{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALYSSA STAIANO","gend":1,"add":"1421 LEAFCREST LN APT 102","city":"RICHMOND","state":"VA","zip":"23235-9998","dob":"1990-05-05","age":"","mstatus":"","insh":"2236578*01","cliId":"","pno":"804\/229-5489","cno":"","email":"","ename":"","eno":"","pphy":"JOHNSON, RUSSELL MD","ppno":"804\/379-1500","pcpadd":"12731 STONE VILLAGE WAY","pcpcity":"MIDLOTHIAN","pcpstate":"VA","pcpzip":23113,"pcpcounty":"","pcpid":"","pcpname":"SHORT PUMP FAMILY CARE LLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/379-1633","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O24.414","Z3A.35","I10.","R60.0","O14.95","O26.891","R51.","Z3A.01","Z39.1","Z34.82","Z34.83","Z20.822","U07.1","J06.9","R05.9","O13.4","O24.429","Z23.","O24.424","O70.0","Z37.0","Z3A.38","Z71.1","N64.4","R73.03","R00.0","L40.9","Z68.32","L40.8","D22.9","Z12.83","Z00.00","H91.91","R00.2","I49.9","R94.31","J40.","O99.89","J01.00","D62.","O98.32","O99.02","A60.09","O69.81X0","O11.5","O10.93","Z20.828","Z86.32","Z32.01","Z31.430","Z11.3","Z3A.34","O90.89","Z91.09","I34.0","I36.1","I47.1","R05."],"date":["2020-07-31","2020-07-31","2021-05-19","2020-09-01","2020-09-01","2020-01-02","2020-09-01","2020-01-02","2020-07-31","2020-07-31","2020-07-31","2021-09-28","2021-12-25","2021-12-25","2021-12-25","2020-08-24","2020-08-24","2021-05-12","2020-08-24","2020-08-24","2020-08-24","2020-08-24","2021-10-05","2021-10-05","2021-04-29","2021-04-29","2021-10-20","2021-04-29","2021-09-08","2021-10-20","2021-10-20","2021-10-27","2021-10-27","2021-06-09","2021-05-19","2021-05-19","2021-12-23","2020-01-02","2020-02-19","2020-08-23","2020-08-23","2020-08-23","2020-08-23","2020-08-23","2020-09-01","2020-09-01","2020-09-01","2020-09-01","2020-01-23","2020-01-23","2020-01-23","2020-07-23","2020-09-01","2020-09-01","2021-06-09","2021-06-09","2021-06-09","2021-09-28"],"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":[["","","ONETOUCH","TES ULTRA","","Select","Select",""],["","57237000430","FLUCONAZOLE","TAB 100MG","7","Select","Select",""],["","51672125902","CLOBETASOL","OIN 0.0005","60","Select","Select",""],["","00713080753","BETAMETH","LOT 0.0005","60","Select","Select",""],["","45802093716","HYDROCORT","LOT 0.025","59","Select","Select",""],["","","VALACYCLOVIR","TAB 500MG","","Select","Select",""],["","65862053750","LEVOFLOXACIN","TAB 500MG","7","Select","Select",""],["","","IBUPROFEN","TAB 600MG","","Select","Select",""],["","","LABETALOL","TAB 200MG","","Select","Select",""],["","","NIFEDIPINE","TAB 30MG ER","","Select","Select",""],["","","INSULIN","MIS 0.3\/31G","","Select","Select",""],["","","AMOXICILLIN","TAB 875MG","","Select","Select",""],["","","HUMULIN","INJ U-100","","Select","Select",""],["","","SHINGRIX","INJ 50\/0.5ML","","Select","Select",""],["","","BOOSTRIX","INJ ","","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":""}]}]}