{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LAUREN HOWARD","gend":1,"add":"1416 LORRAINE AVE","city":"RICHMOND","state":"VA","zip":"23227-9998","dob":"1988-04-05","age":"","mstatus":"","insh":"2354740*01","cliId":"","pno":"434\/665-4418","cno":"434\/665-4418","email":"","ename":"","eno":"","pphy":"BANERJEE, RUMKI MD","ppno":"804\/273-0010","pcpadd":"STE A 5310 TWIN HICKORY RD","pcpcity":"GLEN ALLEN","pcpstate":"VA","pcpzip":23059,"pcpcounty":"","pcpid":170284,"pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","region":"CENTRAL","aligned":"","ano":"434\/229-5417","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/273-0049","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K50.90","K58.9","R29.898","S13.4XXA","S00.05XA","G44.89","R51.9","M35.00","M22.2X1","M22.2X2","Z68.1","R10.2","K51.90","M54.2","M54.5","K62.4","M50.21","R06.2","E46.","R10.84","G89.4","R63.6","E63.9","M81.0","G60.9","F41.9","G47.01","M54.6","F90.9","N94.6","N92.0","R63.4","M85.80","T14.90XA","R11.0","D23.9","Z87.42","M51.26","M54.16","M79.10","M41.86","M47.812","Z20.822","D48.5","L82.1","D18.01","L30.9","V87.7XXA","Y92.410","Y93.89","M47.816","M79.18","M50.20","F33.3","R53.83","Z79.899","E55.9","F32.9","V89.2XXA","K21.9","N92.1","R10.9","R20.2","M79.605","M79.604","Z13.31","G47.00","R05.","K62.89","K59.00","M62.9","Z30.42","K63.5","Z51.81","G58.8","F33.1","K31.89","D12.3","G90.09","E24.9","F51.04","X58.XXXA","Z79.891"],"date":["2021-08-04","2021-07-21","2021-06-22","2021-07-26","2021-03-02","2021-03-02","2021-03-02","2021-07-26","2021-03-11","2021-03-11","2021-07-13","2021-07-26","2021-07-07","2021-03-22","2021-04-13","2021-07-09","2021-06-03","2021-06-03","2021-06-22","2021-07-21","2021-08-16","2021-08-04","2021-07-26","2021-06-15","2021-07-13","2021-06-24","2021-06-24","2021-06-15","2021-06-15","2021-07-16","2021-07-16","2021-06-24","2021-04-13","2021-05-20","2021-05-20","2021-06-10","2021-05-20","2021-08-02","2021-05-24","2021-06-14","2021-06-14","2021-06-14","2021-06-02","2021-06-10","2021-06-10","2021-06-10","2021-06-10","2021-03-02","2021-03-02","2021-03-02","2021-04-19","2021-04-19","2021-06-03","2021-01-21","2021-01-21","2021-01-21","2021-01-21","2021-01-21","2021-03-02","2021-07-13","2021-06-15","2021-08-16","2021-06-16","2021-06-16","2021-06-16","2021-07-13","2021-07-13","2021-07-13","2021-08-16","2021-08-16","2021-07-16","2021-07-16","2021-07-21","2021-07-26","2021-08-16","2021-06-24","2021-07-21","2021-07-21","2021-07-26","2021-07-26","2021-07-26","2021-07-26","2021-08-13"],"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":[["","42806033901","AMPHET\/DEXTR","5MG","45","Select","Select",""],["","59417010210","VYVANSE","20MG","30","Select","Select",""],["","00093005805","TRAMADOL","50MG","28","Select","Select",""],["","57894006103","STELARA","90MG\/ML","1","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","28","Select","Select",""],["","70710122600","AMITRIPTYLIN","25MG","30","Select","Select",""],["","00378668977","PANTOPRAZOLE","40MG","-180","Select","Select",""],["","52268001101","SUPREP","PREP KIT","177","Select","Select",""],["","88888888887","DMR","","1","Select","Select",""],["","60505083001","MOMETASONE","50MCG","51","Select","Select",""],["","50428057834","CVS","4%","10","Select","Select",""],["","65862039110","ONDANSETRON","8MG ODT","42","Select","Select",""],["","00172392670","DIAZEPAM","5MG","1","Select","Select",""],["","58487002801","COPPER","2MG","90","Select","Select",""],["","42806016005","HYDROXYZ","25MG","30","Select","Select",""],["","00555077902","MEDROXYPR","10MG","5","Select","Select",""],["","00456120330","LINZESS","72MCG","90","Select","Select",""],["","24658031205","DOXYCYCL","100MG","14","Select","Select",""],["","00832105410","BACLOFEN","10MG","90","Select","Select",""],["","80777027310","MODERNA","COVID-19","0","Select","Select",""],["","00591024105","LORAZEPAM","1MG","1","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","28","Select","Select",""],["","69584061150","METHOCARBAM","500MG","6","Select","Select",""],["","42806033901","AMPHET\/DEXTR ","5MG","45","Select","Select",""],["","59417010210","VYVANSE ","20MG","30","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","20","Select","Select",""],["","50428057834","CVS ","4%","10","Select","Select",""],["","52817019610","TRAMADOL ","100MG","28","Select","Select",""],["","57894006103","STELARA ","90MG\/ML","1","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","28","Select","Select",""],["","69584061150","METHOCARBAM ","500MG","6","Select","Select",""],["","65862039110","ONDANSETRON ","8MG ODT","42","Select","Select",""],["","00832105410","BACLOFEN ","10MG","90","Select","Select",""],["","24658031205","DOXYCYCL ","100MG","14","Select","Select",""],["","42806016005","HYDROXYZ ","25MG","30","Select","Select",""],["","62175061743","PANTOPRAZOLE ","40MG","90","Select","Select",""],["","88888888887","DMR ","","1","Select","Select",""],["","80777027310","MODERNA ","COVID-19","0","Select","Select",""],["","52268001101","SUPREP ","PREP KIT","177","Select","Select",""],["","70710122600","AMITRIPTYLIN ","25MG","30","Select","Select",""],["","58487002801","COPPER ","2MG","90","Select","Select",""],["","00172392670","DIAZEPAM ","5MG","1","Select","Select",""],["","00115175701","CYPROHEPTAD ","4MG","30","Select","Select",""],["","00555077902","MEDROXYPR ","10MG","5","Select","Select",""],["","69315090405","LORAZEPAM ","0.5MG","2","Select","Select",""],["","00591352530","LIDOCAINE ","5%","30","Select","Select",""],["","59011041020","OXYCONTIN ","10MG CR","30","Select","Select",""],["","55566670001","CLENPIQ ","","320","Select","Select",""],["","00456120330","LINZESS ","72MCG","90","Select","Select",""],["","60505083001","MOMETASONE ","50MCG","51","Select","Select",""],["","68180096301","ALBUTEROL ","HFA","8","Select","Select",""],["","59310058020","PROAIR ","","1","Select","Select",""],["","65649030302","XIFAXAN ","550MG","42","Select","Select",""],["","53746051105","SPIRONOLACT ","25MG","270","Select","Select",""],["","00093573101","OXYCODONE ","10MG ER","60","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":""}]}]}