{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KELLI WIGGS","gend":1,"add":"908 STORM LAKE DR","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1983-08-10","age":"","mstatus":"","insh":"1048932*01","cliId":"","pno":"216\/357-9487","cno":"","email":"","ename":"","eno":"","pphy":"BORZA, MERIDITH DO","ppno":"804\/968-5700","pcpadd":"5000 COX ROAD SUITE 100","pcpcity":"GLEN ALLEN","pcpstate":"VA","pcpzip":23060,"pcpcounty":"","pcpid":"","pcpname":"PATIENT FIRST RICHMOND MEDICAL GROUP PLLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/968-5739","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.6","M54.2","N64.4","L30.4","N62.","F51.09","F43.12","F31.0","F41.1","F90.2","M25.551","G57.01","NO DATA","M99.05","M99.03","M99.04","F31.60","F43.10","Z20.828","R82.89","G89.29","R82.81","R11.2","F60.3","A41.9","L03.116","L02.416","E87.1","M54.9","N30.01","J06.9","E66.8","Z68.36","S13.4XXA","S23.3XXA","S33.5XXA","S86.312A","S73.191A","M25.751","S79.811A","M47.816","R60.0","Z13.9","B34.9","R03.0","Z88.0","Z88.5","Z88.8","M54.89","L02.412","Z23.","T14.91XA","F90.9","F31.9","T63.301A","D64.9","E66.9","Z79.899","E86.1","A49.02","R65.10","M51.36","M54.5"],"date":["2019-10-22","2019-07-25","2019-06-11","2019-07-25","2019-07-25","2019-07-02","2020-01-08","2020-01-08","2020-01-08","2020-01-08","2019-07-18","2019-07-18","2019-07-18","2019-07-18","2019-07-18","2019-07-18","2021-03-29","2021-03-01","2021-12-27","2021-05-14","2019-10-22","2021-05-16","2021-05-16","2020-01-08","2020-02-29","2020-02-29","2020-02-29","2020-02-25","2020-08-23","2020-08-21","2021-11-05","2020-02-29","2020-02-29","2020-10-14","2020-10-14","2020-10-14","2020-10-14","2019-07-02","2019-07-02","2019-07-02","2019-07-02","2020-02-26","2019-05-06","2020-08-23","2021-01-18","2020-02-25","2020-02-25","2019-05-06","2019-07-25","2019-12-08","2019-12-06","2020-02-12","2020-02-25","2020-02-25","2020-02-25","2020-02-25","2020-02-25","2020-02-25","2020-02-25","2020-02-25","2020-02-25","2020-09-01","2020-09-01"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","","LAMOTRIGINE"," LAMOTRIGINE ","180","Select","Select",""],["","","ALPRAZOLAM"," ALPRAZOLAM ","60","Select","Select",""],["","","AMPHET\/DEXTR"," AMPHET\/DEXTR ","90","Select","Select",""],["","00185012201","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","","ESCITALOPRAM","TAB 10MG","","Select","Select",""],["","","AMITRIPTYLIN"," AMITRIPTYLIN ","180","Select","Select",""],["","","PROMETHAZINE","TAB 25MG","","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","","TRAZODONE","TAB 100MG","","Select","Select",""],["","","MIRTAZAPINE","TAB 45MG","","Select","Select",""],["","","OXYCOD\/APAP","TAB 5-325MG","","Select","Select",""],["","","OFLOXACIN","DRO 0.3% OP","","Select","Select",""],["","","CEFUROXIME","TAB 500MG","","Select","Select",""],["","","METHOCARBAM","TAB 500MG","","Select","Select",""],["","","INDOMETHACIN","CAP 50MG","","Select","Select",""],["","","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","","METHYLPRED","TAB 4MG","","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}