{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHANTE HARRIS-SCOTT","gend":1,"add":"1004 BLAND AVE","city":"HOPEWELL","state":"VA","zip":"23860-9998","dob":"1983-09-27","age":"","mstatus":"","insh":"20040262*01","cliId":"","pno":"804\/295-7458","cno":"804\/295-7458","email":"","ename":"","eno":"","pphy":"PINSON, ANDY MD","ppno":"804\/828-0381","pcpadd":"417 N 11TH ST","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23235,"pcpcounty":"","pcpid":670982,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/828-0910","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J18.9","E87.70","I50.9","R26.9","I31.9","R07.9","R56.1","E66.9","R06.00","M32.9","J45.901","R56.9","I16.0","G40.909","F32.9","R09.02","M32.13","R93.89","I44.0","J44.9","I10.","G81.91","S06.2X0S","I42.9","G62.9","D64.9","F41.9","Z87.440","Z87.01","N17.9","N39.0","R27.0","R06.82","R09.89","I11.0","I50.30","R42.","M32.14","E83.42","D53.9","D69.6","R82.71","J44.1","R68.89","R91.8","J96.11","R40.0","Z71.9","R05.","NO DATA","R06.02","R94.2","R93.1","E66.01","Z79.899","Z68.43","G47.33","Z04.9","D61.818","Z30.433","I50.33","Z91.11","Z20.828","D75.89","M21.379","G40.409","G40.109","M79.674","G89.29","I21.3","R03.1","U07.1","E55.9","J98.4","R94.31","Z23.","M21.371","R00.1","R10.13","R41.82","G72.81","J06.9","J81.0","K30.","R60.0","D89.9","L63.0","J96.91","M32.12","J44.0","E78.5","F17.200","I13.10","N18.3","J45.909","Z12.4","M25.562","I51.7","R09.81","Z71.3","I37.1","J96.21","J84.10","I50.32","Z20.822","Z86.16","I13.0","R06.2","N18.9","F54.","F43.21","J18.8","E87.1"],"date":["2021-09-08","2020-08-29","2021-09-05","2020-06-22","2020-07-29","2020-08-29","2020-07-28","2021-03-18","2020-07-28","2021-07-13","2021-07-20","2021-03-18","2020-07-30","2021-07-22","2021-01-06","2020-07-29","2021-07-20","2021-03-17","2020-08-28","2021-09-05","2021-03-18","2020-02-05","2020-02-05","2020-02-05","2020-02-05","2020-02-05","2020-02-05","2020-08-30","2020-02-05","2021-09-11","2020-08-29","2020-08-28","2020-08-30","2020-08-30","2021-09-13","2021-01-27","2020-08-30","2021-09-13","2020-08-30","2020-08-30","2020-08-30","2020-08-31","2021-07-22","2021-03-17","2021-03-23","2021-03-23","2021-03-23","2021-03-23","2020-03-05","2020-03-06","2021-09-07","2021-01-27","2021-01-27","2021-08-13","2021-09-13","2021-08-13","2021-07-20","2021-07-20","2020-07-23","2020-01-28","2020-07-23","2020-07-22","2021-01-06","2020-07-22","2020-07-22","2020-07-25","2020-11-17","2020-01-13","2020-01-13","2020-07-26","2020-08-27","2021-01-08","2021-01-08","2021-01-08","2021-03-17","2020-02-28","2020-07-09","2020-07-22","2020-07-22","2020-07-25","2020-01-07","2021-01-06","2020-03-05","2020-07-21","2020-07-21","2020-07-21","2020-07-21","2020-07-25","2020-07-25","2021-07-20","2021-09-05","2020-07-25","2020-07-25","2020-07-25","2021-03-18","2020-01-28","2020-07-06","2021-09-09","2021-09-05","2021-02-09","2021-09-09","2021-09-11","2021-07-20","2021-09-13","2021-09-05","2021-07-20","2021-09-05","2021-09-05","2021-09-05","2021-08-13","2021-08-13","2021-09-11","2021-09-11"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","00131248035","VIMPAT ","200MG","60","Select","Select",""],["","68462012605","GABAPENTIN ","600MG","180","Select","Select",""],["","68180011416","LEVETIRACETA ","750MG","60","Select","Select",""],["","00781155601","ISOSORB ","10MG","60","Select","Select",""],["","65862014405","CARVEDILOL ","12.5MG","180","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","65862020199","LOSARTAN ","25MG","180","Select","Select",""],["","13107003134","MIRTAZAPINE ","15MG","30","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","90","Select","Select",""],["","00054429931","FUROSEMIDE ","40MG","90","Select","Select",""],["","00781598801","CARBAMAZEPIN ","400MG ER","60","Select","Select",""],["","68382009601","HYDROXYCHLOR ","200MG","60","Select","Select",""],["","67877012425","SILVER ","1%","50","Select","Select",""],["","69097052444","DICLOFENAC ","1%","100","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","4","Select","Select",""],["","29300013601","CLONIDINE ","0.2MG","180","Select","Select",""],["","00378108601","COLCHICINE ","0.6MG","20","Select","Select",""],["","42806031250","DOXYCYCL ","100MG","14","Select","Select",""],["","31604002743","MELATONIN ","5MG","90","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","00781185220","AMOX\/K ","875-125","20","Select","Select",""],["","00115168774","BUDESONIDE ","0.25MG\/2","60","Select","Select",""],["","00536116361","MUCUS ","600MG ER","20","Select","Select",""],["","70954005920","PREDNISONE ","10MG","30","Select","Select",""],["","83490031065","VIOS ","SYSTEM","1","Select","Select",""],["","76439021712","MAG ","400MG","10","Select","Select",""],["","00363051908","PAIN ","500MG\/RR","12","Select","Select",""],["","62037099901","POT  CL MICRO","20MEQ ER","10","Select","Select",""],["","65862001705","AMOXICILLIN ","500MG","21","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","62756052269","SUMATRIPTAN ","100MG","9","Select","Select",""],["","65862017760","CEFDINIR ","300MG","8","Select","Select",""],["","08373747800","OPTICHAMBER ","DIAMOND","1","Select","Select",""],["","67877057305","BENZONATATE ","100MG","15","Select","Select",""],["","31722052101","HYDRALAZINE ","50MG","120","Select","Select",""],["","51672302002","LIDOCAINE ","5%","30","Select","Select",""],["","65862014405","CARVEDILOL","12.5MG","180","Select","Select",""],["","47335057686","LEVETIRACETA","750MG ER","60","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","65862020199","LOSARTAN","25MG","180","Select","Select",""],["","00131247835","VIMPAT","100MG","120","Select","Select",""],["","00781155601","ISOSORB","10MG","60","Select","Select",""],["","65162010250","GABAPENTIN","300MG","180","Select","Select",""],["","68382009601","HYDROXYCHLOR","200MG","60","Select","Select",""],["","31722052101","HYDRALAZINE","50MG","120","Select","Select",""],["","00054429931","FUROSEMIDE","40MG","60","Select","Select",""],["","67877012425","SILVER","1%","50","Select","Select",""],["","69097052444","DICLOFENAC","1%","100","Select","Select",""],["","00781801601","CARBAMAZEPIN","100MGER","240","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","68180072003","AMLODIPINE","5MG","30","Select","Select",""],["","69452015120","VITAMIN","50000UNT","4","Select","Select",""],["","42806031250","DOXYCYCL","100MG","14","Select","Select",""],["","00363051908","PAIN","500MG\/RR","12","Select","Select",""],["","76439021712","MAG","400MG","10","Select","Select",""],["","13107003134","MIRTAZAPINE","15MG","30","Select","Select",""],["","80681004002","MELATONIN","5MG","30","Select","Select",""],["","65862001705","AMOXICILLIN","500MG","21","Select","Select",""],["","29300013601","CLONIDINE","0.2MG","180","Select","Select",""],["","00378108601","COLCHICINE","0.6MG","20","Select","Select",""],["","00591544210","PREDNISONE","10MG","120","Select","Select",""],["","62037099901","POT CL MICRO","20MEQ ER","10","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","62756052269","SUMATRIPTAN","100MG","9","Select","Select",""],["","65862017760","CEFDINIR","300MG","8","Select","Select",""],["","83490031065","VIOS","SYSTEM","1","Select","Select",""],["","00781185220","AMOX\/K","875-125","20","Select","Select",""],["","00115168774","BUDESONIDE","0.25MG\/2","60","Select","Select",""],["","00536116361","MUCUS","600MG ER","20","Select","Select",""],["","00085113204","PROVENTIL","HFA","7","Select","Select",""],["","08373747800","OPTICHAMBER","DIAMOND","1","Select","Select",""],["","67877057305","BENZONATATE","100MG","15","Select","Select",""],["","31722072320","LEVOFLOXACIN","750MG","7","Select","Select",""],["","51672302002","LIDOCAINE","5%","30","Select","Select",""],["","31722072320","LEVOFLOXACIN ","TAB 750MG","7","Select","Select",""],["","00085113204","PROVENTIL ","AER HFA","7","Select","Select",""],["","00781107710","ALPRAZOLAM ","TAB 0.5MG","20","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":""}]}]}