{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NICOLE   C POWELL","gend":1,"add":"3014 KROUSE ST","city":"RICHMOND","state":"VA","zip":23223,"dob":"1981-04-10","age":"","mstatus":"","insh":"2097859*01","cliId":"","pno":"804\/309-1004","cno":"804\/309-1004","email":"","ename":"","eno":"","pphy":"GREEN JR, HAROLD T MD","ppno":"804\/644-1665","pcpadd":"STE 308 1510 N 28TH ST","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23223,"pcpcounty":"","pcpid":208009,"pcpname":"PRIMARY HEALTHCARE ASSOCIATES","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/644-5285","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.9","E66.01","Z68.43","R45.89","F31.81","F31.30","G43.009","J45.51","I10.","E55.9","M77.8","Z68.42","S39.012A","X50.0XXA","Y92.89","Y93.89","E11.65","N20.1","U07.1","R07.89","R07.9","J30.9","J30.1","J45.40","H10.45","Z91.018","G47.10","G47.33","E66.9","N64.4","K21.9","J45.909","F17.210","Z87.442","Z86.32","Z87.59","Z90.710","Z71.3","Z88.0","Z88.2","Z88.6","Z88.5","Z91.048"],"date":["2020-07-27","2021-09-20","2020-06-12","2020-07-14","2020-07-14","2020-08-01","2020-11-04","2020-09-03","2021-09-20","2020-09-03","2020-09-03","2021-09-20","2020-10-01","2020-10-01","2020-10-01","2020-10-01","2020-11-04","2020-01-28","2021-08-04","2021-08-04","2021-08-04","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2021-09-20","2021-09-20","2021-09-20","2021-09-20","2021-09-20","2021-09-20","2021-09-20","2021-09-20","2021-09-20","2021-09-20","2021-09-20","2021-09-20","2021-09-20","2021-09-20"],"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":[["","65162004710","OXYCODONE ","5MG","16","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","20","Select","Select",""],["","65162046510","IBUPROFEN ","600MG","30","Select","Select",""],["","65862059801","TAMSULOSIN ","0.4MG","7","Select","Select",""],["","50111043301","TRAZODONE ","50MG","30","Select","Select",""],["","00093226301","AMOXICILLIN ","500MG","21","Select","Select",""],["","69097012203","TOPIRAMATE ","25MG","60","Select","Select",""],["","16571020106","DICLOFENAC ","75MG DR","20","Select","Select",""],["","63304069301","CLINDAMYCIN ","300MG","21","Select","Select",""],["","55111029336","SUMATRIPTAN ","100MG","8","Select","Select",""],["","69097014260","ALBUTEROL ","HFA","7","Select","Select",""],["","00093005805","TRAMADOL ","50MG","10","Select","Select",""],["","00378967130","IPRATROPIUM\/ ","ALBUTER","180","Select","Select",""],["","65162019050","NAPROXEN ","500MG","20","Select","Select",""],["","65862020390","LOSARTAN ","100MG","30","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","30","Select","Select",""],["","57664050658","METOPROL ","25MG","60","Select","Select",""],["","68382075810","METFORMIN ","500MG","60","Select","Select",""],["","70377002811","ATORVASTATIN ","20MG","30","Select","Select",""],["","65162004710","OXYCODONE","5MG","16","Select","Select",""],["","65862059801","TAMSULOSIN","0.4MG","7","Select","Select",""],["","65162046510","IBUPROFEN","600MG","30","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","20","Select","Select",""],["","69097012203","TOPIRAMATE","25MG","60","Select","Select",""],["","50111043301","TRAZODONE","50MG","30","Select","Select",""],["","00093226301","AMOXICILLIN","500MG","21","Select","Select",""],["","63304069301","CLINDAMYCIN","300MG","21","Select","Select",""],["","00093005805","TRAMADOL","50MG","10","Select","Select",""],["","00378967130","IPRATROPIUM\/","ALBUTER","180","Select","Select",""],["","16571020106","DICLOFENAC","75MG DR","20","Select","Select",""],["","00378827052","ALBUTEROL","0.08%","75","Select","Select",""],["","68180072003","AMLODIPINE","5MG","30","Select","Select",""],["","65162019050","NAPROXEN","500MG","20","Select","Select",""],["","65862020390","LOSARTAN","100MG","30","Select","Select",""],["","57664050658","METOPROL","25MG","60","Select","Select",""],["","68382075810","METFORMIN","500MG","60","Select","Select",""],["","70377002811","ATORVASTATIN","20MG","30","Select","Select",""],["","65862057490","MONTELUKAST","10MG","30","Select","Select",""],["","00093031401","KETOROLAC","10MG","10","Select","Select",""],["","08373747800","OPTICHAMBER","DIAMOND","1","Select","Select",""],["","00173071720","ADVAIR","230\/21","12","Select","Select",""],["","16571040250","CETIRIZINE","10MG","30","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","59779045888","ALLERGY","10MG","30","Select","Select",""],["","55111029336","SUMATRIPTAN","100MG","8","Select","Select",""],["","24658031205","DOXYCYCL","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","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":""}]}]}