{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KEYONNA TYLER","gend":1,"add":"14577 ASHLAND ROAD","city":"GLEN ALLEN","state":"VA","zip":"23059-9998","dob":"1999-10-01","age":"","mstatus":"","insh":"20047106*01","cliId":"","pno":"804\/499-0947","cno":"","email":"","ename":"","eno":"","pphy":"STEWART, JACQUELINE MD","ppno":"804\/755-7581","pcpadd":"10150 STAPLES MILL ROAD SUITE C","pcpcity":"GLEN ALLEN","pcpstate":"VA","pcpzip":23060,"pcpcounty":"","pcpid":"","pcpname":"CROSSRIDGE PEDIATRICS & INTERNAL MEDICINE","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/755-7586","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R06.02","R06.2","A59.01","Z71.89","F41.9","F34.1","F39.","H53.8","R00.0","R94.31","F33.1","H66.001","Z20.828","Z20.822","A54.02","F33.0","F41.1","F43.10","J45.20","R11.0","Z23.","L30.9","R03.0","I10.","E28.2","Z68.34","N92.6","B37.3","Z31.69","Z32.02","M77.52","N30.01","K59.00","R10.84","R10.13","R06.00","N91.4","E66.01","F41.0","L02.91","R53.83","Z11.3","Z11.4","Z00.00","R30.0","J45.30","L73.9","K08.89","R10.30","N39.0","J02.9","R10.9","D64.9","M25.562","A64.","R43.0","B96.89","N76.0","N73.9","N89.8","R21.","B86.","Z68.38","R10.2","H61.22","D72.1","J30.9","Z71.9","R07.9","L20.9","J01.10","N76.2","R73.9","R42.","R53.1","L24.3","K29.00","N94.6","L70.9","N91.1","R51."],"date":["2021-02-05","2019-09-17","2019-10-31","2021-12-07","2021-06-10","2020-01-30","2021-02-14","2021-02-14","2021-10-11","2021-10-11","2021-10-21","2021-11-30","2021-12-20","2021-12-20","2021-12-07","2019-10-03","2019-10-03","2020-01-15","2019-06-06","2020-04-18","2021-10-19","2019-08-25","2019-06-06","2019-06-06","2020-09-02","2019-06-06","2020-04-14","2020-04-14","2020-09-02","2020-04-14","2020-07-20","2020-07-20","2020-01-04","2021-02-05","2021-01-15","2020-08-20","2020-09-02","2020-09-02","2021-01-10","2021-10-19","2021-12-20","2021-12-20","2021-12-20","2019-03-27","2020-11-01","2019-03-27","2019-09-10","2020-03-29","2020-08-04","2020-08-04","2020-09-11","2021-02-14","2020-09-11","2021-01-10","2021-02-05","2021-02-05","2019-06-07","2019-06-07","2019-06-07","2020-02-25","2020-02-25","2020-02-25","2020-02-25","2021-07-14","2019-10-27","2019-09-09","2019-09-09","2019-09-09","2020-04-18","2020-04-18","2020-10-24","2020-10-24","2020-10-24","2021-10-11","2021-10-11","2019-10-27","2021-08-02","2019-09-25","2019-11-18","2020-01-28","2020-01-28"],"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":[["","","LETROZOLE","TAB 2.5MG","","Select","Select",""],["","75854031530","PRENATE","CAP ","30","Select","Select",""],["","","FLUCONAZOLE"," FLUCONAZOLE ","1","Select","Select",""],["","","METRONIDAZOL"," METRONIDAZOL ","14","Select","Select",""],["","","BUPROPION"," BUPROPION ","30","Select","Select",""],["","","HYDROXYZ"," HYDROXYZ ","60","Select","Select",""],["","","MEGESTROL"," MEGESTROL ","10","Select","Select",""],["","","PRENATAL"," PRENATAL ","30","Select","Select",""],["","","AMOX\/K","TAB 875-125","","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","20","Select","Select",""],["","00168000615","TRIAMCINOLON","OIN 0.001","15","Select","Select",""],["","57237016199","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","65862070260","ZIPRASIDONE","CAP 20MG","30","Select","Select",""],["","67877021560","CEFUROXIME","TAB 250MG","20","Select","Select",""],["","47781030801","NITROFUR","CAP 100MG","10","Select","Select",""],["","59267100003","PFIZER","INJ COVID-19","0","Select","Select",""],["","","METFORMIN"," METFORMIN ","120","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","68180065208","DOXYCYC","CAP 100MG","14","Select","Select",""],["","","PAIN","TAB 325MG","","Select","Select",""],["","","PERMETHRIN","CRE 0.05","","Select","Select",""],["","","LATUDA","TAB 60MG","","Select","Select",""],["","","INDOMETHACIN","CAP 50MG","","Select","Select",""],["","","NITROFURANTN","CAP 100MG","","Select","Select",""],["","","CLINDAMYCIN","CAP 300MG","","Select","Select",""],["","","DOCUSATE","CAP 100MG","","Select","Select",""],["","","MELATONIN","TAB 3MG","","Select","Select",""],["","","AMOXICILLIN","CAP 500MG","","Select","Select",""],["","","METHYLPRED","TAB 4MG","","Select","Select",""],["","","NAPROXEN","TAB 500MG","","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","","PROVENTIL","AER HFA","","Select","Select",""],["","","CIPROFLOXACN","TAB 250MG","","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":""}]}]}