{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHAQUINA MCCANTS","gend":1,"add":"71 W PILKINGTON ST","city":"RICHMOND","state":"VA","zip":"23225-9998","dob":"1980-08-11","age":"","mstatus":"","insh":"5044359*01","cliId":"","pno":"804\/291-3852","cno":"804\/291-3852","email":"","ename":"","eno":"","pphy":"JACKSON, RICHARD A MD","ppno":"804\/225-7148","pcpadd":"304 E LEIGH ST","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23219,"pcpcounty":"","pcpid":105660,"pcpname":"Dominion Medical Associates, INC.","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/225-7159","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.12","Z11.1","A59.01","B37.3","N76.0","N89.8","R39.9","Z11.3","I10.","R30.0","Z20.2","Z01.419","A59.9","R87.810","R87.610","Z32.02","B35.3"],"date":["2020-03-08","2020-11-07","2020-12-20","2020-12-20","2021-05-12","2021-05-12","2021-01-06","2021-01-06","2021-01-06","2021-03-29","2020-05-22","2020-02-28","2020-10-21","2020-03-17","2020-03-17","2020-03-17","2021-09-23"],"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":[["","51224012230","AZITHROMYCIN ","500MG","2","Select","Select",""],["","50111033402","METRONIDAZOL ","500MG","14","Select","Select",""],["","64380073706","VITAMIN ","50000UNT","4","Select","Select",""],["","60505257909","ATORVASTATIN ","20MG","90","Select","Select",""],["","00135020005","ABREVA ","10%","30","Select","Select",""],["","68180031906","BUPROPN ","150MG XL","90","Select","Select",""],["","62332008090","VALSART\/HCTZ ","160-12.5","30","Select","Select",""],["","68462019001","NAPROXEN ","500MG","90","Select","Select",""],["","57237000511","FLUCONAZOLE ","150MG","2","Select","Select",""],["","00591555601","PROPRANOLOL ","40MG","30","Select","Select",""],["","51672200306","CLOTRIMAZOLE ","1% VAG","45","Select","Select",""],["","00093363020","ACYCLOVIR ","5%","30","Select","Select",""],["","00187099445","ZOVIRAX ","5%","30","Select","Select",""],["","00536430608","FIBER-LAX ","625MG","14","Select","Select",""],["","00093101042","MUPIROCIN ","2%","22","Select","Select",""],["","50383008716","GUAIATUSS ","100-10\/5","100","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","00310737220","BUDES\/FORMOT ","80-4.5","10","Select","Select",""],["","00023650110","UBRELVY ","100MG","10","Select","Select",""],["","00005250033","FIBERCON ","625MG","14","Select","Select",""],["","29300012810","HYDROCHLOROT ","25MG","90","Select","Select",""],["","00093005401","BUSPIRONE ","10MG","60","Select","Select",""],["","00185061501","HYDROXYZ ","50MG","120","Select","Select",""],["","50096050105","UREA ","47%","142","Select","Select",""],["","00186037220","SYMBICORT ","80-4.5","10","Select","Select",""],["","64380071206","BENZONATATE ","100MG","30","Select","Select",""],["","00378427593","VALACYCLOVIR ","500MG","14","Select","Select",""],["","55111015330","ONDANSETRON ","4MG","30","Select","Select",""],["","00245086070","VANDAZOLE ","0.75%","70","Select","Select",""],["","53489012002","DOXYCYCL ","100MG","14","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","00591298135","DOCOSANOL ","10%","2","Select","Select",""],["","65862020299","LOSARTAN ","50MG","90","Select","Select",""],["","10481300105","GORMEL ","20%","340","Select","Select",""],["","00904250091","FIBER ","625MG","60","Select","Select",""],["","57883040105","KERALAC ","47%","142","Select","Select",""],["","00884044904","UREACIN-20 ","20%","113","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","50111033402","METRONIDAZOL","500MG","14","Select","Select",""],["","51224012230","AZITHROMYCIN","500MG","2","Select","Select",""],["","68462019005","NAPROXEN","500MG","90","Select","Select",""],["","68462010340","FLUCONAZOLE","150MG","1","Select","Select",""],["","00591555601","PROPRANOLOL","40MG","30","Select","Select",""],["","00536430608","FIBER-LAX","625MG","14","Select","Select",""],["","64380073706","VITAMIN","50000UNT","4","Select","Select",""],["","60505257909","ATORVASTATIN","20MG","90","Select","Select",""],["","00135020005","ABREVA","10%","30","Select","Select",""],["","68180031906","BUPROPN","150MG XL","90","Select","Select",""],["","62332008090","VALSART\/HCTZ","160-12.5","30","Select","Select",""],["","51672200306","CLOTRIMAZOLE","1% VAG","45","Select","Select",""],["","00093101042","MUPIROCIN","2%","22","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","00310737220","BUDES\/FORMOT","80-4.5","10","Select","Select",""],["","68462074617","ACYCLOVIR","5%","30","Select","Select",""],["","00186037220","SYMBICORT","80-4.5","10","Select","Select",""],["","00378427593","VALACYCLOVIR","500MG","14","Select","Select",""],["","55111015330","ONDANSETRON","4MG","30","Select","Select",""],["","64380071206","BENZONATATE","100MG","30","Select","Select",""],["","00187099445","ZOVIRAX","5%","30","Select","Select",""],["","00245086070","VANDAZOLE","0.75%","70","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","53489012002","DOXYCYCL","100MG","14","Select","Select",""],["","00536110945","UREA","20%","340","Select","Select",""],["","00023650110","UBRELVY","100MG","10","Select","Select",""],["","00005250033","FIBERCON","625MG","14","Select","Select",""],["","29300012810","HYDROCHLOROT","25MG","90","Select","Select",""],["","00093005401","BUSPIRONE","10MG","60","Select","Select",""],["","00185061501","HYDROXYZ","50MG","120","Select","Select",""],["","10481300105","GORMEL","20%","340","Select","Select",""],["","00904250091","FIBER","625MG","60","Select","Select",""],["","57883040105","KERALAC","47%","142","Select","Select",""],["","31722070190","LOSARTAN","50MG","90","Select","Select",""],["","51672129802","KETOCONAZOLE","2%","30","Select","Select",""],["","00591298135","DOCOSANOL","10%","2","Select","Select",""],["","00884044904","UREACIN-20","20%","113","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","50383008716","GUAIATUSS","100-10\/5","100","Select","Select",""],["","00713063818","CICLOPIROX","0.77%","90","Select","Select",""],["","51672129802","KETOCONAZOLE ","CRE 0.02","30","Select","Select",""],["","00713063818","CICLOPIROX ","CRE 0.0077","90","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":""}]}]}