{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MAKAYLA   A HOLMAN","gend":1,"add":"15696 CONCORD ROAD","city":"RUTHER GLEN","state":"VA","zip":"22546-9998","dob":"2001-09-28","age":"","mstatus":"","insh":"7618700*01","cliId":"","pno":"804\/994-2694","cno":"804\/994-2694","email":"","ename":"","eno":"","pphy":"NICHOLSON, JOYNITA R MD","ppno":"804\/266-7611","pcpadd":"10571 TELEGRAPH RD STE 130","pcpcity":"GLEN ALLEN","pcpstate":"VA","pcpzip":23059,"pcpcounty":"","pcpid":208061,"pcpname":"BROOK RUN FAMILY PHYSICIANS","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"804\/867-1428","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/262-9249","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.8","F41.1","Z01.419","Q85.1","R73.9","Z79.899","J32.9","Z20.822","J30.2","R51.9","R13.10","S61.111A","W26.0XXA","G40.401","G40.409","F32.1","F41.9","F32.9","Z01.818","K08.89","R56.9","F33.1","Z68.39","F33.0","K01.1","T78.40XA","R09.82","N93.8","F31.9","F43.20","R22.2","L90.5","J45.20","H10.13","J06.9","J02.9","Z68.37","R06.83","R53.82","M25.472","E55.9","M79.89","E66.09","R63.5","G40.109","H92.03","F39.","R22.43","G40.919","R22.1","R60.0","S02.5XXA","Z91.14","Z11.52"],"date":["2020-07-02","2020-07-22","2020-10-15","2021-09-24","2021-01-11","2021-05-10","2021-03-19","2021-09-09","2021-03-30","2021-03-30","2021-03-30","2021-06-14","2021-06-14","2021-07-07","2020-02-28","2020-03-25","2020-05-21","2020-05-21","2020-11-23","2020-11-23","2020-11-23","2020-11-23","2020-11-23","2021-03-10","2020-12-09","2020-12-09","2021-03-19","2020-09-30","2021-02-02","2020-01-15","2021-09-24","2021-09-24","2020-03-17","2020-03-17","2020-03-17","2020-03-17","2020-05-04","2020-08-14","2020-08-14","2020-08-14","2020-05-04","2020-05-04","2020-05-04","2020-08-14","2020-06-24","2020-08-14","2021-01-27","2021-05-10","2020-01-28","2021-03-30","2020-12-06","2020-02-24","2020-04-20","2021-09-09"],"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":[["","00093415573","AMOXICILLIN ","250\/5ML","200","Select","Select",""],["","00378827052","ALBUTEROL ","0.08%","75","Select","Select",""],["","50111064801","FLUOXETINE ","20MG","60","Select","Select",""],["","55111065401","SIROLIMUS ","2MG","120","Select","Select",""],["","65162064978","OXCARBAZEPIN ","300MG\/5M","500","Select","Select",""],["","55111053201","DIVALPROEX ","125MG","300","Select","Select",""],["","45802091987","CETIRIZINE ","10MG","90","Select","Select",""],["","00173068220","VENTOLIN ","","36","Select","Select",""],["","61570007201","MENEST ","0.3MG","20","Select","Select",""],["","50111043401","TRAZODONE ","100MG","30","Select","Select",""],["","00378020810","FUROSEMIDE ","20MG","4","Select","Select",""],["","00143998275","AMOX\/K ","400\/5ML","200","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","00093005805","TRAMADOL ","50MG","20","Select","Select",""],["","43386035701","HYDROCO\/APAP ","7.5-325","20","Select","Select",""],["","00116200116","CHLORHEX ","0.12%","473","Select","Select",""],["","69842087651","CVS ","325MG","20","Select","Select",""],["","00603533815","PREDNISONE ","10MG","21","Select","Select",""],["","59310057922","PROAIR ","","17","Select","Select",""],["","42806016005","HYDROXYZ ","25MG","60","Select","Select",""],["","50111033401","METRONIDAZOL ","500MG","14","Select","Select",""],["","00450049660","","","20","Select","Select",""],["","49483060350","IBUPROFEN ","600MG","22","Select","Select",""],["","00093031401","KETOROLAC ","10MG","20","Select","Select",""],["","50111064801","FLUOXETINE","20MG","60","Select","Select",""],["","65162064978","OXCARBAZEPIN","300MG\/5M","500","Select","Select",""],["","55111053201","DIVALPROEX","125MG","300","Select","Select",""],["","55111065401","SIROLIMUS","2MG","120","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","00093415580","AMOXICILLIN","250\/5ML","150","Select","Select",""],["","00378827052","ALBUTEROL","0.08%","75","Select","Select",""],["","45802091987","CETIRIZINE","10MG","90","Select","Select",""],["","50111043401","TRAZODONE","100MG","30","Select","Select",""],["","00093005805","TRAMADOL","50MG","20","Select","Select",""],["","61570007201","MENEST","0.3MG","20","Select","Select",""],["","00378020810","FUROSEMIDE","20MG","4","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","43386035701","HYDROCO\/APAP","7.5-325","20","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","14","Select","Select",""],["","00143998275","AMOX\/K","400\/5ML","225","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","59310057922","PROAIR","","17","Select","Select",""],["","00603533815","PREDNISONE","10MG","21","Select","Select",""],["","42806016005","HYDROXYZ","25MG","60","Select","Select",""],["","69842087651","CVS","325MG","20","Select","Select",""],["","00093031401","KETOROLAC","10MG","20","Select","Select",""],["","49483060350","IBUPROFEN","600MG","22","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","4","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":""}]}]}