{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KRISTY   L ROMANO","gend":1,"add":"18725 FLATFOOT ROAD","city":"DINWIDDIE","state":"VA","zip":"23841-9998","dob":"1989-04-12","age":"","mstatus":"","insh":"2089667*01","cliId":"","pno":"804\/513-6707","cno":"","email":"","ename":"","eno":"","pphy":"RUSSELL, AMANDA MD","ppno":"804\/469-3731","pcpadd":"13855 COURTHOUSE ROAD","pcpcity":"DINWIDDIE","pcpstate":"VA","pcpzip":23841,"pcpcounty":"","pcpid":"","pcpname":"SOUTHERN DOMINION HEALTH SYSTEM INC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/469-5307","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S63.501A","F41.1","Z22.7","E66.8","Z68.41","O36.8130","O13.3","O99.213","E66.9","Z3A.37","R00.2","Z20.828","M54.89","R06.02","I10.","R55.","I51.7","H66.001","M25.531","S53.401A","Z20.822","R53.83","R11.2","R25.2","E87.6","Z01.30","M54.5","B34.9","Z39.1","Z34.82","Z34.83","E66.3","H92.09","R73.9","O34.211","O10.92","O99.02","D64.9","Z3A.38","Z37.0","Z98.891","Z88.8","O13.9","O34.219","Z30.017","Z32.02","Z39.2","Z03.818","F17.200","G43.909","R10.11","Z79.3","Z79.899","M25.571","M25.572","S93.491A","S93.492A","F42.9","L30.9","L53.9","F32.9","L65.9"],"date":["2021-02-05","2021-03-04","2021-08-17","2021-07-19","2021-07-19","2019-02-07","2019-02-07","2019-02-07","2021-05-26","2019-02-07","2021-06-07","2021-03-06","2019-01-23","2021-05-24","2021-11-08","2020-12-17","2020-12-02","2021-01-13","2021-02-05","2021-02-05","2021-03-08","2021-11-08","2021-12-06","2021-12-06","2021-12-06","2019-03-13","2020-08-26","2021-03-06","2019-01-18","2019-01-18","2019-01-18","2021-06-07","2021-05-11","2021-05-26","2019-02-12","2019-02-11","2019-02-11","2019-02-11","2019-02-12","2019-02-12","2019-02-11","2019-02-11","2019-02-12","2019-02-12","2019-03-29","2019-03-29","2019-03-29","2020-05-28","2021-11-08","2021-11-08","2021-11-08","2021-11-08","2021-11-08","2021-03-21","2021-03-21","2021-03-21","2021-03-21","2020-09-24","2020-09-24","2020-09-24","2020-09-24","2020-09-24"],"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":[["","","PRENATE"," PRENATE ","30","Select","Select",""],["","","BUSPIRONE"," BUSPIRONE ","60","Select","Select",""],["","","METOPROL"," METOPROL ","30","Select","Select",""],["","","LABETALOL"," LABETALOL ","60","Select","Select",""],["","","OXYCOD\/APAP"," OXYCOD\/APAP ","30","Select","Select",""],["","","IBUPROFEN"," IBUPROFEN ","40","Select","Select",""],["","","FLUOXETINE"," FLUOXETINE ","30","Select","Select",""],["","","HYDROCHLOROT"," HYDROCHLOROT ","30","Select","Select",""],["","","LISINOPRIL","TAB 10MG","","Select","Select",""],["","","CEFDINIR","CAP 300MG","","Select","Select",""],["","","DICLOFENAC","TAB 75MG DR","","Select","Select",""],["","","BACLOFEN","TAB 10MG","","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":""}]}]}