{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KIWANDA  A YOUNG","gend":1,"add":"1223 ADMIRAL GRAVELY BLVD APT B","city":"HENRICO","state":"VA","zip":23231,"dob":"1975-09-05","age":"","mstatus":"","insh":"1852529*01","cliId":"","pno":"804\/967-4664","cno":"","email":"","ename":"","eno":"","pphy":"Route,  barbara","ppno":"804\/818-7041","pcpadd":"5424 Discovery Park Blvd BLDB A STE 201","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23231,"pcpcounty":"","pcpid":"","pcpname":"Primary Health Group - Village Green","plan":"OHP","program":"Medicaid","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/785-5550","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R42.","Z00.00","D64.9","J30.9","Z13.220","Z12.39","Z23.","Z20.9","E11.65","Z68.42","E78.2","Z68.43","L02.818","L02.91","R03.0","S63.92XA","B37.0","R35.0","R30.0","Z79.4","E11.9","Z20.822","N76.0","V89.2XXD","M62.838","M25.519","M25.529","S50.869A","W57.XXXA","M25.442","S63.502S","R29.898","R07.9","M79.602","L91.8","M77.9","J06.9","J45.30","J02.9","R68.83","R07.0","J09.X2","L03.114","J40.","M75.32","S43.402A","S16.1XXA","J45.909","M25.512","F43.0","S66.912A","V89.2XXA","S96.912A","T07.XXXA","V49.40XA"],"date":["2020-02-19","2020-03-12","2022-04-27","2021-07-27","2020-03-12","2020-03-12","2020-03-12","2020-03-12","2022-04-27","2022-04-27","2022-04-27","2021-07-27","2021-10-03","2021-10-11","2021-07-08","2021-12-06","2020-02-18","2020-02-18","2020-02-18","2020-02-18","2020-02-18","2021-08-02","2020-01-22","2020-01-22","2020-01-22","2020-01-22","2020-01-22","2020-10-29","2020-10-29","2022-03-03","2022-03-03","2022-03-03","2019-12-07","2019-12-07","2019-09-13","2019-12-07","2019-03-04","2019-02-28","2019-02-28","2019-02-28","2019-03-04","2019-03-05","2019-01-27","2019-11-11","2019-12-10","2019-12-19","2019-12-19","2019-12-19","2019-12-19","2019-12-20","2021-12-08","2021-12-08","2021-12-08","2022-02-26","2022-02-26"],"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":[["","","ONETOUCH","KIT ULTRA 2","","Select","Select",""],["","59310057922","PROAIR","AER ","17","Select","Select",""],["","","LEVEMIR","INJ FLEXTOUC","","Select","Select",""],["","","TRESIBA","INJ 200UNIT","","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","17","Select","Select",""],["","","METFORMIN","TAB 500MG","","Select","Select",""],["","08290320749","BD  PEN NEEDL","MIS 32GX6MM","100","Select","Select",""],["","00067815202","VOLTAREN","GEL 0.01","50","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","20","Select","Select",""],["","08222710086","PEN  NEEDLES","MIS 31GX6MM","30","Select","Select",""],["","57599080300","FREESTY","MIS 2 READER","1","Select","Select",""],["","","NYSTATIN","SUS 100000","","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","MIS READER","1","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","00591264001","BUT\/APAP\/CAF","CAP ","20","Select","Select",""],["","69238110005","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","45802011222","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","59651036105","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","51672128202","TRIAMCINOLON","CRE 0.001","30","Select","Select",""],["","","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","","METRONIDAZOL","TAB 500MG","","Select","Select",""],["","","ROSUVASTATIN","TAB 5MG","","Select","Select",""],["","","LANTUS","INJ 100\/ML","","Select","Select",""],["","","NOVOFINE","MIS 32GX4MM","","Select","Select",""],["","","LANCET","MIS THIN 30G","","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":{"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":""}]}]}