{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHARMANINA FLORENCE","gend":1,"add":"2528 ROSETTA ST","city":"RICHMOND","state":"VA","zip":"23223-9998","dob":"1982-03-28","age":"","mstatus":"","insh":"20027371*01","cliId":"","pno":"804\/668-8557","cno":"804\/668-8557","email":"","ename":"","eno":"","pphy":"BROOKS WILLIAMS, MALINDA A MD","ppno":"804\/780-0840","pcpadd":"2740 BENSLEY COMMONS BLVD","pcpcity":"NORTH CHESTERFIELD","pcpstate":"VA","pcpzip":23237,"pcpcounty":"","pcpid":177187,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/780-0862","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R07.9","Z30.42","Z32.02","A46.","L95.9","J45.909","Z79.899","F17.210","R21.","L28.2","F39.","F51.01","Z91.09","T14.90XA","K21.9","F32.9","F41.9","K02.9","R00.0","R07.0","J30.1","Z00.01","E78.6","F43.9","Z68.35","J45.20","F51.02","Z28.20","L03.116","T78.40XA","R09.81","Z20.822","L24.0"],"date":["2020-07-20","2021-03-03","2021-03-03","2020-09-25","2020-11-27","2020-11-27","2020-11-27","2020-11-27","2021-04-06","2021-02-22","2021-04-06","2021-04-06","2020-06-08","2020-05-19","2020-11-03","2021-01-05","2021-01-05","2020-03-18","2020-05-10","2020-05-06","2020-11-03","2020-11-03","2020-11-03","2020-11-03","2020-11-03","2020-11-03","2020-11-03","2020-11-03","2020-12-05","2021-06-03","2021-06-03","2021-08-23","2021-09-15"],"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":[["","00143993905","AMOXICILLIN ","500MG","23","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","28","Select","Select",""],["","00406048410","APAP\/CODEINE ","300-30MG","14","Select","Select",""],["","65862085901","FAMOTIDINE ","20MG","20","Select","Select",""],["","00603533815","PREDNISONE ","10MG","21","Select","Select",""],["","64380076111","OMEGA-3-ACID ","1GM","60","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","16","Select","Select",""],["","00173088408","LOVAZA ","1GM","60","Select","Select",""],["","47781030601","NITROFUR ","25MG","40","Select","Select",""],["","57237000511","FLUCONAZOLE ","150MG","2","Select","Select",""],["","45802065078","LORATADINE ","10MG","90","Select","Select",""],["","49035026045","","","90","Select","Select",""],["","57237004105","PENICILLN ","500MG","30","Select","Select",""],["","00115180301","HYDROXYZ ","25MG","20","Select","Select",""],["","00168002031","HYDROCORT ","1%","28","Select","Select",""],["","65862001705","AMOXICILLIN","500MG","23","Select","Select",""],["","64380080707","IBUPROFEN","800MG","28","Select","Select",""],["","00406048410","APAP\/CODEINE","300-30MG","14","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","16","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","00172572860","FAMOTIDINE","20MG","20","Select","Select",""],["","00603533815","PREDNISONE","10MG","21","Select","Select",""],["","64380076111","OMEGA-3-ACID","1GM","60","Select","Select",""],["","47781030601","NITROFUR","25MG","40","Select","Select",""],["","57237000511","FLUCONAZOLE","150MG","2","Select","Select",""],["","00173088408","LOVAZA","1GM","60","Select","Select",""],["","57237004105","PENICILLN","500MG","30","Select","Select",""],["","00115180301","HYDROXYZ","25MG","20","Select","Select",""],["","45802065087","LORATADINE","10MG","90","Select","Select",""],["","00168002031","HYDROCORT","1%","28","Select","Select",""],["","65862050220","AMOX\/K ","TAB 500-125","15","Select","Select",""],["","00781286810","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","43598081115","CETIRIZINE ","TAB 10MG","30","Select","Select",""],["","00406012305","HYDROCO\/APAP ","TAB 5-325MG","10","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","",""],["Yes","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":""}]}]}