{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHRISTINE   A WAKEFIELD","gend":1,"add":"220 ENGLESIDE CIR APT 2A","city":"RICHMOND","state":"VA","zip":"23222-9998","dob":"1991-12-08","age":"","mstatus":"","insh":"20036742*01","cliId":"","pno":"804\/442-8681","cno":"804\/442-8681","email":"","ename":"","eno":"","pphy":"AKERS-WHITE, LATANIA MD","ppno":"804\/554-3464","pcpadd":"110 NORTH ROBINSON STREET SUITE 101","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23220,"pcpcounty":"","pcpid":177588,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F99.","F33.2","K80.50","N39.0","B20.","F32.9","Z79.899","F84.0","F31.81","F43.10","F60.3","E55.9","J11.1","G51.0"],"date":["2020-09-07","2021-11-15","2020-07-09","2020-07-09","2020-11-23","2020-07-28","2020-11-23","2021-11-03","2021-11-03","2021-11-03","2021-11-03","2020-11-23","2020-01-21","2021-06-29"],"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":[["","49702022813","TIVICAY ","50MG","30","Select","Select",""],["","00173071920","FLOVENT ","110MCG","12","Select","Select",""],["","13668033005","TRAZODONE ","50MG","30","Select","Select",""],["","00378727253","NORETHINDRON ","0.35MG","28","Select","Select",""],["","00115180301","HYDROXYZ ","25MG","90","Select","Select",""],["","61958200201","DESCOVY ","200\/25","30","Select","Select",""],["","33342025866","OSELTAMIVIR ","75MG","10","Select","Select",""],["","00603533815","PREDNISONE ","10MG","21","Select","Select",""],["","63402030630","LATUDA ","60MG","30","Select","Select",""],["","65862037401","ESCITALOPRAM ","10MG","30","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","5","Select","Select",""],["","75854031530","PRENATE ","","30","Select","Select",""],["","50111033402","METRONIDAZOL ","500MG","14","Select","Select",""],["","57237000511","FLUCONAZOLE ","150MG","1","Select","Select",""],["","68462015713","ONDANSETRON ","4MG ODT","10","Select","Select",""],["","52817033200","CYCLOBENZAPR ","10MG","20","Select","Select",""],["","00591079401","DICYCLOMINE ","10MG","20","Select","Select",""],["","00093314705","CEPHALEXIN ","500MG","15","Select","Select",""],["","13811071910","NITROFURANTN ","100MG","6","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","10","Select","Select",""],["","51293081101","PHENAZOPYRID ","200MG","10","Select","Select",""],["","65862044990","VALACYCLOVIR ","1GM","21","Select","Select",""],["","60846050201","PYRIDIUM ","200MG","10","Select","Select",""],["","61958200201","DESCOVY","200\/25","30","Select","Select",""],["","49702022813","TIVICAY","50MG","30","Select","Select",""],["","00378727253","NORETHINDRON","0.35MG","28","Select","Select",""],["","00115180301","HYDROXYZ","25MG","90","Select","Select",""],["","00591544221","PREDNISONE","10MG","21","Select","Select",""],["","13668033005","TRAZODONE","50MG","30","Select","Select",""],["","33342025866","OSELTAMIVIR","75MG","10","Select","Select",""],["","65862037401","ESCITALOPRAM","10MG","30","Select","Select",""],["","63402030630","LATUDA","60MG","30","Select","Select",""],["","68462015713","ONDANSETRON","4MG ODT","10","Select","Select",""],["","13811071910","NITROFURANTN","100MG","6","Select","Select",""],["","52817033200","CYCLOBENZAPR","10MG","20","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","15","Select","Select",""],["","00591079401","DICYCLOMINE","10MG","20","Select","Select",""],["","69452015120","VITAMIN","50000UNT","5","Select","Select",""],["","50111033402","METRONIDAZOL","500MG","14","Select","Select",""],["","57237000511","FLUCONAZOLE","150MG","1","Select","Select",""],["","75854031530","PRENATE","","30","Select","Select",""],["","65862044990","VALACYCLOVIR","1GM","21","Select","Select",""],["","60846050201","PYRIDIUM","200MG","10","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","10","Select","Select",""],["","00555097102","AMPHET\/DEXTR","5MG","60","Select","Select",""],["","00173071920","FLOVENT","110MCG","12","Select","Select",""],["","51293081101","PHENAZOPYRID","200MG","10","Select","Select",""],["","00555097102","AMPHET\/DEXTR ","TAB 5MG","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","",""],["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":""}]}]}