{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LAKETRA WILKERSON","gend":1,"add":"5805 COUNTRY MANOR WAY","city":"RICHMOND","state":"VA","zip":"23234-9998","dob":"1978-05-30","age":"","mstatus":"","insh":"1752948*01","cliId":"","pno":"804\/252-5226","cno":"804\/252-5226","email":"","ename":"","eno":"","pphy":"CLASBEY, SHEILA MD","ppno":"804\/271-8990","pcpadd":"12018 WEST BROAD STREET STE 101","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23233,"pcpcounty":"","pcpid":147624,"pcpname":"Primary Health Group - Ironbridge","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R87.612","N92.0","R10.2","R87.613","N81.2","N92.1","J01.90","Z04.9","Z01.419","Z30.431","N87.1","Z30.430","NO DATA","D25.0","R87.69","H65.92","J32.9","J45.909","K21.9","R09.81","J06.9","J45.30","Z20.828","D25.9","N76.0","N92.6","H65.112","H65.02","Z71.89"],"date":["2020-07-08","2021-08-19","2021-08-19","2020-08-13","2020-07-28","2021-06-30","2020-05-09","2021-05-07","2021-06-24","2021-06-24","2020-07-28","2020-10-20","2020-12-31","2020-08-28","2020-08-28","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2021-08-09","2020-12-27","2020-12-27","2021-08-19","2021-02-11","2021-03-23","2020-09-25","2020-09-25","2021-08-19"],"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":[["","57237000511","FLUCONAZOLE ","150MG","3","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","14","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","16","Select","Select",""],["","00781808926","AZITHROMYCIN ","250MG","6","Select","Select",""],["","00173071820","FLOVENT ","44MCG","11","Select","Select",""],["","00378729189","NORETHIN ","5MG","40","Select","Select",""],["","52817033200","CYCLOBENZAPR ","10MG","24","Select","Select",""],["","00406051205","OXYCOD\/APAP ","5-325MG","7","Select","Select",""],["","00781707787","METRONIDAZOL ","0.75%VAG","70","Select","Select",""],["","00135057603","FLONASE ","50MCG","16","Select","Select",""],["","00185012201","NITROFURANTN ","100MG","14","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","60432060416","PROMETHAZINE ","DM","100","Select","Select",""],["","00591352530","LIDOCAINE ","5%","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","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","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":""}]}]}