{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"XUAN QUACH","gend":1,"add":"1900 WOODMONT DR APT 22","city":"RICHMOND","state":"VA","zip":"23223-9998","dob":"1992-10-24","age":"","mstatus":"","insh":"2199186*01","cliId":"","pno":"703\/486-4173","cno":"703\/486-4173","email":"","ename":"","eno":"","pphy":"PEEBLES II, RICHARD MD","ppno":"804\/822-3480","pcpadd":"SUITE 400 110 NORTH ROBINSON STREET","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23220,"pcpcounty":"","pcpid":"","pcpname":"Primary Health Group - Retreat","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/358-9477","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","F41.9","F33.2","F41.1","Z20.822","Z13.1","Z13.220","R19.7","Z86.018","Z30.9","Z91.013","R10.11","K30.","K29.70","R51.9","Z20.828","R09.81","U07.1","L23.7","F31.9","F34.1","N30.00","Z30.011","B00.9","K21.9","Z20.2","Z12.4","J30.81","F32.9","Z91.018","L30.9","N30.01","M23.8X2","Z23.","Z01.419","Z11.4","Z11.3","J06.9","R06.2","Z72.0","T78.40XA","J30.89","T78.1XXA","L50.9","L29.9","N92.6","R63.5","F43.25"],"date":["2022-01-18","2022-04-05","2022-11-16","2022-11-16","2022-01-07","2022-04-05","2022-04-05","2022-04-05","2022-04-05","2022-06-13","2022-04-05","2022-04-05","2022-11-10","2022-11-10","2022-01-07","2022-05-26","2020-10-21","2021-03-01","2020-07-24","2020-08-27","2020-08-27","2020-07-11","2020-08-25","2020-08-25","2022-11-10","2020-08-25","2021-03-12","2020-08-25","2020-11-17","2020-10-26","2020-11-17","2022-05-14","2022-11-25","2022-11-25","2022-06-13","2020-09-16","2020-09-16","2021-09-01","2022-05-26","2022-05-26","2022-11-10","2021-01-29","2021-01-29","2021-01-29","2021-01-29","2021-03-12","2022-06-13","2022-11-16"],"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":[["","51991075033","DULOXETINE","CAP 40MG","30","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","73302045601","ELLA","TAB 30MG","1","Select","Select",""],["","00378427577","VALACYCLOVIR","TAB 500MG","90","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","31722094531","DROSPIR\/ETHI","TAB 3-0.03MG","84","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","70700011585","SYEDA","TAB 3-0.03MG","84","Select","Select",""],["","49502010202","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","00185012201","NITROFURANTN","CAP 100MG","30","Select","Select",""],["","65162068210","PHENAZOPYRID","TAB 200MG","9","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","65862052890","VENLAFAXINE","CAP 75MG ER","30","Select","Select",""],["","00115165901","PROPRANOLOL","TAB 10MG","60","Select","Select",""],["","00115180301","HYDROXYZ","CAP 25MG","30","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","55111012601","CIPROFLOXACN","TAB 250MG","10","Select","Select",""],["","67877025130","TRIAMCINOLON","CRE 0.001","30","Select","Select",""],["","11523715703","CLARITIN","TAB 10MG","90","Select","Select",""],["","69238110005","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","62175011843","OMEPRAZOLE","CAP 20MG","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":""}]}]}