10","2021-02-10","2021-02-01","2021-11-09","2021-02-15","2021-02-01","2020-09-17","2020-09-17","2021-10-18","2021-02-10","2021-02-26","2021-02-10","2021-02-10","2021-02-10","2021-09-22","2021-09-22","2021-02-15","2021-09-20","2021-02-26","2021-06-14","2020-03-17","2020-03-17","2020-03-17","2021-11-09","2020-03-17","2021-10-20","2021-11-09","2021-01-05","2021-01-05","2021-01-05","2021-01-05","2021-01-05","2021-01-05","2020-10-12","2020-10-12","2020-10-12","2020-10-12","2021-02-26","2021-02-26","2021-09-20","2021-10-22","2021-10-26","2021-10-26","2021-10-25","2021-11-02","2021-10-27","2021-11-09","2021-11-09","2021-11-09","2021-10-26"],"priorHcc":[null,"",null,"","","","","","","","","","","","","","",null,"","","","",null,"","","","","","","","","","","","","","",null,"",null,null,"","","","","","","","","","","","","",null,null,null,null,null,null,null,null,null,null]}},{"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":[["","00093742698","MONTELUKAST","10MG","90","Select","Select",""],["","47781030301","NITROFURANTN","100MG","6","Select","Select",""],["","00378827052","ALBUTEROL","0.08%","75","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","2","Select","Select",""],["","00472016615","NYSTATIN","100000","15","Select","Select",""],["","00168000615","TRIAMCINOLON","0.10%","30","Select","Select",""],["","68382003416","VENLAFAXINE","37.5 ER","90","Select","Select",""],["","13668000805","ZOLPIDEM","10MG","30","Select","Select",""],["","75826011510","PHENAZOPYRID","200MG","6","Select","Select",""],["","64764073030","TRINTELLIX","10MG","30","Select","Select",""],["","65862018730","ONDANSETRON","4MG","6","Select","Select",""],["","59310057922","PROAIR","","-8","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","14","Select","Select",""],["","74312019939","D3","2000UNIT","60","Select","Select",""],["","65862050320","AMOX\/K","875-125","14","Select","Select",""],["","51672404806","CLOTRIM\/BETA","DIPROP","45","Select","Select",""],["","68180030360","CEFUROXIME","500MG","14","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","40985027070","CALCIUM","","30","Select","Select",""],["","00378064205","PREDNISONE","20MG","3","Select","Select",""],["","42806016005","HYDROXYZ","25MG","30","Select","Select",""],["","50428016183","CVS","2000UNIT","60","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","65162019050","NAPROXEN","500MG","20","Select","Select",""],["","60505100301","KETOROLAC","0.50%","5","Select","Select",""],["","70710122501","AMITRIPTYLIN","10MG","30","Select","Select",""],["","68382003416","VENLAFAXINE ","37.5 ER","90","Select","Select",""],["","00093742698","MONTELUKAST ","10MG","90","Select","Select",""],["","13668000805","ZOLPIDEM ","10MG","30","Select","Select",""],["","00168000615","TRIAMCINOLON ","0.10%","30","Select","Select",""],["","75826011510","PHENAZOPYRID ","200MG","6","Select","Select",""],["","47781030301","NITROFURANTN ","100MG","6","Select","Select",""],["","00378827052","ALBUTEROL ","0.08%","75","Select","Select",""],["","70710113908","FLUCONAZOLE ","150MG","2","Select","Select",""],["","00472016615","NYSTATIN ","100000","15","Select","Select",""],["","74312019939","D3 ","2000UNIT","60","Select","Select",""],["","50428016183","CVS ","2000UNIT","60","Select","Select",""],["","64764073030","TRINTELLIX ","10MG","30","Select","Select",""],["","59310057922","PROAIR ","","-8","Select","Select",""],["","40985027070","CALCIUM ","","30","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","1","Select","Select",""],["","68180016013","AZITHROMYCIN ","250MG","6","Select","Select",""],["","68462010530","ONDANSETRON ","4MG","-6","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","14","Select","Select",""],["","65162019050","NAPROXEN ","500MG","20","Select","Select",""],["","60505100301","KETOROLAC ","0.50%","5","Select","Select",""],["","00378064205","PREDNISONE ","20MG","3","Select","Select",""],["","68180030360","CEFUROXIME ","500MG","14","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","65862050320","AMOX\/K ","875-125","14","Select","Select",""],["","51672404806","CLOTRIM\/BETA ","DIPROP","45","Select","Select",""],["","70710122501","AMITRIPTYLIN ","10MG","30","Select","Select",""],["","42806016005","HYDROXYZ ","25MG","30","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","50742061510","METOPROL","25MG ER","45","Select","Select",""],["","59267100002","PFIZER ","INJ COVID-19","0","Select","Select",""],["","00173071920","FLOVENT ","AER 110MCG","12","Select","Select",""],["","50742061510","METOPROL ","TAB 25MG ER","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","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","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":""}]}]}