{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHANTEL WILLIS","gend":1,"add":"3728 FOREST HAVEN DR STE 211","city":"RICHMOND","state":"VA","zip":"23234-9998","dob":"1974-11-11","age":"","mstatus":"","insh":"1348738*01","cliId":"","pno":"804\/381-7636","cno":"","email":"","ename":"","eno":"","pphy":"MOORE, WILLIAM F MD","ppno":"804\/226-2444","pcpadd":"4620 S LABURNUM AVE","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23231,"pcpcounty":"","pcpid":"","pcpname":"LABURNUM MEDICAL CENTER ","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/222-0458","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M79.604","F33.1","F41.9","F60.0","L98.9","N17.9","E11.9","I10.","E11.621","Z88.9","M86.9","F25.9","L97.519","E11.69","M86.171","T87.81","L03.115","L97.514","M86.671","T87.43","R26.9","E66.01","Z47.81","Z89.421","C50.019","E78.5","N76.2","E11.29","R80.9","Z79.4","U07.1","L97.512","R06.00","A41.9","E11.65","E87.6","M86.271","R26.81","Z48.1","R53.81","I73.9","M86.00","Z68.54","L90.0","Z48.01","E11.40","J45.909","K21.9","R21.","Z32.02","R10.84","N91.2","B37.2","J45.21","Z12.11","E55.9","Z68.43","F20.0","F33.2","N39.0","B00.9","I63.50","R26.89","M79.671","S91.311D","L84.","G43.109","E11.8","D64.9","S40.021A","S70.11XA","T22.031A","R00.0","V58.89","Z98.890","Z79.899","D72.829","E11.21","Z68.42","R74.8","L08.9","B37.9","L08.89","M79.89","M79.672","M79.675","Z45.2","N28.89","A60.09","I12.9","N18.9","R26.2","G62.9","E83.42","R19.7","M86.10","R06.83","R06.81","G47.10","E66.9","J02.9","E11.42","R05.","J02.0","S49.91XA","R52.","V49.40XA","S55.111A","S61.511A","R27.0","R29.818","R29.898","A60.04","N89.8","B37.3","Z79.51","E78.00","G89.29","M54.9","G92.","M86.8X7","R90.82","S91.121A","L03.031","W25.XXXA","R07.9","R62.7","L28.1","Z20.828","L97.419","D63.8","E11.22","N76.6","Z71.9","R11.0","L53.9","L98.8","L29.9","S91.111D","S91.101A","R10.11","R10.12","Z09.","B35.4","N18.32","T22.231A","J45.41","J06.9","B97.89","R06.09","R60.0","R07.89","G47.33","M17.11","Z01.419","Z12.4","Z12.31","Z85.41","E11.3593","E11.59","Z13.31","H66.93","J45.901","J09.X2","R11.10","S29.012A","S16.1XXA","M79.605","R01.1","Z23.","M17.0","M20.42","L30.9","B35.3","B35.1","F29.","I16.0","R00.2","N94.89","L97.511","M79.662","M25.572","NO DATA","Z79.82","Z20.822","C50.912","Z88.1","F20.9","Z79.891","Z85.3","N20.0","Z87.891","R22.42","N13.2","R10.9","J40.","Z04.9","M21.6X2","M21.6X1","M95.9","S86.012A","R11.2","M25.472","M10.9","Z87.442","Z88.0","R10.32"],"date":["2020-05-28","2020-08-05","2020-08-06","2020-07-14","2021-09-24","2020-08-06","2022-11-15","2022-10-26","2021-11-17","2020-07-30","2022-10-26","2020-06-17","2022-03-06","2022-03-06","2022-03-01","2020-07-20","2022-03-06","2020-07-27","2020-07-27","2020-08-04","2020-08-17","2022-03-28","2022-03-28","2022-11-15","2020-09-11","2022-02-28","2020-10-09","2020-10-09","2020-10-09","2022-09-30","2020-10-09","2022-02-28","2022-02-26","2020-06-08","2021-09-24","2020-07-22","2020-06-02","2020-11-18","2020-08-05","2020-08-15","2020-08-15","2020-08-18","2020-08-20","2020-08-27","2020-09-11","2022-09-30","2022-09-30","2022-09-30","2022-04-09","2021-08-27","2021-08-27","2021-08-27","2021-08-27","2021-09-24","2021-09-24","2021-09-24","2022-10-26","2022-07-26","2022-06-28","2020-08-14","2020-08-14","2020-10-30","2022-03-04","2022-02-26","2021-07-23","2022-10-04","2021-07-23","2021-07-23","2021-07-23","2021-11-03","2021-11-03","2021-11-03","2021-11-03","2021-11-17","2021-11-17","2022-03-28","2020-06-01","2020-06-02","2022-02-26","2020-07-22","2020-07-22","2020-07-22","2020-07-25","2021-07-10","2020-07-25","2020-07-25","2020-07-25","2020-07-25","2020-08-06","2022-09-30","2020-08-06","2020-