{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CAROLYN   E JONES","gend":1,"add":"300 BROWN AVE","city":"HOPEWELL","state":"VA","zip":"23860-9998","dob":"1958-06-11","age":"","mstatus":"","insh":"20030198*01","cliId":"","pno":"804\/892-8433","cno":"","email":"","ename":"","eno":"","pphy":"MOHIUDDIN, ABDUL Q MD","ppno":"804\/458-8583","pcpadd":"1012 WINSTON CHURCHIL","pcpcity":"HOPEWELL","pcpstate":"VA","pcpzip":23860,"pcpcounty":"","pcpid":"","pcpname":"TWIN RIVERS MEDICAL CLINIC PC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/541-2724","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I87.2","I83.893","I83.813","I89.0","I83.891","M79.669","R60.9","M79.662","R51.9","R42.","I83.819","K21.9","F84.0","Z23.","U07.1","NO DATA","R10.32","I44.0","I70.213","I10.","Z87.891","Z20.822","I83.811","L30.1","R21.","I70.235","I87.033","T50.995A","I83.892","I83.812","R60.0","D25.1","N83.201","R07.9","R06.02","I70.223","R39.15","R35.0","F17.200","R43.9","N39.0","R11.0","Z76.89","R00.1","I87.023","R10.84","N83.202","R93.89","R31.9","R93.5","L03.116","J45.909","M79.609","M79.89","M79.604","R10.9","L03.115","M79.605","A41.9","Z68.41","E66.9","Z90.710","Z98.51","Z88.0","L30.8","T88.7XXA","L29.8","R10.13","M79.606","R07.89","R06.00","Z01.419","R69.","E87.6","G72.9","I44.1","I73.9","R09.81","Z68.43","D64.9","E66.01","K29.70","T50.2X5A","G72.89"],"date":["2021-12-28","2021-12-28","2021-12-28","2021-08-30","2021-08-30","2021-08-30","2021-08-30","2021-08-30","2021-07-07","2021-12-09","2020-10-08","2021-04-20","2020-10-26","2020-10-26","2022-08-16","2021-02-17","2021-02-17","2021-12-09","2021-12-28","2022-08-16","2021-02-12","2021-12-09","2020-10-12","2021-10-28","2021-12-04","2021-12-23","2021-12-23","2020-06-21","2021-08-30","2021-08-30","2021-08-30","2022-06-17","2022-06-17","2021-12-22","2021-12-22","2021-12-22","2021-02-09","2021-02-09","2021-02-09","2021-02-09","2021-02-12","2021-02-12","2021-12-09","2020-06-21","2021-08-26","2021-04-20","2021-04-20","2021-05-18","2021-04-20","2021-05-18","2021-12-04","2021-12-04","2019-05-16","2019-04-10","2019-04-10","2022-05-21","2019-04-10","2019-05-14","2019-07-29","2019-07-29","2022-02-23","2019-07-29","2019-07-29","2022-02-23","2019-08-30","2019-08-30","2019-08-30","2022-01-01","2022-01-01","2022-02-03","2022-02-03","2022-05-20","2022-05-21","2022-02-23","2022-02-23","2022-02-23","2022-02-23","2022-08-16","2022-02-23","2022-02-23","2022-02-23","2022-02-23","2022-02-23","2022-02-23"],"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":[["","55111034101","AMLOD\/BENAZP","CAP 10-20MG","30","Select","Select",""],["","00172208380","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","64380073706","VITAMIN","CAP 50000UNT","12","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00093221001","SUCRALFATE","TAB 1GM","120","Select","Select",""],["","45802086866","POLYETH","POW 3350 NF","14","Select","Select",""],["","00093206406","CILOSTAZOL","TAB 100MG","60","Select","Select",""],["","68180063609","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","11822316450","LORATADINE","TAB 10MG","30","Select","Select",""],["","60432026415","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","50383026860","CLOBETASOL","OIN 0.0005","60","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","15","Select","Select",""],["","65162046650","IBUPROFEN","TAB 800MG","15","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","67877022001","CEPHALEXIN","CAP 250MG","20","Select","Select",""],["","00054418625","DEXAMETHASON","TAB 6MG","9","Select","Select",""],["","00135057602","FLONASE","SPR 50MCG","16","Select","Select",""],["","63304061650","DOXYCYC","CAP 100MG","20","Select","Select",""],["","70710116201","MECLIZINE","TAB 25MG","6","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","31722072250","LEVOFLOXACIN","TAB 500MG","5","Select","Select",""],["","","METOCLOPRAM","TAB 10MG","","Select","Select",""],["","50458057930","XARELTO","TAB 20MG","30","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","63653117106","PLAVIX","TAB 75MG","90","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","12","Select","Select",""],["","00234057508","HIBICLENS","LIQ 0.04","236","Select","Select",""],["","65162062710","TRAMADOL","TAB 50MG","10","Select","Select",""],["","55111015901","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","52380127206","CHLOR","LIQ 0.04","473","Select","Select",""],["","45802005505","TRIAMCINOLON","OIN 0.001","454","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","30","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":""}]}]}