{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"STACEY  L MUHAMMAD","gend":1,"add":"2212 FERNDALE AVE","city":"PETERSBURG","state":"VA","zip":23803,"dob":"1981-06-21","age":"","mstatus":"","insh":"20063892*01","cliId":"","pno":"805\/508-5845","cno":"","email":"","ename":"","eno":"","pphy":"Route,  barbara","ppno":"757\/536-2246","pcpadd":"5424 Discovery Park Blvd BLDB A STE 201","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23803,"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":"804\/541-2724","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","I51.7","I34.0","I36.1","I21.4","Z95.5","I25.10","I42.1","I10.","R55.","I45.6","R07.9","R77.8","R06.02","I27.0","Z95.810","Z20.828","B34.9","R10.2","Z12.31","R10.84","R11.10","R19.7","R94.31","R00.0","E11.9","E78.5","E87.6","E55.9","E05.10","I08.1","Z98.891","Z83.3","Z82.49","Z79.82","Z79.02","K21.9","I42.2","R07.89","Z53.21","Z53.29","I25.2","Z79.899","J06.9","N94.6","A59.01","N89.8","Z32.02","I49.1","R94.39","D70.9","D64.9","N93.8","R92.8","R11.2","R10.9","Z86.73","F41.1","J10.1","Z74.3","N39.0","NO DATA","I25.119","I42.9","F41.9","F32.9","R05.","R43.0","R43.2","Z45.02","Y04.0XXA","R42.","I20.0","I16.0","Z82.41","I49.9","R00.2","I11.0","E83.42","I50.9","Z01.419","R82.90","Z11.51","R07.2","S00.12XA","Z79.01","S29.9XXA","Z95.0","R53.1","Z79.51","Z80.3","I50.22","S09.90XA","R51.9","W22.8XXA","N30.00","A49.3","B96.20","B95.2","F33.3","Z01.810","C53.9","Z91.199"],"date":["2022-10-31","2022-11-08","2022-11-08","2021-05-17","2020-11-28","2021-10-25","2022-11-08","2022-06-01","2022-10-16","2022-06-01","2021-05-20","2022-10-16","2020-11-28","2021-06-10","2021-06-10","2022-11-08","2021-09-16","2021-09-16","2021-10-18","2021-10-15","2020-02-05","2020-02-05","2020-02-05","2022-10-16","2021-10-22","2021-10-23","2020-07-18","2021-05-20","2020-06-25","2020-06-23","2021-05-18","2020-06-23","2020-06-23","2020-11-27","2022-09-09","2022-07-17","2020-06-23","2022-11-08","2022-10-16","2020-11-27","2020-11-27","2022-11-08","2022-09-09","2022-01-06","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-10-22","2021-10-22","2021-10-24","2021-10-23","2021-10-23","2020-01-21","2020-02-05","2020-02-05","2022-11-08","2020-06-17","2020-02-11","2020-07-30","2021-05-20","2021-05-20","2022-09-09","2020-07-22","2020-08-07","2020-08-07","2021-03-23","2021-03-23","2021-03-23","2021-05-20","2021-10-25","2020-07-14","2020-07-19","2021-10-05","2021-10-05","2020-06-25","2020-08-07","2022-09-09","2021-05-18","2021-10-25","2021-09-23","2021-09-23","2021-09-23","2022-07-17","2021-10-25","2021-10-25","2021-10-25","2022-10-16","2022-07-17","2022-09-09","2022-09-09","2022-09-09","2022-07-17","2022-07-17","2022-07-17","2022-06-09","2022-06-09","2022-06-09","2022-06-09","2022-11-03","2022-11-08","2022-11-08","2022-11-08"],"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":[["","68180098103","LISINOPRIL","TAB 20MG","30","Select","Select",""],["","68382070718","DOXYCYC","CAP 100MG","14","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","15","Select","Select",""],["","00093719801","FLUOXETINE","CAP 40MG","30","Select","Select",""],["","63824004124","MUCINEX","TAB 120-1200","24","Select","Select",""],["","00904676320","ROBAFEN","LIQ 200\/10ML","120","Select","Select",""],["","00536360735","NASAL","TAB 30MG","24","Select","Select",""],["","00904404073","ASPIRIN","CHW 81MG","30","Select","Select",""],["","43547034150","RISPERIDONE","TAB 1MG","30","Select","Select",""],["","43598083205","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","16729018317","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","16714085302","METOPROL","TAB 50MG ER","90","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","15","Select","Select",""],["","00185012201","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","65162068210","PHENAZOPYRID","TAB 200MG","15","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","45802065087","LORATADINE","TAB 10MG","15","Select","Select",""],["","00781185220","AMOX\/K","TAB 875-125","10","Select","Select",""],["","65862083430","AMLOD\/VALSAR","TAB \/HCTZ","30","Select","Select",""],["","00363051954","PAIN","TAB 500MG\/RR","30","Select","Select",""],["","59310058020","PROAIR","AER ","1","Select","Select",""],["","68001013100","AMLOD\/BENAZP","CAP 10-40MG","30","Select","Select",""],["","68001036503","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","65162062711","TRAMADOL","TAB 50MG","15","Select","Select",""],["","65862042001","SMZ\/TMP","TAB 800-160","6","Select","Select",""],["","60432060416","PROMETHAZINE","SYP DM","200","Select","Select",""],["","00093720198","PRAVASTATIN","TAB 20MG","30","Select","Select",""],["","16729021816","CLOPIDOGREL","TAB 75MG","30","Select","Select",""],["","13107000334","MIRTAZAPINE","TAB 30MG","30","Select","Select",""],["","16729013716","CLONAZEPAM","TAB 1MG","30","Select","Select",""],["","63304071890","DILTIAZEM","CAP 120MG ER","30","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","65862066230","ARIPIPRAZOLE","TAB 5MG","30","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","5","Select","Select",""],["","63304001760","RANOLAZINE","TAB 500MG ER","60","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":""}]}]}