{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DENISE JONES","gend":1,"add":"1816 N 29TH ST","city":"RICHMOND","state":"VA","zip":"23223-9998","dob":"1961-12-17","age":"","mstatus":"","insh":"1170534*01","cliId":"","pno":"804\/986-8652","cno":"804\/986-8652","email":"","ename":"","eno":"","pphy":"BHAT, SHRIDHAR V M D","ppno":"804\/780-2610","pcpadd":"STE 304 110 N ROBINSON","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23220,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/649-1041","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.5","M25.562","F32.9","F17.210","G89.4","M25.561","M25.50","M19.90","M62.830","G43.909","F41.9","R00.0","E78.5","E78.00","G90.09","M12.9","E55.9","F11.20","J45.909","F17.290","E66.9","G89.29","Z00.00","M17.12","M25.552","I10.","K21.9","M25.462"],"date":["2021-03-05","2021-08-06","2021-02-05","2020-03-18","2021-08-06","2021-08-06","2021-04-30","2021-04-30","2020-10-16","2021-08-06","2021-04-30","2022-01-01","2021-08-06","2020-02-25","2020-08-18","2021-02-05","2021-08-06","2021-05-03","2021-04-30","2020-06-17","2021-08-06","2020-06-17","2022-09-02","2020-02-25","2020-01-28","2021-08-06","2021-08-06","2021-01-08"],"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":[]},{"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":[["","43547040011","CYCLOBENZAPR","TAB 10MG","90","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","68382013905","TOPIRAMATE","TAB 50MG","90","Select","Select",""],["","68001032205","BUPROPN","TAB 150MG XL","90","Select","Select",""],["","62332046431","VITAMIN","CAP 50000","2","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","00093719805","FLUOXETINE","CAP 40MG","30","Select","Select",""],["","68382056501","METOPROL","TAB 50MG ER","90","Select","Select",""],["","76204020025","ALBUTEROL","NEB 0.00083","1125","Select","Select",""],["","00378395105","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","16729017217","AMITRIPTYLIN","TAB 25MG","30","Select","Select",""],["","82607066026","FLOWFLEX","KIT TEST","2","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","50111045001","TRAZODONE","TAB 150MG","30","Select","Select",""],["","00527169505","BUT\/APAP\/CAF","TAB ","90","Select","Select",""],["","70461032203","FLUCLVX","INJ 2022-23","0","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","31","Select","Select",""],["","00006483703","PNEUMOVAX","INJ 25\/0.5","0","Select","Select",""],["","53746020301","OXYCOD\/APAP","TAB 5-325MG","15","Select","Select",""],["","12496120803","SUBOXONE","MIS 8-2MG","30","Select","Select",""],["","00054018913","BUPREN\/NALOX","SUB 8-2MG","30","Select","Select",""],["","00005197102","PREVNAR","INJ ","0","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","58160084252","BOOSTRIX","INJ ","0","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","30","Select","Select",""],["","51672128208","TRIAMCINOLON","CRE 0.001","80","Select","Select",""],["","68382004101","PROMETHAZINE","TAB 25MG","60","Select","Select",""],["","51224010150","PHENTERMINE","TAB 37.5MG","30","Select","Select",""],["","19515081852","FLULAVAL","INJ 2021-22","0","Select","Select",""],["","00002143611","EMGALITY","INJ 120MG\/ML","11","Select","Select",""],["","68382005101","MELOXICAM","TAB 15MG","30","Select","Select",""],["","67877025010","QUETIAPINE","TAB 100MG","30","Select","Select",""],["","69097082112","GEMFIBROZIL","TAB 600MG","60","Select","Select",""],["","10702001210","HYDROXYZ","TAB 50MG","90","Select","Select",""],["","00172392760","DIAZEPAM","TAB 10MG","1","Select","Select",""],["","00603188016","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","67877022301","GABAPENTIN","CAP 300MG","60","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","33332032001","AFLURIA","INJ 2020-21","0","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}