{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KAREN   J HAINSWORTH","gend":1,"add":"4418 MARLIN AVE","city":"SUFFOLK","state":"VA","zip":"23435-9998","dob":"1982-05-29","age":"","mstatus":"","insh":"2104538*01","cliId":"","pno":"518\/538-4252","cno":"","email":"","ename":"","eno":"","pphy":"WUNDER, NICHOLAS PA","ppno":"804\/968-5700","pcpadd":"5000 COX ROAD SUITE 100","pcpcity":"GLEN ALLEN","pcpstate":"VA","pcpzip":"23060","pcpcounty":"","pcpid":"","pcpname":"PATIENT FIRST RICHMOND MEDICAL GROUP PLLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/968-5739","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25.532","F90.2","V54.12","R05.","J45.909","J45.901","O09.522","R79.89","Z3A.25","V23.9","Z36.9","O99.891","O47.1","N89.8","Z3A.37","O62.2","O42.90","Z3A.38","S52.572A","Z34.93","R68.89","L29.9","Z23.","M54.89","R10.2","O09.523","O99.513","Z79.51","Z79.899","Z87.891","Z88.2","R10.9","Z36.89","N81.6","Z30.431","S62.102A","Z30.430","Z32.02","Z30.09","J34.89","Z98.890","Z68.28","O26.893","R10.84","O42.02","Z37.0","O99.52","O99.214","O99.344","F32.9","O77.0","Z80.0","Z80.51","O80.","Z3A.00","Z39.1","Z34.82","Z34.83","Z03.71","Z79.52","Z86.59","R32.","J01.00"],"date":["2020-07-23","2021-12-30","2020-07-30","2020-09-29","2021-09-25","2020-09-29","2021-06-30","2021-08-26","2021-06-30","2021-08-26","2021-09-17","2021-09-20","2021-09-20","2021-09-20","2021-09-22","2021-09-25","2021-09-25","2021-09-25","2020-04-09","2021-09-10","2021-09-10","2021-09-10","2021-09-10","2021-09-07","2021-09-16","2021-09-22","2021-09-22","2021-09-25","2021-09-25","2021-09-25","2021-09-25","2021-09-22","2021-09-24","2021-12-16","2021-12-16","2020-03-31","2021-11-22","2021-11-22","2021-11-22","2020-03-11","2020-03-11","2020-03-11","2021-09-22","2021-09-22","2021-09-25","2021-09-25","2021-09-25","2021-09-25","2021-09-25","2021-09-25","2021-09-25","2021-09-25","2021-09-25","2021-09-25","2021-09-25","2021-08-13","2021-08-13","2021-08-13","2021-09-20","2021-09-20","2021-09-20","2021-09-27","2021-11-10"],"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":[["","54092039101","ADDERALL","CAP 30MG","20","Select","Select",""],["","00555077702","AMPHET\/DEXTR","TAB 15MG","60","Select","Select",""],["","00085113204","PROVENTIL","AER HFA","7","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","20","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","20","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","10","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","7","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","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":""}]}]}