{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DERRON   L HARRIS","gend":1,"add":"15125 BROADWATER WAY","city":"CHESTER","state":"VA","zip":"23831-9998","dob":"1981-01-04","age":"","mstatus":"","insh":"1916268*01","cliId":"","pno":"804\/277-7701","cno":"","email":"","ename":"","eno":"","pphy":"ROTHMAN, SAMANTHA E NP","ppno":"804\/828-5883","pcpadd":"401 N 11TH ST","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23219,"pcpcounty":"","pcpid":"","pcpname":"MCV ASSOCIATED PHYSICIANS","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/828-5399","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H40.43X0","H20.023","H31.012","E11.9","R10.2","N89.8","E11.65","D50.9","Z79.84","D25.1","D25.9","R10.822","R10.9","Z00.00","R30.0","D50.8","Z01.00","H40.43X2","H04.123","H20.029","Z79.899","E11.36","H25.13","S91.201A","Z11.3","N76.0","H20.9","H40.30X0","H40.33X2","N80.9","D21.9","L30.1","L85.3","M54.9","R53.83","K76.0","E11.42","B35.3","M20.41","M20.42","NO DATA","Z79.4","D64.9","D50.0","K59.02","R10.13","M79.671","M19.071","N73.6","Z12.4"],"date":["2021-09-13","2020-08-24","2022-07-25","2022-07-25","2022-09-14","2022-09-14","2022-08-11","2021-12-10","2022-01-26","2021-10-13","2022-08-11","2021-12-10","2021-12-10","2021-12-10","2022-06-03","2022-06-03","2022-07-25","2022-07-25","2022-03-11","2021-05-17","2022-01-26","2021-09-13","2021-09-13","2022-03-08","2022-08-17","2022-08-17","2020-07-24","2022-01-28","2022-01-28","2022-09-14","2022-09-14","2020-03-12","2020-03-12","2021-05-14","2021-05-14","2022-01-26","2020-11-19","2020-11-19","2020-11-19","2020-11-19","2021-10-20","2021-10-20","2022-01-26","2022-02-01","2022-02-01","2022-02-01","2022-03-08","2022-03-08","2022-03-15","2022-03-15"],"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":[["","00591079501","DICYCLOMINE","TAB 20MG","60","Select","Select",""],["","67877056105","METFORMIN","TAB 500MG","120","Select","Select",""],["","50383023310","DORZOL\/TIMOL","SOL 22.3-6.8","10","Select","Select",""],["","16571020110","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","64980028001","GLIPIZIDE","TAB 5MG","90","Select","Select",""],["","68462056529","NORGEST\/ETHI","TAB ESTRADIO","84","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","100","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","16571066401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","51672130406","TERCONAZOLE","CRE 0.004","45","Select","Select",""],["","65162046650","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","72888001405","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","15","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","15","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","53885004401","ONE","KIT VERIO FL","1","Select","Select",""],["","70069023101","BRIMONIDINE","SOL 0.2% OP","15","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":""}]}]}