{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LAURIE FRANKLIN","gend":1,"add":"5741 WESTOVER VILLAGE DR APT C5","city":"RICHMOND","state":"VA","zip":"23225-9998","dob":"1998-01-16","age":"","mstatus":"","insh":"20027516*01","cliId":"","pno":"804\/387-1363","cno":"","email":"","ename":"","eno":"","pphy":"JOHNSON, RUSSELL MD","ppno":"804\/379-1500","pcpadd":"12731 STONE VILLAGE WAY","pcpcity":"MIDLOTHIAN","pcpstate":"VA","pcpzip":23113,"pcpcounty":"","pcpid":"","pcpname":"SHORT PUMP FAMILY CARE LLC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/379-1633","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N76.0","Z30.011","A60.04","Z30.432","Z11.3","B34.9","Z20.828","R53.83","M19.021","G89.18","M25.521","N92.6","L70.0","R51.9","M25.721","M25.821","Z20.822","F32.9","K59.00","O99.341","Z3A.12","O36.8120","Z3A.21","R53.1","R11.2","O99.343","Z3A.31","N89.8","R60.0","Z34.83","Z3A.37","A54.9","Z30.09","Z32.01","N76.2","H10.33","J45.909","H57.9","M79.604","M79.605","O99.342","Z3A.20","Z87.81","S93.402A","Z87.891","S99.912A","B35.4","R35.0","R39.15","R10.9","N91.2","R05.","R07.0","B96.89","R43.2","G56.11","M65.9","J06.9","O99.893","R06.02","Z3A.29","O47.03","Z3A.36","O62.0","G89.29","R22.31","R30.0","Z47.89","R14.0","Z3A.15","J01.00","Z11.59","B37.3","L29.2","Z20.2","Z72.51","M54.89","N39.0","O21.2","H10.89","Z30.430","Z32.02","Z3A.10","Z13.89","O26.893","O99.513","Z3A.30","O99.013","E78.5","Z79.1","Z79.899","O99.283","E78.00","O60.03","Z34.93","H10.9","H66.91","J01.90","M24.021","M67.321","B37.49","R10.84","O36.8131","W50.0XXA","O9A.313","S01.511A","S10.91XA","Y04.8XXA","T81.40XA","O26.93","Z51.89","Z39.0","O9A.213","S01.512A","X58.XXXA","Z48.02","Z33.1","O99.03","D64.9","O99.345","G43.909","T78.40XA","S80.12XA","Y09.","Z53.21","H92.01","O26.892","R10.11","Z3A.16","O60.20X0"],"date":["2021-09-13","2020-09-21","2020-03-20","2020-09-21","2020-11-06","2020-11-20","2021-09-19","2021-11-16","2021-04-07","2021-04-07","2021-04-07","2020-07-09","2021-02-24","2021-10-14","2021-01-26","2021-03-30","2021-10-14","2021-08-06","2021-07-28","2021-07-09","2021-07-09","2021-09-10","2021-09-10","2021-11-16","2021-11-16","2021-11-16","2021-11-18","2021-12-28","2021-12-28","2021-12-28","2021-12-29","2020-05-14","2020-05-14","2020-07-18","2020-07-18","2020-08-29","2021-11-08","2020-08-29","2021-09-02","2021-09-02","2021-09-08","2021-09-02","2020-03-06","2020-07-18","2021-11-08","2020-07-18","2020-07-20","2020-08-20","2020-08-20","2021-11-08","2020-08-20","2020-09-13","2020-09-13","2020-09-21","2020-11-14","2021-03-24","2021-04-07","2021-09-19","2021-10-14","2021-10-14","2021-10-14","2021-12-17","2021-12-17","2021-12-17","2021-02-05","2021-02-05","2021-02-11","2021-05-28","2021-07-28","2021-07-28","2021-10-11","2020-07-03","2020-10-15","2020-09-09","2020-10-15","2020-10-15","2020-10-15","2021-06-15","2021-11-18","2020-05-12","2020-07-23","2020-11-06","2021-06-21","2021-06-21","2021-11-08","2021-11-08","2021-11-08","2021-11-08","2021-11-08","2021-11-08","2021-11-08","2021-11-08","2021-11-08","2021-11-08","2021-12-16","2020-05-13","2020-06-04","2020-06-04","2021-04-07","2021-04-07","2021-09-13","2021-11-08","2021-12-29","2019-04-26","2019-05-15","2019-05-22","2019-05-15","2019-05-15","2019-05-17","2019-05-17","2019-05-17","2019-08-10","2019-05-17","2019-05-17","2019-05-17","2019-05-22","2019-05-22","2019-08-10","2019-08-10","2019-08-10","2019-02-22","2019-12-12","2019-04-26","2019-04-26","2019-12-17","2019-12-17","2019-03-22","2019-03-22","2019-03-22","2019-08-10"],"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":[["","","VALACYCLOVIR","TAB 500MG","","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","55111014512","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","68645056354","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","","ADAPALENE","CRE 0.001","","Select","Select",""],["","","ONDANSETRON","TAB 4MG ODT","","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","28","Select","Select",""],["","69452014320","BENZONATATE","CAP 100MG","15","Select","Select",""],["","00085113204","PROVENTIL","AER HFA","7","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","10","Select","Select",""],["","","TERCONAZOLE","CRE 0.004","","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","","CLOTRIMAZOLE","CRE 0.01","","Select","Select",""],["","69097081312","GABAPENTIN","CAP 100MG","90","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","42","Select","Select",""],["","","MINOCYCLINE","TAB 100MG","","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","6","Select","Select",""],["","65862001205","SERTRALINE","TAB 50MG","30","Select","Select",""],["","65162047810","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","50428310425","STOOL","CAP 100MG","60","Select","Select",""],["","00536408501","PRENATAL","TAB 28-0.8MG","30","Select","Select",""],["","00781577626","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","50428034583","GENTLE","SUP 10MG","3","Select","Select",""],["","43547040011","CYCLOBENZAPR","TAB 10MG","7","Select","Select",""],["","00472016615","NYSTATIN","OIN 100000","15","Select","Select",""],["","","HYDROCO\/APAP","TAB 7.5-325","","Select","Select",""],["","","POLYMYXIN","SOL TRIMETHP","","Select","Select",""],["","","GENTAMICIN","SOL 0.3% OP","","Select","Select",""],["","","AVIANE","TAB ","","Select","Select",""],["","","TRETINOIN","CRE 0.00025","","Select","Select",""],["","","CLOTRIM\/BETA","CRE DIPROP","","Select","Select",""],["","","NAPHCON-A","SOL OP","","Select","Select",""],["","","LARISSIA","TAB ","","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","20","Select","Select",""],["","00054001925","PREDNISONE","TAB 50MG","5","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","12","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00093220301","METOCLOPRAM","TAB 10MG","20","Select","Select",""],["","65162019011","NAPROXEN","TAB 500MG","20","Select","Select",""],["","42192060716","BROM\/PSE\/DM","SYP ","240","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":""}]}]}