{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"YURI   ROSEMARY PRADO","gend":1,"add":"4135 WISTAR ROAD","city":"HENRICO","state":"VA","zip":"23228-9998","dob":"1990-02-12","age":"","mstatus":"","insh":"2354680*01","cliId":"","pno":"804\/550-6055","cno":"804\/550-6055","email":"","ename":"","eno":"","pphy":"GUIRGUIS, EKRAM G MD","ppno":"804\/448-0198","pcpadd":"SUITE 100 8051 PROSPERITY WAY","pcpcity":"RUTHER GLEN","pcpstate":"VA","pcpzip":22546,"pcpcounty":"","pcpid":151449,"pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","region":"CENTRAL","aligned":"","ano":"804\/550-6055, ","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/448-0598","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z20.828","R07.0","M79.10","N83.202","D27.1","R10.9","T83.32XA","T83.84XA","R10.2","N93.8","Z87.42","Z87.19","Z87.891","Z32.02","Z80.0","K21.9","Z79.899","Z01.419","Z11.51","R87.610","Z71.3","E66.3","Z51.81","Z30.432","Z30.430","N83.292","K59.00","R04.0","J33.9","K92.2","D64.9","K62.5","R10.31","R10.32","T83.32XD","N83.201","N80.9","K66.0","D50.0","K60.2","E22.9","R73.09","E55.9","E28.2","D51.9","D50.9","N76.0","Z30.011","Z00.00","R73.02","Z68.26","R39.9","N83.8","R87.69"],"date":["2021-01-19","2021-01-08","2021-01-08","2021-07-16","2021-04-02","2021-05-28","2021-05-29","2021-05-29","2021-07-16","2021-07-16","2021-07-13","2021-05-29","2021-05-29","2021-05-29","2021-05-29","2021-05-29","2021-05-29","2021-02-12","2021-02-12","2021-02-12","2021-03-26","2021-03-26","2021-03-26","2021-05-29","2021-05-20","2021-02-25","2021-05-18","2021-05-27","2021-05-17","2021-05-17","2021-05-17","2021-05-28","2021-05-28","2021-05-28","2021-05-29","2021-04-14","2021-07-23","2021-04-14","2021-05-18","2021-05-18","2021-03-12","2021-03-12","2021-07-23","2021-03-12","2021-03-12","2021-03-12","2021-02-25","2021-06-11","2021-07-23","2021-07-23","2021-07-23","2021-08-30","2021-07-16","2021-09-10"],"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":[["","50742011808","CABERGOLINE","0.5MG","13","Select","Select",""],["","68001025320","FLUCONAZOLE","150MG","1","Select","Select",""],["","10702002501","PHENTERMINE","37.5MG","-30","Select","Select",""],["","42806054701","VITAMIN","1.25MG","13","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","67877021905","CEPHALEXIN","500MG","14","Select","Select",""],["","52268001201","SUPREP","PREP KIT","-354","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","10","Select","Select",""],["","00406012301","HYDROCO\/APAP","5-325MG","4","Select","Select",""],["","50742011808","CABERGOLINE ","0.5MG","7","Select","Select",""],["","68001025320","FLUCONAZOLE ","150MG","1","Select","Select",""],["","10702002501","PHENTERMINE ","37.5MG","30","Select","Select",""],["","42806054701","VITAMIN ","1.25MG","13","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","67877021905","CEPHALEXIN ","500MG","-14","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","10","Select","Select",""],["","52268001201","SUPREP ","PREP KIT","354","Select","Select",""],["","00406012301","HYDROCO\/APAP ","5-325MG","4","Select","Select",""],["","51672131603","ALCLOMETASON ","0.05%","-60","Select","Select",""],["","69238110002","DOXYCYCL ","100MG","60","Select","Select",""],["","42192015101","HYDROQUINONE ","4%","28","Select","Select",""],["","69238110002","DOXYCYCL","100MG","60","Select","Select",""],["","51672131603","ALCLOMETASON","0.05%","-60","Select","Select",""],["","42192015101","HYDROQUINONE","4%","28","Select","Select",""],["","21922001704","CLOBETASOL","0.05%","30","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","",""],["No","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":""}]}]}