{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MAIRCALE THOMPSON","gend":1,"add":"900 E MARSHALL ST","city":"RICHMOND","state":"VA","zip":"23219-9998","dob":"1998-05-08","age":"","mstatus":"","insh":"20063736*01","cliId":"","pno":"804\/533-9244","cno":"804\/533-9244","email":"","ename":"","eno":"","pphy":"DOMAH, NAU DEAVIN MD","ppno":"804\/329-8510","pcpadd":"2421 CHAMBERLAYNE AVE","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23222,"pcpcounty":"","pcpid":124812,"pcpname":"LABURNUM MEDICAL CENTER ","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":["R10.0","G40.901","J69.0","J96.01","F19.10","V62.84","F44.5","R56.9","F31.63","R29.818","Z68.23","S99.912A","S09.90XA","W10.8XXA","F31.9","L02.92","R52.","R11.10","R07.89","I34.0","F11.23","R07.9","F33.1","F11.10","T50.901A","G92.","J96.00","G81.94","R51.9","F10.10","R41.82","F43.10","F11.20","F14.10","F17.210","F11.129","J11.1","B99.9","L03.811","L03.115","L08.9","B95.8","Z78.9","R23.9","Z68.21","E87.6","S01.511A","T40.1X1A","Y09.","R11.2","G40.909","R40.20","F33.2","M79.604","R06.00","Z20.828","R07.2","NO DATA","G43.909","R42.","Z00.01","J45.20","Z23.","Z71.89","F17.200","S09.93XA","T76.11XA","N39.0","R10.13","R19.7","F39.","E11.9","J45.909","F31.32","F33.9","I36.1","I34.8","I49.9","E83.51","R07.0","R10.2","N93.9","R10.9","O47.9","Z3A.00","R00.1","T40.5X1A","F14.20","Z79.84","Z88.8","Z91.018","R00.0","R94.31","R06.02","J18.9","Z20.822","S00.81XA","T14.90XA","T40.2X1A","D50.9","F32.9","Z76.0","R21.","S80.829A","U07.1","J45.901","L03.818","L40.3","F19.24","F50.2","F19.20","A74.9","R45.88","G40.509"],"date":["2020-04-16","2021-02-09","2020-11-03","2020-11-08","2021-07-26","2021-10-15","2021-06-20","2021-04-16","2021-04-30","2021-06-20","2021-06-20","2021-06-23","2021-06-23","2021-06-23","2021-06-26","2020-06-28","2021-06-06","2021-04-15","2021-04-15","2020-08-05","2020-08-25","2021-04-15","2020-11-08","2021-06-18","2021-02-10","2020-11-08","2020-11-08","2020-11-06","2021-04-16","2020-11-08","2021-09-20","2020-02-24","2020-02-24","2021-06-26","2021-02-08","2021-02-10","2021-04-22","2021-04-22","2021-06-18","2021-06-18","2021-06-22","2021-06-18","2021-06-19","2021-06-19","2021-06-19","2021-02-10","2021-03-03","2021-06-22","2021-03-03","2020-04-16","2021-10-19","2021-01-29","2021-04-05","2021-06-19","2020-07-21","2020-07-21","2021-10-09","2021-02-09","2021-01-21","2021-01-21","2021-02-09","2021-02-09","2021-02-09","2021-02-09","2021-04-16","2021-03-03","2021-03-03","2021-04-15","2021-04-15","2021-04-15","2021-06-26","2021-06-26","2021-06-26","2020-01-27","2020-02-26","2020-11-02","2020-11-02","2021-01-23","2021-02-01","2020-02-27","2020-03-22","2020-03-22","2020-03-22","2020-07-31","2020-07-31","2020-08-25","2020-09-11","2020-09-11","2020-09-11","2020-09-11","2020-09-11","2021-02-01","2021-02-01","2021-04-22","2021-04-22","2021-10-15","2021-03-03","2021-03-03","2021-03-03","2021-07-19","2021-06-24","2021-01-15","2021-07-26","2021-05-27","2021-09-26","2021-09-26","2021-06-18","2021-06-18","2021-10-19","2021-10-19","2021-10-19","2021-10-19","2021-10-19","2021-09-26"],"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":[["","57664049983","MIRTAZAPINE ","15MG","30","Select","Select",""],["","65162019050","NAPROXEN ","500MG","20","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","20","Select","Select",""],["","53746010901","HYDROCO\/APAP ","5-325MG","8","Select","Select",""],["","68180011507","LEVETIRACETA ","1000MG","60","Select","Select",""],["","00378064205","PREDNISONE ","20MG","15","Select","Select",""],["","65862050320","AMOX\/K ","875-125","14","Select","Select",""],["","65162068090","PROMETHAZINE ","DM","100","Select","Select",""],["","00573262119","ALAVERT ","10MG","90","Select","Select",""],["","45802027603","HYDROCORT ","1%","28","Select","Select",""],["","45802091987","CETIRIZINE ","10MG","30","Select","Select",""],["","00093101042","MUPIROCIN ","2%","22","Select","Select",""],["","16729020301","BUSPIRONE ","15MG","90","Select","Select",""],["","53489011905","DOXYCYCL ","100MG","20","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","10","Select","Select",""],["","68180016006","AZITHROMYCIN ","250MG","4","Select","Select",""],["","31722054501","LITHIUM ","300MG","60","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","14","Select","Select",""],["","59779036751","SLEEP ","25MG","30","Select","Select",""],["","50428868796","PROBIOTIC ","","14","Select","Select",""],["","50428031251","CVS ","400UNIT","30","Select","Select",""],["","63304069301","CLINDAMYCIN ","300MG","40","Select","Select",""],["","57664049983","MIRTAZAPINE","15MG","30","Select","Select",""],["","53746010901","HYDROCO\/APAP","5-325MG","8","Select","Select",""],["","16714035701","LEVETIRACETA","1000MG","60","Select","Select",""],["","59779036751","SLEEP","25MG","30","Select","Select",""],["","68180016006","AZITHROMYCIN","250MG","4","Select","Select",""],["","65862050320","AMOX\/K","875-125","14","Select","Select",""],["","00378064205","PREDNISONE","20MG","15","Select","Select",""],["","65162068090","PROMETHAZINE","DM","100","Select","Select",""],["","65162019050","NAPROXEN","500MG","20","Select","Select",""],["","50428868796","PROBIOTIC","","14","Select","Select",""],["","00093101042","MUPIROCIN","2%","22","Select","Select",""],["","16729020301","BUSPIRONE","15MG","90","Select","Select",""],["","53489011905","DOXYCYCL","100MG","20","Select","Select",""],["","00573262119","ALAVERT","10MG","90","Select","Select",""],["","45802091987","CETIRIZINE","10MG","30","Select","Select",""],["","45802027603","HYDROCORT","1%","28","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","20","Select","Select",""],["","50428031251","CVS","400UNIT","30","Select","Select",""],["","63304069301","CLINDAMYCIN","300MG","40","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","10","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","14","Select","Select",""],["","31722054501","LITHIUM","300MG","60","Select","Select",""],["","49483060450","IBUPROFEN ","TAB 800MG","30","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}