{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MONIQUE   E PERKINS","gend":1,"add":"142 CALLAWAY LN","city":"FARMVILLE","state":"VA","zip":"23901-9998","dob":"1981-11-04","age":"","mstatus":"","insh":"20033323*01","cliId":"","pno":"434\/394-8360","cno":"804\/245-7078","email":"","ename":"","eno":"","pphy":"HAHESY-CALHOUN, MARIAN MD","ppno":"434\/542-5560","pcpadd":"165 LEGRANDE AVENUE","pcpcity":"CHARLOTTE COURT HOUSE","pcpstate":"VA","pcpzip":23923,"pcpcounty":"","pcpid":"","pcpname":"CENTRAL VIRGINIA HEALTH SERVICES INC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/542-4670","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G47.33","F33.1","J30.1","F81.9","Z59.6","M62.81","M54.41","R76.8","Z30.430","B02.9","M54.5","D57.3","D50.9","N92.1","G43.009","B02.29","Z71.89","Z71.3","N92.6","N64.4","J01.90","F41.0","G56.03","F17.200","Z68.43","M25.512","G89.29","M54.9","N93.8","Z98.51","M19.90","Q12.0","D64.9","E66.9","J45.909","I95.1","R51.","M25.511","W18.30XA","Y09.","R10.31","R11.0","N92.0","R10.9","R11.2","N93.9","F32.9","N39.0","N94.6"],"date":["2020-09-23","2021-05-19","2021-05-17","2021-05-17","2021-05-17","2021-10-27","2021-10-27","2020-04-30","2020-04-10","2020-08-07","2021-05-03","2020-11-12","2020-11-12","2020-04-30","2020-04-30","2020-11-12","2020-09-03","2020-09-03","2020-09-03","2020-09-03","2020-10-15","2020-11-12","2020-11-12","2020-11-12","2020-11-12","2020-11-12","2020-11-12","2021-07-06","2020-02-19","2020-02-19","2020-04-24","2020-08-31","2019-05-01","2019-05-01","2019-05-01","2019-03-03","2019-03-14","2019-03-28","2019-03-28","2019-03-28","2019-07-23","2019-07-23","2019-03-03","2019-01-04","2019-01-04","2019-03-02","2019-03-02","2019-04-10","2019-04-10"],"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":[["","49035061246","ALLERGY","TAB 10MG","30","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","28","Select","Select",""],["","31722000290","VENLAFAXINE","CAP 37.5 ER","30","Select","Select",""],["","","MOMETASONE","SPR 50MCG","","Select","Select",""],["","65162067684","AZELASTINE","SPR 0.001","30","Select","Select",""],["","55111017915","TIZANIDINE","TAB 2MG","30","Select","Select",""],["","68382005105","MELOXICAM","TAB 15MG","30","Select","Select",""],["","","LORATADINE","TAB 10MG","","Select","Select",""],["","","NAPROXEN","TAB 500MG","","Select","Select",""],["","00245010810","FERROUS","TAB 325MG EC","30","Select","Select",""],["","","HYDROXYZ","TAB 10MG","","Select","Select",""],["","","IBUPROFEN","TAB 800MG","","Select","Select",""],["","","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","","ESCITALOPRAM","TAB 10MG","","Select","Select",""],["","00555077902","MEDROXYPR","TAB 10MG","30","Select","Select",""],["","42195095510","BUT\/APAP\/CAF","CAP ","20","Select","Select",""],["","","VALACYCLOVIR","TAB 500MG","","Select","Select",""],["","","GABAPENTIN","CAP 300MG","","Select","Select",""],["","","AMOXICILLIN","CAP 500MG","","Select","Select",""],["","","LIDOCAINE","PAD 0.05","","Select","Select",""],["","57237007810","ONDANSETRON","TAB 8MG ODT","24","Select","Select",""],["","68645051890","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","00555021110","NORETHIN","TAB 5MG","30","Select","Select",""],["","68645014059","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","60505006501","OMEPRAZOLE","CAP 20MG","15","Select","Select",""],["","51991018142","FERROCITE","TAB 324MG","60","Select","Select",""],["","57237001760","DULOXETINE","CAP 20MG","30","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","42","Select","Select",""],["","55111014512","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","00143314250","DOXYCYCL","CAP 100MG","28","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":""}]}]}