{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KEYONNA TYLER","gend":1,"add":"14577 ASHLAND ROAD","city":"GLEN ALLEN","state":"VA","zip":"23059-9998","dob":"1999-10-01","age":"","mstatus":"","insh":"20047106*01","cliId":"","pno":"804\/499-0947","cno":"804\/499-0947","email":"","ename":"","eno":"","pphy":"EVANS, WENDY C DO","ppno":"804\/755-7581","pcpadd":"10150 STAPLES MILL ROAD SUITE E","pcpcity":"GLEN ALLEN","pcpstate":"VA","pcpzip":23060,"pcpcounty":"","pcpid":141012,"pcpname":"CROSSRIDGE PEDIATRICS & INTERNAL MEDICINE","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":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N91.4","E28.2","E66.01","Z31.69","F41.0","K59.00","R10.84","F34.1","F41.9","N92.6","B37.3","Z32.02","R11.0","R07.9","R06.00","L20.9","R10.30","N39.0","M77.52","N30.01","Z11.3","Z11.4","J01.10","N76.2","R73.9","Z23.","N89.8","R21.","B86.","Z68.38","R10.13","M25.562","R06.02","A64.","R43.0","Z20.822","F39.","H53.8","R42.","R10.9","F33.1","F43.10","N91.1","R51.","K08.89","J02.9","D64.9","R30.0","L02.91","K29.00","R10.2"],"date":["2020-09-02","2020-09-02","2020-09-02","2020-09-02","2021-01-10","2020-01-04","2021-02-05","2020-01-30","2021-06-10","2020-04-14","2020-04-14","2020-04-14","2020-04-18","2020-04-18","2020-08-20","2020-04-18","2020-08-04","2020-08-04","2020-07-20","2020-07-20","2020-10-24","2020-10-24","2020-10-24","2020-10-24","2020-10-24","2020-10-24","2020-02-25","2020-02-25","2020-02-25","2020-02-25","2021-01-15","2021-01-10","2021-02-05","2021-02-05","2021-02-05","2021-02-05","2021-02-14","2021-02-14","2021-02-14","2021-02-14","2021-10-21","2020-01-15","2020-01-28","2020-01-28","2020-03-29","2020-09-11","2020-09-11","2020-11-01","2021-05-25","2021-08-02","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":[["","00093742698","MONTELUKAST ","10MG","30","Select","Select",""],["","69097083512","SERTRALINE ","100MG","60","Select","Select",""],["","45802091987","CETIRIZINE ","10MG","30","Select","Select",""],["","42192032130","PNV-DHA ","","30","Select","Select",""],["","45802048678","DOCUSATE ","100MG","60","Select","Select",""],["","00093816201","QUETIAPINE ","100MG","30","Select","Select",""],["","00555032402","HYDROXYZ ","100MG","60","Select","Select",""],["","23155019201","BUPROPION ","100MG","30","Select","Select",""],["","63402030630","LATUDA ","60MG","30","Select","Select",""],["","49884070155","CLOMIPHENE ","50MG","5","Select","Select",""],["","70954001910","PRAZOSIN ","1MG","30","Select","Select",""],["","16729003415","LETROZOLE ","2.5MG","10","Select","Select",""],["","60258019701","PRENATAL ","TAB","30","Select","Select",""],["","00228212810","CLONIDINE ","0.2MG","60","Select","Select",""],["","49884028901","MEGESTROL ","20MG","10","Select","Select",""],["","50111033401","METRONIDAZOL ","500MG","14","Select","Select",""],["","45802026937","PERMETHRIN ","5%","60","Select","Select",""],["","50428035025","MELATONIN ","3MG","60","Select","Select",""],["","68382076010","METFORMIN ","1000MG","60","Select","Select",""],["","59779073041","CVS ","7","45","Select","Select",""],["","00093227534","AMOX\/K ","875-125","20","Select","Select",""],["","70710113803","FLUCONAZOLE ","100MG","5","Select","Select",""],["","00093310905","AMOXICILLIN ","500MG","14","Select","Select",""],["","68462019005","NAPROXEN ","500MG","20","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","00254100752","ALBUTEROL ","HFA","7","Select","Select",""],["","00555077902","MEDROXYPR ","10MG","10","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","14","Select","Select",""],["","51672130200","TERCONAZOLE ","0.80%","20","Select","Select",""],["","68462030205","INDOMETHACIN ","50MG","20","Select","Select",""],["","63304069301","CLINDAMYCIN ","300MG","40","Select","Select",""],["","00185012201","NITROFURANTN ","100MG","10","Select","Select",""],["","75854031530","PRENATE ","","30","Select","Select",""],["","00085113204","PROVENTIL ","HFA","7","Select","Select",""],["","00093031401","KETOROLAC ","10MG","20","Select","Select",""],["","65862007601","CIPROFLOXACN ","250MG","10","Select","Select",""],["","47781030801","NITROFUR ","100MG","10","Select","Select",""],["","65862070260","ZIPRASIDONE ","20MG","30","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","20","Select","Select",""],["","59267100002","PFIZER ","COVID-19","0","Select","Select",""],["","59779076678","PAIN ","325MG","20","Select","Select",""],["","57237016199","OMEPRAZOLE ","20MG","30","Select","Select",""],["","70954001910","PRAZOSIN","1MG","30","Select","Select",""],["","69097083512","SERTRALINE","100MG","60","Select","Select",""],["","45802091987","CETIRIZINE","10MG","30","Select","Select",""],["","00555032402","HYDROXYZ","100MG","60","Select","Select",""],["","00093816201","QUETIAPINE","100MG","30","Select","Select",""],["","00093742698","MONTELUKAST","10MG","30","Select","Select",""],["","59779076678","PAIN","325MG","20","Select","Select",""],["","42192032130","PNV-DHA","","30","Select","Select",""],["","45802048678","DOCUSATE","100MG","60","Select","Select",""],["","23155019201","BUPROPION","100MG","30","Select","Select",""],["","49884070155","CLOMIPHENE","50MG","5","Select","Select",""],["","00228212810","CLONIDINE","0.2MG","60","Select","Select",""],["","49884028901","MEGESTROL","20MG","10","Select","Select",""],["","45802026937","PERMETHRIN","5%","60","Select","Select",""],["","63402030630","LATUDA","60MG","30","Select","Select",""],["","50428035025","MELATONIN","3MG","60","Select","Select",""],["","70710113803","FLUCONAZOLE","100MG","5","Select","Select",""],["","00093227534","AMOX\/K","875-125","20","Select","Select",""],["","68382076010","METFORMIN","1000MG","60","Select","Select",""],["","16729003415","LETROZOLE","2.5MG","10","Select","Select",""],["","00093310905","AMOXICILLIN","500MG","14","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","68462019005","NAPROXEN","500MG","20","Select","Select",""],["","60258019701","PRENATAL","TAB","30","Select","Select",""],["","59779073041","CVS","7","45","Select","Select",""],["","00254100752","ALBUTEROL","HFA","7","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","14","Select","Select",""],["","68462030205","INDOMETHACIN","50MG","20","Select","Select",""],["","00185012201","NITROFURANTN","100MG","10","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","14","Select","Select",""],["","00555077902","MEDROXYPR","10MG","10","Select","Select",""],["","00085113204","PROVENTIL","HFA","7","Select","Select",""],["","75854031530","PRENATE","","30","Select","Select",""],["","65862007601","CIPROFLOXACN","250MG","10","Select","Select",""],["","47781030801","NITROFUR","100MG","10","Select","Select",""],["","65862070260","ZIPRASIDONE","20MG","30","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","20","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","57237016199","OMEPRAZOLE","20MG","30","Select","Select",""],["","51672130200","TERCONAZOLE","0.80%","20","Select","Select",""],["","63304069301","CLINDAMYCIN","300MG","40","Select","Select",""],["","00093031401","KETOROLAC","10MG","20","Select","Select",""],["","00168000615","TRIAMCINOLON ","OIN 0.001","15","Select","Select",""],["","67877021560","CEFUROXIME ","TAB 250MG","20","Select","Select",""],["","68180065208","DOXYCYC ","CAP 100MG","14","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":""}]}]}