{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALEXXUS   L ALLEN","gend":1,"add":"113 CROTAAN DR APT E","city":"PETERSBURG","state":"VA","zip":"23803-9998","dob":"2000-11-28","age":"","mstatus":"","insh":"20049983*01","cliId":"","pno":"804\/894-4185","cno":"804\/894-4185","email":"","ename":"","eno":"","pphy":"GONZALES, PATRICIA D MD","ppno":"804\/520-6137","pcpadd":"210 NORTH TEMPLE AVE","pcpcity":"COLONIAL HEIGHTS","pcpstate":"VA","pcpzip":23834,"pcpcounty":"","pcpid":110095,"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":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M67.833","S99.912A","F90.2","F33.9","H00.021","R53.1","R42.","R10.9","R11.0","G56.01","B37.3","S39.012A","R35.0","R21.","R11.10","Z01.419","N94.6","R06.02","R07.0"],"date":["2020-07-19","2021-06-30","2020-08-17","2020-08-17","2020-10-28","2021-04-27","2021-04-27","2021-04-27","2021-07-15","2020-07-14","2020-02-03","2021-03-01","2020-02-26","2020-02-26","2021-06-04","2021-08-18","2021-08-18","2021-07-15","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":[["","59762501801","FLUCONAZOLE ","200MG","14","Select","Select",""],["","45802005505","TRIAMCINOLON ","0.10%","45","Select","Select",""],["","57237023305","SMZ-TMP ","800-160","14","Select","Select",""],["","49483060450","IBUPROFEN ","800MG","30","Select","Select",""],["","00591544243","PREDNISONE ","10MG","48","Select","Select",""],["","68001016208","PROMETHAZINE ","25MG","12","Select","Select",""],["","00574402435","ERYTHROMYCIN ","5MG\/GM","4","Select","Select",""],["","69543038810","KETOROLAC ","10MG","30","Select","Select",""],["","59762040105","SUCRALFATE ","1GM","28","Select","Select",""],["","70010077001","METHOCARBAM ","750MG","30","Select","Select",""],["","16571020210","DICLOFENAC ","50MG DR","30","Select","Select",""],["","63304045830","ONDANSETRON ","4MG","12","Select","Select",""],["","68001039708","FAMOTIDINE ","20MG","20","Select","Select",""],["","00093314705","CEPHALEXIN ","500MG","21","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","46122016752","ALLER\/CONGES ","10-240MG","14","Select","Select",""],["","68180096301","ALBUTEROL ","HFA","8","Select","Select",""],["","11523716102","CLARITIN-D ","10-240MG","14","Select","Select",""],["","65862098799","POT  CHLORIDE","10MEQ ER","7","Select","Select",""],["","59762501801","FLUCONAZOLE","200MG","14","Select","Select",""],["","45802005505","TRIAMCINOLON","0.10%","45","Select","Select",""],["","49483060450","IBUPROFEN","800MG","30","Select","Select",""],["","57237023305","SMZ-TMP","800-160","14","Select","Select",""],["","00574402435","ERYTHROMYCIN","5MG\/GM","4","Select","Select",""],["","70010077001","METHOCARBAM","750MG","30","Select","Select",""],["","68001039708","FAMOTIDINE","20MG","20","Select","Select",""],["","68001016208","PROMETHAZINE","25MG","12","Select","Select",""],["","16571020210","DICLOFENAC","50MG DR","30","Select","Select",""],["","69543038810","KETOROLAC","10MG","18","Select","Select",""],["","68180096301","ALBUTEROL","HFA","8","Select","Select",""],["","46122016752","ALLER\/CONGES","10-240MG","14","Select","Select",""],["","11523716102","CLARITIN-D","10-240MG","14","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","21","Select","Select",""],["","65862098799","POT CHLORIDE","10MEQ ER","7","Select","Select",""],["","68001024604","ONDANSETRON","4MG ODT","20","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00591544243","PREDNISONE","10MG","48","Select","Select",""],["","59762040105","SUCRALFATE","1GM","28","Select","Select",""],["","00904530680","BANOPHEN ","CAP 25MG","30","Select","Select",""],["","00904673080","ACETAMIN ","TAB 500MG","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","",""],["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":""}]}]}