{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JONTE   M RUFFIN","gend":0,"add":"304 HIGH ST APT 2","city":"LAWRENCEVILLE","state":"VA","zip":"23868-9998","dob":"2000-01-21","age":"","mstatus":"","insh":"2192478*01","cliId":"","pno":"434\/378-7064","cno":"434\/378-7064","email":"","ename":"","eno":"","pphy":"ACKERMAN, CHRISTOPHER J MD","ppno":"434\/848-0771","pcpadd":"203 SHARP ST","pcpcity":"LAWRENCEVILLE","pcpstate":"VA","pcpzip":23868,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/848-3814","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J45.909","R09.02","E83.42","E87.6","R00.0","J09.X1","J45.20","L02.214","U07.1","A41.89","J18.1","F19.20","M41.20","Z79.899","Z71.6","F17.210","J30.9","R05.","J45.901","Z23.","N43.3","J15.9","A41.9","Z72.0","J44.9","J18.9","J44.1","B34.9","J45.40","Z87.891","L03.90"],"date":["2022-04-13","2020-01-17","2020-01-16","2020-01-16","2020-01-18","2020-01-18","2020-11-10","2021-11-02","2022-04-13","2020-01-15","2020-01-15","2020-01-15","2020-01-15","2020-01-15","2020-01-15","2020-01-15","2021-04-20","2020-12-22","2021-01-06","2021-08-25","2021-10-15","2020-01-27","2020-01-17","2020-01-17","2020-03-13","2020-03-13","2020-12-22","2020-12-22","2021-04-20","2021-04-20","2021-11-09"],"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":[["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00173071920","FLOVENT","AER 110MCG","12","Select","Select",""],["","33342020010","LEVOCETIRIZI","TAB 5MG","30","Select","Select",""],["","82607066026","FLOWFLEX","KIT TEST","2","Select","Select",""],["","57237003005","AMOXICILLIN","CAP 250MG","21","Select","Select",""],["","00487020103","IPRATROPIUM\/","SOL ALBUTER","90","Select","Select",""],["","60432026415","FLUTICASONE","SPR 50MCG","48","Select","Select",""],["","16714089803","LORATADINE","TAB 10MG","90","Select","Select",""],["","59746017206","PREDNISONE","TAB 5MG","14","Select","Select",""],["","72647033104","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00173089310","TRELEGY","AER ELLIPTA","60","Select","Select",""],["","62332000831","VENLAFAXINE","TAB 25MG","180","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","00121077516","GG\/CODEINE","SOL 100-10\/5","120","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","20","Select","Select",""],["","69543038810","KETOROLAC","TAB 10MG","15","Select","Select",""],["","31722063231","OSELTAMIVIR","CAP 75MG","4","Select","Select",""],["","11822222590","RA","DIS 21MG\/24H","14","Select","Select",""],["","00135057602","FLONASE","SPR 50MCG","10","Select","Select",""],["","00536589453","NICOTINE","DIS 7MG\/24HR","14","Select","Select",""],["","64679096105","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","31722072320","LEVOFLOXACIN","TAB 750MG","7","Select","Select",""],["","50383008707","GUAIATUSS","SYP 100-10\/5","120","Select","Select",""],["","70461031903","FLUCLVX","INJ 2019-20","0","Select","Select",""],["","59310030480","QVAR","AER 80MCG","11","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","10939073744","SM","DIS 7MG\/24HR","28","Select","Select",""],["","65162046510","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","63824000886","MUCINEX","TAB 600MG ER","60","Select","Select",""],["","65862019105","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","00186091706","PULMICORT","INH 90MCG","1","Select","Select",""],["","00536379001","VITAMIN","CAP 2000UNIT","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":""}]}]}