{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KRISTINA GARVEY","gend":1,"add":"10206 GUYANA CT","city":"HENRICO","state":"VA","zip":"23233-9998","dob":"1990-05-24","age":"","mstatus":"","insh":"2373698*01","cliId":"","pno":"804\/922-7086","cno":"804\/922-7086","email":"","ename":"","eno":"","pphy":"SIEDLECKI, JOHN MD","ppno":"804\/330-3335","pcpadd":"3742 WINTERFIELD RD","pcpcity":"MIDLOTHIAN","pcpstate":"VA","pcpzip":23113,"pcpcounty":"","pcpid":104193,"pcpname":"Family Practice Specialists of Richmond P.C.","plan":"OHP","program":"ACA","lob":"Individual","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/330-9205","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.2","Z87.442","R10.31","N92.1","Z13.29","R10.9","M79.671","S90.31XA","N83.291","N30.01","N30.00","R39.15","R35.0","H92.09","R30.0","N83.01","M19.90","G40.209","R00.0","J45.909","I48.91","Z79.899","Z20.822","N83.201","N83.202","R31.9","Z01.812","J45.20","F90.0","N20.0","M54.12","Z20.828","J30.89","M54.5","M65.4","M79.641","G56.23","Z86.69","M79.642","M54.16","M51.36","Z98.890","Z87.39","M19.041","M19.042","R20.0","R20.2","R11.2","R50.9","Z86.16","R19.4","R19.7"],"date":["2021-03-25","2021-04-20","2021-04-16","2021-03-04","2021-03-04","2021-11-05","2021-03-23","2021-03-23","2021-03-25","2021-05-13","2021-06-14","2021-06-14","2021-06-14","2021-06-14","2021-04-01","2021-03-25","2021-03-25","2021-03-25","2021-03-25","2021-03-25","2021-03-25","2021-03-25","2021-11-06","2021-03-25","2021-03-25","2021-04-13","2021-03-21","2021-08-18","2021-08-18","2021-05-04","2021-06-19","2021-11-06","2021-08-07","2021-08-18","2021-10-13","2021-09-29","2021-09-16","2021-09-16","2021-09-29","2021-09-20","2021-09-20","2021-09-20","2021-09-20","2021-09-29","2021-09-29","2021-09-29","2021-09-29","2021-11-05","2021-11-05","2021-11-05","2021-09-23","2021-09-23"],"priorHcc":["","","","","",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":[["","00555097302","AMPHET\/DEXTR","20MG","60","Select","Select",""],["","64380080707","IBUPROFEN","800MG","30","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","-14","Select","Select",""],["","00115165901","PROPRANOLOL","10MG","30","Select","Select",""],["","52817033010","CYCLOBENZAPR","5MG","30","Select","Select",""],["","68382091634","METHYLPRED","4MG","21","Select","Select",""],["","65862007601","CIPROFLOXACN","250MG","-10","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","67877021560","CEFUROXIME","250MG","20","Select","Select",""],["","00555097302","AMPHET\/DEXTR ","20MG","60","Select","Select",""],["","00115165901","PROPRANOLOL ","10MG","30","Select","Select",""],["","59651036205","IBUPROFEN ","800MG","30","Select","Select",""],["","00093314705","CEPHALEXIN ","500MG","14","Select","Select",""],["","52817033200","CYCLOBENZAPR ","10MG","30","Select","Select",""],["","65862007601","CIPROFLOXACN ","250MG","10","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","67877021560","CEFUROXIME ","250MG","20","Select","Select",""],["","68382091634","METHYLPRED ","4MG","21","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","16","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","16","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","10","Select","Select",""],["","57237007710","ONDANSETRON ","TAB 4MG ODT","10","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0","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":""}]}]}