08-06","2022-03-04","2020-08-06","2020-08-06","2020-08-08","2020-08-21","2020-08-21","2020-08-21","2020-08-21","2022-05-25","2022-10-04","2020-09-30","2020-09-30","2021-11-03","2021-11-03","2021-11-03","2020-09-11","2020-09-11","2020-10-30","2021-06-14","2021-06-14","2020-01-23","2020-07-22","2020-10-07","2020-06-01","2020-06-01","2020-06-01","2020-06-01","2020-06-01","2020-07-28","2020-11-06","2021-07-13","2021-07-27","2021-07-13","2022-02-28","2021-11-10","2020-07-02","2020-07-22","2020-07-22","2020-07-22","2022-09-30","2020-08-27","2020-08-28","2020-10-07","2020-11-02","2020-11-02","2020-11-02","2021-07-27","2021-10-26","2021-11-10","2021-11-10","2020-06-15","2020-07-10","2021-07-26","2021-11-03","2019-02-23","2019-11-13","2019-05-28","2019-05-23","2022-09-30","2019-05-23","2022-03-28","2019-09-09","2019-12-18","2019-12-18","2019-12-18","2019-12-18","2019-05-28","2019-05-28","2019-05-28","2019-10-19","2019-11-06","2019-02-18","2022-04-09","2019-07-25","2019-07-25","2022-09-30","2019-01-23","2019-01-23","2019-09-18","2019-07-01","2019-07-01","2019-07-01","2022-10-04","2022-02-27","2022-03-06","2022-02-28","2022-03-11","2022-05-04","2022-09-30","2022-10-04","2022-10-26","2022-09-30","2022-05-25","2022-03-04","2022-03-04","2022-10-26","2022-03-28","2022-03-28","2022-05-23","2022-05-25","2022-09-30","2022-04-09","2022-04-09","2022-05-25","2022-02-26","2022-05-11","2022-05-11","2022-10-04","2022-10-04","2022-04-09","2022-09-26","2022-09-26","2022-02-26","2022-02-26","2022-04-09"],"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":[["","","CARVEDILOL","TAB 25MG","","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","55111015810","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","67877043103","ARIPIPRAZOLE","TAB 5MG","30","Select","Select",""],["","","LISINOPRIL","TAB 10MG","","Select","Select",""],["","60432027504","BROM\/PSE\/DM","SYP ","120","Select","Select",""],["","00406048410","APAP\/CODEINE","TAB 300-30MG","8","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00169643810","LEVEMIR","INJ FLEXTOUC","30","Select","Select",""],["","08627009111","DEXCOM","MIS RECEIVER","1","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","6","Select","Select",""],["","65862044990","VALACYCLOVIR","TAB 1GM","30","Select","Select",""],["","00169406012","VICTOZA","INJ 18MG\/3ML","12","Select","Select",""],["","","FEROSUL","TAB 325MG","","Select","Select",""],["","68462018135","CLOTRIMAZOLE","CRE 0.01","30","Select","Select",""],["","00472037945","CLOTRIM\/BETA","CRE DIPROP","45","Select","Select",""],["","","TERCONAZOLE","CRE 0.004","","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","65162025009","CHLORTHALID","TAB 50MG","30","Select","Select",""],["","00093506001","HYDROXYZ","TAB 10MG","60","Select","Select",""],["","","VITAMIN","CAP 50000UNT","","Select","Select",""],["","57896079101","SIMETHICONE","CHW 80MG","28","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","32","Select","Select",""],["","00406051205","OXYCOD\/APAP","TAB 5-325MG","15","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","68180046701","LOVASTATIN","TAB 10MG","30","Select","Select",""],["","63824005632","MUCINEX","TAB 30-600ER","20","Select","Select",""],["","00904506860","MI-ACID","CHW 80MG","28","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","15","Select","Select",""],["","00603533815","PREDNISONE","PAK 10MG","21","Select","Select",""],["","","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","68382013201","TAMSULOSIN","CAP 0.4MG","5","Select","Select",""],["","00363041414","ASPIRIN","TAB 81MG EC","90","Select","Select",""],["","11523726803","MIRALAX","POW 3350 