{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NATAVIA   C FRYE","gend":1,"add":"6207 GLENWAY DR APT A","city":"RICHMOND","state":"VA","zip":"23225-9998","dob":"1996-06-18","age":"","mstatus":"","insh":"2190633*01","cliId":"","pno":"804\/519-8949","cno":"804\/519-8949","email":"","ename":"","eno":"","pphy":"ROSE, ANDREW MD","ppno":"804\/717-5300","pcpadd":"SUITE 117 16011 IRONBRIDGE ROAD","pcpcity":"CHESTER","pcpstate":"VA","pcpzip":23831,"pcpcounty":"","pcpid":168359,"pcpname":"IRONBRIDGE FAMILY PRACTICE","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/748-7269","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.2","M62.838","V89.2XXA","Z00.00","E66.9","A60.00","R20.0","M54.5","Z83.3","Z11.3","G89.29","Z68.32","M25.511","M25.512","M54.9","F17.200","NO DATA","F32.9","K08.89"],"date":["2021-02-09","2021-02-09","2021-02-09","2021-09-02","2021-09-02","2021-09-02","2021-09-02","2021-09-02","2021-09-02","2021-09-02","2021-09-02","2021-09-02","2021-01-08","2021-01-08","2021-01-08","2021-01-08","2020-01-31","2020-01-31","2020-06-27"],"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":[["","69097084805","ESCITALOPRAM","10MG","30","Select","Select",""],["","66685100100","AMOX\/K","875-125","20","Select","Select",""],["","50383077504","LIDOCAINE","2% VISC","100","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","40","Select","Select",""],["","43598081115","CETIRIZINE","10MG","30","Select","Select",""],["","64380080707","IBUPROFEN","800MG","30","Select","Select",""],["","57237000511","FLUCONAZOLE","150MG","1","Select","Select",""],["","57237004105","PENICILLN","500MG","28","Select","Select",""],["","57237002801","AMOXICILLIN","500MG","21","Select","Select",""],["","68382079101","ACYCLOVIR","400MG","90","Select","Select",""],["","31722053301","METHOCARBAM","500MG","45","Select","Select",""],["","69097052444","DICLOFENAC","1%","100","Select","Select",""],["","52817033200","CYCLOBENZAPR","10MG","20","Select","Select",""],["","68462019005","NAPROXEN","500MG","20","Select","Select",""],["","00378427577","VALACYCLOVIR","500MG","90","Select","Select",""],["","65162062711","TRAMADOL","50MG","8","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":""}]}]}