{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ERIN   B BAY-SPROUSE","gend":1,"add":"2524 BENT OAKS DR 12410 BUCKINGHAM STREET","city":"COLONIAL HEIGHTS","state":"VA","zip":"23834-9998","dob":"1979-06-05","age":"","mstatus":"","insh":"1262205*01","cliId":"","pno":"804\/704-3929","cno":"","email":"","ename":"","eno":"","pphy":"HERRERA, JOLANTA A MD","ppno":"804\/526-7990","pcpadd":"2552 ALDRIDGE AVE","pcpcity":"SOUTH CHESTERFIELD","pcpstate":"VA","pcpzip":23834,"pcpcounty":"","pcpid":"","pcpname":"JOLANTA A HERRERA MD PLLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/526-7905","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R30.0","M54.5","M54.40","G43.909","F11.10","R45.89","NO DATA","F11.20","J45.20","F41.9","R10.2","J30.9","F17.200","M54.9","R39.15","Z12.39","N92.6","N94.10","N92.1","H70.12","H70.11","F33.1","H71.91","H70.13","H70.10","M79.672","H65.02","H66.92","H60.92","S92.352A","G56.01","N93.0","H92.02","R42.","G89.29","B36.9","R45.4","N95.1","Z01.419","Z71.6","Z11.51","N60.02","M54.89","H91.91","H65.20","H90.A31","Z30.41","R05.","J09.X2","R11.2","Z68.1","H65.01","R51.","H66.91","Q01.9","H65.192"],"date":["2020-08-06","2020-08-06","2021-07-26","2021-10-18","2021-04-02","2021-04-02","2021-04-02","2021-12-31","2020-11-23","2021-10-18","2021-11-05","2020-11-23","2021-10-18","2020-04-22","2020-04-22","2020-12-17","2020-12-17","2021-11-05","2021-10-14","2020-05-04","2020-09-01","2021-11-02","2020-02-04","2020-07-15","2020-10-01","2020-10-07","2020-01-29","2020-01-30","2020-01-30","2020-10-16","2021-07-26","2021-11-05","2020-01-22","2020-01-22","2020-01-30","2020-08-06","2021-03-22","2021-10-14","2021-10-14","2021-10-18","2020-12-17","2020-12-17","2019-05-17","2019-09-26","2019-09-26","2019-12-31","2019-06-12","2019-01-18","2019-01-18","2019-01-18","2019-01-18","2019-12-10","2019-07-19","2019-12-31","2019-12-31","2019-12-31"],"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":[["","","SUBOXONE","MIS 8-2MG","","Select","Select",""],["","","SYMBICORT","AER 160-4.5","","Select","Select",""],["","","PROAIR"," PROAIR ","8","Select","Select",""],["","","BUT\/APAP\/CAF"," BUT\/APAP\/CAF ","60","Select","Select",""],["","","ALPRAZOLAM"," ALPRAZOLAM ","90","Select","Select",""],["","","CLOMIPRAMINE","CAP 25MG","","Select","Select",""],["","","LIDOCAINE","PAD 0.05","","Select","Select",""],["","","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","","ARIPIPRAZOLE","TAB 5MG","","Select","Select",""],["","59267100003","PFIZER","INJ COVID-19","0","Select","Select",""],["","","GABAPENTIN"," GABAPENTIN ","60","Select","Select",""],["","","LORATADINE","TAB 10MG","","Select","Select",""],["","","MONTELUKAST"," MONTELUKAST ","30","Select","Select",""],["","23155050110","HYDROXYZ","TAB 25MG","30","Select","Select",""],["","00074003956","ORILISSA","TAB 200MG","60","Select","Select",""],["","","TOPIRAMATE","TAB 25MG","","Select","Select",""],["","","IBUPROFEN"," IBUPROFEN ","90","Select","Select",""],["","","ALBUTEROL"," ALBUTEROL ","18","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","","BUPREN\/NALOX","MIS 8-2MG","","Select","Select",""],["","","CETIRIZINE"," CETIRIZINE ","30","Select","Select",""],["","","BUDES\/FORMOT","AER 160-4.5","","Select","Select",""],["","00904671146","FEXOFENADINE","TAB 180MG","30","Select","Select",""],["","","OSELTAMIVIR"," OSELTAMIVIR ","10","Select","Select",""],["","","TAMIFLU"," TAMIFLU ","10","Select","Select",""],["","","IBU"," IBU ","90","Select","Select",""],["","","TRI-LO-"," TRI-LO- ","28","Select","Select",""],["","","VENTOLIN"," VENTOLIN ","18","Select","Select",""],["","","ALLERGY"," ALLERGY ","30","Select","Select",""],["","","FLUTICASONE"," FLUTICASONE ","16","Select","Select",""],["","","HYDROCO\/APAP"," HYDROCO\/APAP ","10","Select","Select",""],["","","TRINESSA"," TRINESSA ","28","Select","Select",""],["","","TRI-SPRINTEC"," TRI-SPRINTEC ","28","Select","Select",""],["","","FLUCONAZOLE"," FLUCONAZOLE ","2","Select","Select",""],["","","AMOX\/K"," AMOX\/K ","20","Select","Select",""],["","","OFLOXACIN"," OFLOXACIN ","5","Select","Select",""],["","","OXYCOD\/APAP","TAB 7.5-325","","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","","SUMATRIPTAN","TAB 100MG","","Select","Select",""],["","","BACITRACIN","OIN 500\/GM","","Select","Select",""],["","","PROMETHAZINE","TAB 12.5MG","","Select","Select",""],["","","VITAMIN","CAP 50000UNT","","Select","Select",""],["","","ONDANSETRON","TAB 4MG","","Select","Select",""],["","","BREO","INH 100-25","","Select","Select",""],["","","CEFDINIR","CAP 300MG","","Select","Select",""],["","","CIPRODEX","SUS 0.3-0.1%","","Select","Select",""],["","","METHYLPRED","TAB 4MG","","Select","Select",""],["","","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","","AFLURIA","INJ 2020-21","","Select","Select",""],["","","VALACYCLOVIR","TAB 1GM","","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":""}]}]}