{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRANDI   L CAIN","gend":1,"add":"3310 DECATUR ST","city":"RICHMOND","state":"VA","zip":"23224-9998","dob":"2003-03-28","age":"","mstatus":"","insh":"20042599*01","cliId":"","pno":"717\/729-4741","cno":"717\/729-4741","email":"","ename":"","eno":"","pphy":"CREWE, STEPHANIE MD","ppno":"804\/828-2467","pcpadd":"417 N 11TH STREET","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23298,"pcpcounty":"","pcpid":117980,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/828-4762","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N20.0","A54.9","Z00.00","M54.9","A56.2","Z23.","R11.10","R63.4","K21.9","K59.00","K52.9","R10.9","J30.2","Z86.19","M54.6","M62.81","R20.9","R11.2","G89.29","R30.0","N89.8","J45.909","F32.9","N92.0","N39.0","N94.6","R53.81","D64.9","R00.2"],"date":["2020-06-04","2020-10-15","2021-04-26","2021-04-26","2021-04-26","2021-04-26","2020-06-04","2020-02-14","2020-02-14","2020-02-14","2020-04-06","2020-06-04","2021-04-05","2021-04-05","2021-04-29","2021-04-29","2021-04-29","2020-01-27","2020-01-27","2020-01-27","2020-01-27","2020-01-27","2020-01-27","2020-10-14","2020-10-14","2020-10-14","2021-07-14","2021-07-14","2021-07-14"],"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":[["","00904671760","CETIRIZINE ","10MG","90","Select","Select",""],["","00093742698","MONTELUKAST ","10MG","90","Select","Select",""],["","00173071920","FLOVENT ","110MCG","12","Select","Select",""],["","50111033401","METRONIDAZOL ","500MG","14","Select","Select",""],["","59310057922","PROAIR ","","17","Select","Select",""],["","50383070016","FLUTICASONE ","50MCG","16","Select","Select",""],["","70000041501","CLEARLAX ","","119","Select","Select",""],["","00093314705","CEPHALEXIN ","500MG","20","Select","Select",""],["","68462015713","ONDANSETRON ","4MG ODT","10","Select","Select",""],["","64380080907","IBUPROFEN ","400MG","30","Select","Select",""],["","65862001705","AMOXICILLIN ","500MG","30","Select","Select",""],["","00904759160","FERROUS ","325MG","90","Select","Select",""],["","68180016106","AZITHROMYCIN ","500MG","2","Select","Select",""],["","67877058450","CEFIXIME ","400MG","1","Select","Select",""],["","59267100002","PFIZER ","COVID-19","0","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","14","Select","Select",""],["","00093742698","MONTELUKAST","10MG","30","Select","Select",""],["","59310057922","PROAIR","","17","Select","Select",""],["","00904671760","CETIRIZINE","10MG","90","Select","Select",""],["","00173071920","FLOVENT","110MCG","12","Select","Select",""],["","50383070016","FLUTICASONE","50MCG","16","Select","Select",""],["","00093314505","CEPHALEXIN","250MG","40","Select","Select",""],["","69238110105","IBUPROFEN","400MG","30","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","20","Select","Select",""],["","65862001705","AMOXICILLIN","500MG","30","Select","Select",""],["","00904759160","FERROUS","325MG","90","Select","Select",""],["","68180016106","AZITHROMYCIN","500MG","2","Select","Select",""],["","67877058450","CEFIXIME","400MG","1","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","70000041501","CLEARLAX","","119","Select","Select",""],["","70461032103","FLUCLVX","2021-22","0","Select","Select",""],["","00378334053","XULANE ","DIS 150-35","3","Select","Select",""],["","70461032103","FLUCLVX ","INJ 2021-22","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","",""],["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":""}]}]}