{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ASHLEY WOODWARD","gend":1,"add":"10508 THAMES DR","city":"HENRICO","state":"VA","zip":"23238-9998","dob":"1978-05-11","age":"","mstatus":"","insh":"20054161*01","cliId":"","pno":"804\/200-2666","cno":"804\/200-2666","email":"","ename":"","eno":"","pphy":"HOPKINS, SYMONE NP","ppno":"804\/673-2814","pcpadd":"5855 BREMO RD STE 102","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23226,"pcpcounty":"","pcpid":"","pcpname":"MONUMENT INTERNAL MEDICINE","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/673-2873","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.2","F11.20","F33.1","M79.671","M96.0","R26.9","F17.200","E55.9","M20.21","F19.21","F33.41","F40.01","F11.21","M19.171","M54.5","M25.562","M23.8X2","M25.561","M23.8X1","I10.","L23.7","K21.9","E66.9","Z68.31","F43.12","NO DATA","S83.281A","M79.7","M25.461","Z86.718","Z68.29","M22.41","M22.42","R94.31","H60.319","J02.9","R05.1","E78.1","R56.9","M79.661","V62.84","F41.9","Z20.822","K52.9","Z68.30","G89.29","M94.28","M94.8X6","M17.11","H90.3","K11.20","H69.83","H74.02","T14.91XA","R00.0","M17.10","R73.03","Z68.28"],"date":["2022-10-17","2022-11-22","2020-09-02","2020-07-07","2020-07-07","2020-07-07","2022-10-09","2021-05-24","2020-07-07","2020-07-07","2022-10-05","2022-05-19","2021-07-08","2020-03-12","2020-08-08","2021-05-04","2020-10-20","2021-05-04","2020-12-14","2022-10-09","2021-05-24","2021-05-24","2021-05-24","2021-05-24","2022-10-17","2022-10-17","2020-12-28","2021-01-13","2021-01-13","2021-01-13","2021-01-13","2021-05-04","2021-05-04","2022-10-09","2022-09-19","2022-10-26","2022-10-26","2022-10-26","2020-05-02","2021-05-31","2022-10-09","2022-10-09","2022-10-09","2020-04-13","2020-04-13","2020-11-17","2020-11-17","2020-11-23","2020-12-28","2022-09-19","2022-09-19","2022-09-19","2022-09-19","2022-10-09","2020-08-08","2020-08-13","2020-08-13","2022-04-01"],"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":[["","16729013716","CLONAZEPAM","TAB 1MG","45","Select","Select",""],["","68645055254","LISINOPRIL","TAB 10MG","90","Select","Select",""],["","00115180301","HYDROXYZ","CAP 25MG","60","Select","Select",""],["","70954001910","PRAZOSIN","CAP 1MG","30","Select","Select",""],["","31722059590","FENOFIBRATE","TAB 48MG","30","Select","Select",""],["","68645052254","SERTRALINE","TAB 50MG","30","Select","Select",""],["","50458057990","XARELTO","TAB 20MG","90","Select","Select",""],["","61314063006","NEO\/POLY\/DEX","SUS 0.1% OP","5","Select","Select",""],["","51672404801","CLOTRIM\/BETA","CRE DIPROP","45","Select","Select",""],["","69584009150","BUSPIRONE","TAB 5MG","90","Select","Select",""],["","00536589588","NICOTINE","DIS 14MG\/24H","14","Select","Select",""],["","59779044574","CVS","DIS 14MG\/24H","14","Select","Select",""],["","29300015001","QUETIAPINE","TAB 200MG","30","Select","Select",""],["","68180016011","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","64764073030","TRINTELLIX","TAB 10MG","30","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","40","Select","Select",""],["","69315090501","LORAZEPAM","TAB 1MG","60","Select","Select",""],["","00603548621","PROPRANOLOL","TAB 80MG","60","Select","Select",""],["","16729017501","AMITRIPTYLIN","TAB 100MG","30","Select","Select",""],["","13668009205","PRAMIPEXOLE","TAB 0.25MG","30","Select","Select",""],["","00536121429","DIPHENHYDRAM","TAB 25MG","20","Select","Select",""],["","00904555159","BANOPHEN","TAB 25MG","20","Select","Select",""],["","68645014059","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","49035092998","EQL","TAB 25MG","20","Select","Select",""],["","42806040021","METHYLPRED","TAB 4MG","21","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","49281042050","FLUZONE","INJ 2020-21","0","Select","Select",""],["","16714084903","CLOMIPRAMINE","CAP 25MG","30","Select","Select",""],["","49035022482","ANTI-DIARRHE","TAB 2MG","12","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","13811071910","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","63481068447","VOLTAREN","GEL 0.01","100","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","65162027250","SMZ\/TMP","TAB 800-160","14","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":""}]}]}