{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CRYSTAL PITMAN","gend":1,"add":"8960 HUNGARY RD APT A","city":"GLEN ALLEN","state":"VA","zip":"23060-9998","dob":"1979-04-18","age":"","mstatus":"","insh":"2153544*01","cliId":"","pno":"804\/986-4141","cno":"804\/986-4141","email":"","ename":"","eno":"","pphy":"HOSSAIN, NASIFFA MD","ppno":"804\/254-3500","pcpadd":"2116 W LABURNUM AVE","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23227,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/254-1616","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E28.310","M79.2","G43.909","E53.8","M81.0","Z96.642","Z90.722","Z86.19","Z90.711","M70.62","R53.1","E66.9","F17.210","Z68.31","M25.552","L29.2","Z86.69","N20.1","S92.014A","S82.831A","G89.29","E78.5","G43.911","G47.00","R44.3","J30.2","Z79.899","M54.5","Z20.828","N76.0","Z20.2","B00.9","Z68.30","G43.709","Z86.61","R39.9","H65.192","Z68.25","R35.89","N89.8","T78.40XS","R05.","J02.9","F43.10","F60.3","G62.9","S92.011D","M79.671","Z04.89","R19.7","R09.81","T84.011A","N95.1","F33.0","Z47.1","G60.3","B34.9","Z20.822","S99.911A","S92.011A","M79.672","R10.2","N94.9","A08.4","Z87.898","R51.","N13.30","N23.","R11.0","G57.02","R50.9","J20.9","R51.9","Z68.26","M87.051","G04.81","R22.2","V54.16","M76.71","M19.079","Z23.","S92.011S","F17.200"],"date":["2020-01-17","2020-07-21","2021-02-18","2022-08-16","2021-09-23","2021-09-17","2020-01-17","2021-02-08","2020-01-17","2021-09-02","2020-02-24","2020-02-24","2021-09-02","2020-06-24","2021-11-01","2020-10-14","2021-04-28","2021-03-05","2021-05-27","2021-05-27","2021-09-02","2021-09-23","2021-09-02","2021-09-23","2021-09-02","2021-09-02","2021-09-02","2020-07-20","2021-10-11","2021-08-19","2020-10-16","2021-07-15","2020-10-16","2022-02-15","2022-02-15","2022-05-16","2022-05-16","2022-05-16","2022-08-16","2022-08-16","2022-08-16","2020-07-21","2021-05-13","2021-09-23","2021-09-23","2020-05-08","2021-07-09","2021-07-09","2021-11-23","2020-07-21","2020-07-21","2021-01-18","2021-02-08","2021-04-26","2021-04-12","2021-04-12","2021-05-13","2021-05-13","2021-05-27","2021-06-01","2021-06-01","2021-07-15","2021-08-19","2020-03-11","2022-02-15","2020-05-08","2021-03-05","2021-03-05","2021-03-01","2021-03-30","2021-10-11","2021-10-11","2021-10-11","2022-02-15","2020-07-21","2020-07-21","2020-10-02","2021-11-15","2022-04-20","2022-04-20","2021-09-23","2022-04-20","2022-04-20"],"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":[["","00002143611","EMGALITY","INJ 120MG\/ML","1","Select","Select",""],["","16571040250","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","42806040021","METHYLPRED","TAB 4MG","21","Select","Select",""],["","57237002901","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","61314064511","NEO\/POLY\/HC","SUS 1% OTIC","10","Select","Select",""],["","55111014512","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","45802006435","TRIAMCINOLON","CRE 0.001","15","Select","Select",""],["","68382007016","PRAVASTATIN","TAB 10MG","30","Select","Select",""],["","96295012847","VITAMIN","TAB 2000UNIT","60","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","67877022210","GABAPENTIN","CAP 100MG","120","Select","Select",""],["","29300011716","TOPIRAMATE","TAB 100MG","30","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","20","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","55111029209","SUMATRIPTAN","TAB 50MG","9","Select","Select",""],["","69543038810","KETOROLAC","TAB 10MG","12","Select","Select",""],["","67877021560","CEFUROXIME","TAB 250MG","10","Select","Select",""],["","69315090401","LORAZEPAM","TAB 0.5MG","2","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","68645048154","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","68382013201","TAMSULOSIN","CAP 0.4MG","30","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","00406051201","OXYCOD\/APAP","TAB 5-325MG","20","Select","Select",""],["","68645056354","IBUPROFEN","TAB 800MG","20","Select","Select",""],["","45802005935","NYSTATIN","CRE 100000","15","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","30","Select","Select",""],["","65862044930","VALACYCLOVIR","TAB 1GM","90","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","5","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","69097022416","ALENDRONATE","TAB 70MG","12","Select","Select",""],["","55111017915","TIZANIDINE","TAB 2MG","20","Select","Select",""],["","00121174410","GUAIFENESIN","SOL 100\/5ML","300","Select","Select",""],["","50111078751","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","50383008707","GUAIATUSS","SYP 100-10\/5","120","Select","Select",""],["","58657050016","CODEINE\/GG","SOL 10-100\/5","120","Select","Select",""],["","00093081201","NORTRIPTYLIN","CAP 50MG","90","Select","Select",""],["","00456120330","LINZESS","CAP 72MCG","30","Select","Select",""],["","62037056005","POT  CHLORIDE","CAP 10MEQ ER","7","Select","Select",""],["","65162019011","NAPROXEN","TAB 500MG","14","Select","Select",""],["","00054004544","IPRATROPIUM","SPR 0.0003","30","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":""}]}]}