{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALYSSA CULLEN","gend":1,"add":"20049 OAK RIVER DR S","city":"PETERSBURG","state":"VA","zip":"23803-9998","dob":"1987-11-20","age":"","mstatus":"","insh":"2282183*01","cliId":"","pno":"804\/896-5830","cno":"804\/896-5830","email":"","ename":"","eno":"","pphy":"BALMER, LUKE NP","ppno":"804\/828-9205","pcpadd":"417 N 11TH ST","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23298,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/828-6082","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E05.00","R23.2","R00.2","F41.0","D75.1","I10.","R00.1","F43.10","F41.1","N95.1","F41.9","E03.9","F43.0","R07.9","R94.31","E89.0","E55.9","E53.8","R63.5","Z68.27","I49.9","R07.89","R03.1","R03.0","R42.","N92.1","R45.89","D45.","Z20.822","R53.83","R50.9","R00.0","J30.1","L27.2","L30.8","J20.9","Z79.899","H92.03","R51.9","Z88.0","Z79.52","N92.0","Z01.419","Z12.31"],"date":["2021-03-15","2022-03-14","2022-03-14","2022-03-14","2020-07-15","2022-05-12","2021-07-26","2022-02-22","2022-02-22","2020-07-27","2020-07-16","2022-08-01","2020-09-28","2021-08-06","2021-07-26","2021-09-09","2022-03-14","2022-03-14","2022-06-02","2021-09-09","2021-08-06","2021-08-06","2021-08-06","2021-08-06","2021-08-06","2021-09-28","2021-09-28","2020-07-27","2022-01-23","2021-11-05","2021-11-05","2021-08-26","2022-04-26","2022-04-26","2022-04-26","2022-05-12","2022-05-12","2022-05-12","2022-02-04","2022-02-04","2022-02-04","2022-03-14","2022-03-22","2022-03-22"],"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":[["","00074706890","SYNTHROID","TAB 125MCG","30","Select","Select",""],["","10006073043","VITAMIN","TAB 1000MCG","30","Select","Select",""],["","00603020922","MAG","TAB 400MG","90","Select","Select",""],["","64980033912","MAGNESIUM-OX","TAB 400MG","90","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","100","Select","Select",""],["","69238183607","LEVOTHYROXIN","TAB 125MCG","30","Select","Select",""],["","68180051202","LISINOPRIL","TAB 2.5MG","90","Select","Select",""],["","00713022515","TRIAMCINOLON","CRE 0.001","45","Select","Select",""],["","00536131385","CHEST","SYP REL DM","100","Select","Select",""],["","58657050508","GG\/DM","SYP 100-10\/5","100","Select","Select",""],["","51224002230","AZITHROMYCIN","TAB 250MG","4","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","00093417773","CEPHALEXIN","SUS 250\/5ML","200","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","16","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","15","Select","Select",""],["","51862094205","DIAZEPAM","TAB 5MG","3","Select","Select",""],["","60793085601","LEVOXYL","TAB 125MCG","25","Select","Select",""],["","00143962125","CYANOCOBALAM","INJ 1000MCG","30","Select","Select",""],["","00378727253","NORETHINDRON","TAB 0.35MG","84","Select","Select",""],["","66685100100","AMOX\/K","TAB 875-125","20","Select","Select",""],["","00378427677","VALACYCLOVIR","TAB 1GM","21","Select","Select",""],["","60432046608","DEXAMETHASON","ELX 0.5\/5ML","150","Select","Select",""],["","00193737701","CONTOUR","KIT NEXT","1","Select","Select",""],["","00143988915","AMOXICILLIN","SUS 250\/5ML","150","Select","Select",""],["","00228202750","ALPRAZOLAM","TAB 0.25MG","10","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":""}]}]}