NF","60","Select","Select",""],["","76204020025","ALBUTEROL","NEB 0.00083","75","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","59148001971","ABILIFY","INJ 400MG","1","Select","Select",""],["","","FERROUS","TAB 325MG","","Select","Select",""],["","00597008717","ATROVENT","AER 17MCG","13","Select","Select",""],["","00536116134","MUCUS","TAB 30-600ER","20","Select","Select",""],["","31722072250","LEVOFLOXACIN","TAB 500MG","10","Select","Select",""],["","70010077001","METHOCARBAM","TAB 750MG","28","Select","Select",""],["","00173071820","FLOVENT","AER 44MCG","11","Select","Select",""],["","","CLOBETASOL","CRE 0.0005","","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","10","Select","Select",""],["","","IBUPROFEN","TAB 800MG","","Select","Select",""],["","","HYDROCORT","CRE 0.025","","Select","Select",""],["","","LINEZOLID","TAB 600MG","","Select","Select",""],["","","SUMATRIPTAN","TAB 50MG","","Select","Select",""],["","50484001030","SANTYL","OIN 250\/GM","30","Select","Select",""],["","08290320122","BD  PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","2","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","MIS READER","1","Select","Select",""],["","67877012420","SILVER","CRE 0.01","20","Select","Select",""],["","53885039310","ONETOUCH","MIS LANCETS","100","Select","Select",""],["","00193731221","CONTOUR","TES NEXT","100","Select","Select",""],["","43598081115","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","00173085910","BREO","INH 100-25","60","Select","Select",""],["","62037083101","METOPROL","TAB 50MG ER","120","Select","Select",""],["","","NYSTAT\/TRIAM","CRE ","","Select","Select",""],["","","ZEASORB-AF","POW 0.02","","Select","Select",""],["","","CLINDAMYCIN","CAP 300MG","","Select","Select",""],["","","AQUAMED","LOT ","","Select","Select",""],["","00093026292","FLUOCINONIDE","CRE 0.0005","120","Select","Select",""],["","","AMMONIUM","CRE 0.12","","Select","Select",""],["","","HYDRALAZINE","TAB 50MG","","Select","Select",""],["","","TRAMADOL","TAB 50MG","","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","","NYSTATIN","SUS 100000","","Select","Select",""],["","","ANTIFUNGAL","CRE 0.02","","Select","Select",""],["","00002143380","TRULICITY","INJ 0.75\/0.5","2","Select","Select",""],["","69543025216","VIRTUSSIN","SOL 100-10\/5","120","Select","Select",""],["","60505265605","TRIAMT\/HCTZ","TAB 37.5-25","30","Select","Select",""],["","00603158658","PROMETHAZINE","SYP DM","280","Select","Select",""],["","65702028810","FASTCLIX","MIS LANCETS","102","Select","Select",""],["","59310030240","QVAR","AER 40MCG","11","Select","Select",""],["","83490044079","AEROSOL","MIS ADULT","1","Select","Select",""],["","00536118485","EXTRA","SYP 10-100\/5","118","Select","Select",""],["","73796009920","ADULT","MIS ","1","Select","Select",""],["","76204060030","IPRATROPIUM\/","SOL ALBUTER","90","Select","Select",""],["","53489014305","SPIRONOLACT","TAB 25MG","30","Select","Select",""],["","00378932132","WIXELA","AER 250\/50","60","Select","Select",""],["","00173069600","ADVAIR","AER 250\/50","60","Select","Select",""],["","64380071306","BENZONATATE","CAP 200MG","90","Select","Select",""],["","73796099110","AIRS","KIT NEBULIZE","1","Select","Select",""],["","65702071210","ACCU-CHEK","TES GUIDE","100","Select","Select",""],["","57599740105","PRECISION","TES QID","100","Select","Select",""],["","00363035926","WAL-TUSSIN","LIQ DM","118","Select","Select",""],["","58468009003","SYNVISC","INJ 8MG\/ML","2","Select","Select",""],["","55111012701","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","00065853302","CIPRODEX","SUS 0.3-0.1%","8","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}