{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KENDRA TOWLES","gend":1,"add":"6221 GROVES CT APT 10A","city":"RUTHER GLEN","state":"VA","zip":"22546-9998","dob":"1997-11-11","age":"","mstatus":"","insh":"2123162*01","cliId":"","pno":"804\/418-1624","cno":"804\/418-1624","email":"","ename":"","eno":"","pphy":"FARKHANI, HASAN MD","ppno":"804\/224-7890","pcpadd":"525B EUCLID AVENUE","pcpcity":"COLONIAL BEACH","pcpstate":"VA","pcpzip":22443,"pcpcounty":"","pcpid":147002,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","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":["Z39.1","O36.5930","O99.02","D64.9","Z3A.38","Z37.0","Z87.891","Z34.83","O80.","Z3A.00","O36.8130","Z3A.35","M25.511","Z3A.37","I49.8","R07.89","O41.03X0","Z3A.33","V23.41","O41.00X0","R87.9","R07.9","V23.87","O99.281","E86.0","O21.9","Z3A.01","I26.90","M41.9","J93.9","R09.1","F31.81","F34.1","O02.1","F31.64","J06.9","F31.9","F12.10","R46.89","D72.829","J30.9","Z03.818","R20.1","NO DATA","F25.9","R45.6","J20.9"],"date":["2020-02-04","2020-02-07","2020-02-07","2020-02-06","2020-02-07","2020-02-07","2021-07-07","2020-02-06","2020-02-07","2020-02-07","2020-02-01","2020-01-16","2021-07-07","2020-02-01","2020-12-13","2020-12-13","2020-01-07","2020-01-07","2020-01-07","2020-01-07","2020-01-07","2021-07-07","2021-07-19","2021-07-13","2021-07-13","2021-07-19","2021-07-13","2021-07-08","2021-07-08","2021-07-08","2021-07-08","2021-05-09","2021-04-03","2021-08-04","2021-11-04","2021-10-18","2021-10-28","2021-10-28","2021-10-30","2021-10-30","2021-10-17","2021-10-17","2021-07-08","2021-07-08","2021-10-28","2021-10-28","2021-10-15"],"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":[["","42858010201","OXYCOD\/APAP ","5-325MG","10","Select","Select",""],["","67877032105","IBUPROFEN ","800MG","20","Select","Select",""],["","00093310905","AMOXICILLIN ","500MG","24","Select","Select",""],["","43386035101","HYDROCO\/APAP ","5-300MG","9","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","20","Select","Select",""],["","00536440601","VITAMIN ","25MG","30","Select","Select",""],["","13107008405","LORAZEPAM ","1MG","1","Select","Select",""],["","49884018601","DOXYL\/PYRID ","10-10MG","14","Select","Select",""],["","57664049983","MIRTAZAPINE ","15MG","30","Select","Select",""],["","13668013601","ESCITALOPRAM ","10MG","30","Select","Select",""],["","53489011905","DOXYCYCL ","100MG","1","Select","Select",""],["","65862022701","LAMOTRIGINE ","25MG","120","Select","Select",""],["","10135011930","PYRIDOXINE ","100MG","30","Select","Select",""],["","59779044101","SLEEP-AID ","25MG","30","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","10","Select","Select",""],["","67877032105","IBUPROFEN","800MG","20","Select","Select",""],["","00093310905","AMOXICILLIN","500MG","24","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","30","Select","Select",""],["","57664049983","MIRTAZAPINE","15MG","30","Select","Select",""],["","65862022701","LAMOTRIGINE","25MG","120","Select","Select",""],["","43386035101","HYDROCO\/APAP","5-300MG","9","Select","Select",""],["","13668013601","ESCITALOPRAM","10MG","30","Select","Select",""],["","49884018601","DOXYL\/PYRID","10-10MG","14","Select","Select",""],["","00536440601","VITAMIN","25MG","30","Select","Select",""],["","13107008405","LORAZEPAM","1MG","1","Select","Select",""],["","59779044101","SLEEP-AID","25MG","30","Select","Select",""],["","10135011901","PYRIDOXINE","25MG","30","Select","Select",""],["","53489011905","DOXYCYCL","100MG","1","Select","Select",""],["","64380071307","BENZONATATE ","CAP 200MG","30","Select","Select",""],["","51991029301","OXCARBAZEPIN ","TAB 300MG","60","Select","Select",""],["","00378064205","PREDNISONE ","TAB 20MG","14","Select","Select",""],["","66993068330","OLANZAPINE ","TAB 10MG","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":[[["No","Select","","","","","Select","",""],["No","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":""}]}]}