{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CRYSTAL   M LIVESAY","gend":1,"add":"200 FAIRFAX AVE","city":"COLONIAL HEIGHTS","state":"VA","zip":"23834-9998","dob":"1982-07-18","age":"","mstatus":"","insh":"2150099*01","cliId":"","pno":"804\/631-5420","cno":"804\/631-5420","email":"","ename":"","eno":"","pphy":"RYAN, MARK H MD","ppno":"804\/230-7777","pcpadd":"4730 N SOUTHSIDE PLAZA","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23224,"pcpcounty":"","pcpid":103190,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/230-2371","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z00.00","Z02.0","Z68.32","NO DATA","N91.2","F33.1","F34.1","F60.3","F39.","Z01.818","Z98.84","Z41.1","O03.4","Z23.","B37.3","R73.03","Z01.810","Z32.01","E11.9","O09.521","Z11.3","A60.04","N89.8","O03.9","Z32.02","N76.0","T81.89XA","R10.30","G89.18","O99.89","Z3A.01","J01.00","Z11.1","K29.70","G89.4","M54.6","M54.5","L40.0","L29.8","Z79.899","Z01.411","B37.9","Z30.432","F17.200","Z30.431","Z98.82","M25.50","M06.4","Z20.2","L68.0","Z30.011","O02.1","Z30.430","B96.89","Z30.09","N92.5","Z72.51"],"date":["2020-12-04","2020-12-04","2020-12-22","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2021-07-14","2021-07-14","2020-04-27","2020-04-27","2020-04-27","2021-03-15","2020-04-08","2021-11-11","2020-12-22","2020-04-27","2020-06-25","2020-06-25","2020-06-25","2021-11-11","2020-08-21","2021-07-26","2020-08-21","2020-08-21","2021-09-10","2021-04-20","2021-04-20","2021-04-20","2020-06-27","2020-06-29","2020-09-10","2020-03-18","2021-04-20","2021-07-27","2021-09-09","2021-07-27","2021-09-21","2021-09-21","2021-09-21","2021-06-24","2021-06-24","2021-06-24","2021-06-24","2021-06-24","2021-06-24","2021-09-21","2021-09-09","2021-07-26","2021-07-26","2021-07-26","2021-03-15","2021-03-15","2021-09-10","2021-09-10","2021-11-11","2021-11-11"],"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":[["","59651000305","OMEPRAZOLE ","40MG","30","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","6","Select","Select",""],["","53746051101","SPIRONOLACT ","25MG","60","Select","Select",""],["","76385012810","METFORMIN ","500MG ER","30","Select","Select",""],["","43386002860","CLOBETASOL ","0.05%","50","Select","Select",""],["","68180086413","BLISOVI ","FE 1\/20","28","Select","Select",""],["","13668013701","ESCITALOPRAM ","20MG","30","Select","Select",""],["","65862085901","FAMOTIDINE ","20MG","60","Select","Select",""],["","45802046564","KETOCONAZOLE ","2%","120","Select","Select",""],["","69097083412","SERTRALINE ","50MG","90","Select","Select",""],["","58160084252","BOOSTRIX ","","0","Select","Select",""],["","58160082152","ENGERIX-B ","20MCG\/ML","1","Select","Select",""],["","58160081552","TWINRIX ","","1","Select","Select",""],["","61442011201","ACYCLOVIR ","400MG","15","Select","Select",""],["","68462079817","TRIAMCINOLON ","0.50%","15","Select","Select",""],["","70710113908","FLUCONAZOLE ","150MG","1","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","10","Select","Select",""],["","70010075401","METHOCARBAM ","500MG","56","Select","Select",""],["","31722070430","VALACYCLOVIR ","500MG","90","Select","Select",""],["","59762500901","CLINDAMYCIN ","2% VAG","40","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","20","Select","Select",""],["","51672130406","TERCONAZOLE ","0.40%","45","Select","Select",""],["","00378064205","PREDNISONE ","20MG","12","Select","Select",""],["","68308015260","NYSTATIN ","100000","60","Select","Select",""],["","65862050320","AMOX\/K ","875-125","28","Select","Select",""],["","69842031278","8HR ","650MG","56","Select","Select",""],["","49483060450","IBUPROFEN ","800MG","63","Select","Select",""],["","00169413212","OZEMPIC ","2\/1.5ML","2","Select","Select",""],["","10702002501","PHENTERMINE ","37.5MG","15","Select","Select",""],["","65862022701","LAMOTRIGINE ","25MG","60","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","15","Select","Select",""],["","71930005512","APAP\/CODEINE ","300-30MG","12","Select","Select",""],["","68682045570","METRONIDAZOL ","0.75%VAG","70","Select","Select",""],["","68462030529","NORETHINDRON ","0.35MG","84","Select","Select",""],["","16571020106","DICLOFENAC ","75MG DR","40","Select","Select",""],["","69452015120","VITAMIN","50000UNT","6","Select","Select",""],["","59651000305","OMEPRAZOLE","40MG","30","Select","Select",""],["","76385012810","METFORMIN","500MG ER","30","Select","Select",""],["","65862085901","FAMOTIDINE","20MG","60","Select","Select",""],["","68180086413","BLISOVI","FE 1\/20","28","Select","Select",""],["","43386002860","CLOBETASOL","0.05%","50","Select","Select",""],["","13668013701","ESCITALOPRAM","20MG","30","Select","Select",""],["","45802046564","KETOCONAZOLE","2%","120","Select","Select",""],["","53746051101","SPIRONOLACT","25MG","60","Select","Select",""],["","58160081552","TWINRIX","","1","Select","Select",""],["","58160084252","BOOSTRIX","","0","Select","Select",""],["","58160082152","ENGERIX-B","20MCG\/ML","1","Select","Select",""],["","61442011201","ACYCLOVIR","400MG","15","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","1","Select","Select",""],["","69097083412","SERTRALINE","50MG","90","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","51672130406","TERCONAZOLE","0.40%","45","Select","Select",""],["","00378064205","PREDNISONE","20MG","12","Select","Select",""],["","68308015260","NYSTATIN","100000","60","Select","Select",""],["","59762500901","CLINDAMYCIN","2% VAG","40","Select","Select",""],["","31722070430","VALACYCLOVIR","500MG","90","Select","Select",""],["","68462079817","TRIAMCINOLON","0.50%","15","Select","Select",""],["","00169413212","OZEMPIC","2\/1.5ML","2","Select","Select",""],["","10702002501","PHENTERMINE","37.5MG","15","Select","Select",""],["","49483060450","IBUPROFEN","800MG","63","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","10","Select","Select",""],["","70010075401","METHOCARBAM","500MG","56","Select","Select",""],["","00406012405","HYDROCO\/APAP","7.5-325","12","Select","Select",""],["","69842031278","8HR","650MG","56","Select","Select",""],["","71930005512","APAP\/CODEINE","300-30MG","12","Select","Select",""],["","68682045570","METRONIDAZOL","0.75%VAG","70","Select","Select",""],["","68462030529","NORETHINDRON","0.35MG","84","Select","Select",""],["","16571020106","DICLOFENAC","75MG DR","40","Select","Select",""],["","69315012710","FOLIC","1000MCG","90","Select","Select",""],["","51285036701","TREXALL","7.5MG","8","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","00378001401","METHOTREXATE","2.5MG","24","Select","Select",""],["","65862050320","AMOX\/K","875-125","28","Select","Select",""],["","65862022701","LAMOTRIGINE","25MG","60","Select","Select",""],["","51285036701","TREXALL ","TAB 7.5MG","8","Select","Select",""],["","59676058015","JANSSEN ","INJ COVID-19","0","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","69315012710","FOLIC ","TAB 1000MCG","90","Select","Select",""],["","00378001401","METHOTREXATE ","TAB 2.5MG","24","Select","Select",""],["","58160088752","FLUARIX ","INJ 2021-22","0","Select","Select",""],["","51224012230","AZITHROMYCIN ","TAB 500MG","2","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":""}]}]}