{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MAYRA PENADO","gend":1,"add":"226 CHESTNUT DR APT 25","city":"CULPEPER","state":"VA","zip":22701,"dob":"1986-05-21","age":"","mstatus":"","insh":"2236059*01","cliId":"","pno":"702\/203-5385","cno":"","email":"","ename":"","eno":"","pphy":"Route,  barbara","ppno":"703\/239-3602","pcpadd":"5424 Discovery Park Blvd BLDB A STE 201","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":22701,"pcpcounty":"","pcpid":"","pcpname":"MANASSAS ADDICTION CENTER LLC","plan":"OHP","program":"Medicaid","lob":"M4","region":"NORTHERN\/ WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"703\/947-5352","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E66.01","Z71.89","Z68.43","Z71.3","E78.5","R94.5","R07.0","E66.9","J45.909","R74.01","K76.0","E55.9","Z23.","G43.909","E53.8","L81.9","Z11.1","R71.8","N92.6","R53.81","T88.1XXA","R07.9","NO DATA","R53.83","Z71.9","Z12.4","E03.9","N64.4","Z80.3","G47.19","G62.9","R51.","N92.5","R23.2","F39.","G47.00","M54.9","F32.9","Z00.00","G44.89","M54.5","Z00.01","L91.8","K29.70","B96.81","Z01.818","E11.9","J45.901","R06.2","K21.9","R73.9","R60.9","M79.606","G47.33","J06.9","Z20.822","R51.9","R05.8","G47.09","F51.11","N39.0","J22.","M54.2"],"date":["2022-03-02","2020-01-27","2020-06-16","2020-05-12","2020-03-26","2021-08-18","2020-03-26","2021-09-10","2022-04-05","2020-12-17","2021-09-10","2021-08-18","2021-04-26","2021-10-28","2021-06-25","2021-06-25","2021-06-28","2021-08-18","2021-08-18","2021-10-28","2021-10-28","2021-10-28","2021-10-28","2021-06-28","2020-05-12","2020-02-27","2020-02-27","2020-02-27","2020-02-27","2020-04-03","2020-04-03","2020-04-03","2020-09-17","2020-09-17","2020-09-17","2021-09-10","2020-11-12","2020-11-12","2021-08-04","2021-08-04","2021-08-04","2021-08-04","2020-03-05","2020-06-16","2020-06-16","2020-06-11","2020-06-11","2020-06-25","2020-10-01","2019-12-18","2022-06-24","2022-06-24","2022-06-24","2022-10-13","2022-03-22","2022-10-04","2022-10-04","2022-03-22","2022-10-13","2022-10-13","2022-04-05","2022-04-05","2022-10-04"],"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":[["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","64380071207","BENZONATATE","CAP 100MG","30","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","20","Select","Select",""],["","00378064110","PREDNISONE","TAB 10MG","30","Select","Select",""],["","","METFORMIN","TAB 750MG ER","","Select","Select",""],["","","VENLAFAXINE","CAP 37.5 ER","","Select","Select",""],["","","VITAMIN","CAP 50000UNT","","Select","Select",""],["","","SYMBICORT","AER 160-4.5","","Select","Select",""],["","","BUDES\/FORMOT","AER 160-4.5","","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","30","Select","Select",""],["","00093342210","CYCLOBENZAPR","TAB 10MG","20","Select","Select",""],["","58160082152","ENGERIX-B","INJ 20MCG\/ML","1","Select","Select",""],["","49483060350","IBUPROFEN","TAB 600MG","21","Select","Select",""],["","","PHENTERMINE","TAB 37.5MG","","Select","Select",""],["","13107008405","LORAZEPAM","TAB 1MG","14","Select","Select",""],["","59746011506","PROCHLORPER","TAB 10MG","15","Select","Select",""],["","","IPRATROPIUM\/","SOL ALBUTER","","Select","Select",""],["","69367017401","HYDROQUINONE","CRE 0.04","28","Select","Select",""],["","","TOPIRAMATE","TAB 25MG","","Select","Select",""],["","","CYANOCOBALAM","INJ 1000MCG","","Select","Select",""],["","00527169505","BUT\/APAP\/CAF","TAB ","30","Select","Select",""],["","69097083305","SERTRALINE","TAB 25MG","30","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","","LANSOPR\/AMOX","MIS \/CLARITH","","Select","Select",""],["","","PYLERA","CAP ","","Select","Select",""],["","","TRIAMCINOLON","CRE 0.001","","Select","Select",""],["","","ONETOUCH","TES VERIO","","Select","Select",""],["","","TRUE","TES GLUCOSE","","Select","Select",""],["","","LOSARTAN","TAB 25MG","","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","","NAPROXEN","TAB 500MG","","Select","Select",""],["","","METHOCARBAM","TAB 500MG","","Select","Select",""],["","60432060616","PROMETH\/COD","SOL 6.25-10","120","Select","Select",""],["","59310057922","PROAIR","AER ","8","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":""}]}]}