{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TIARA   M SHORTER","gend":1,"add":"240 WELLFORDS WHARF ROAD","city":"WARSAW","state":"VA","zip":"22572-9998","dob":"2000-12-28","age":"","mstatus":"","insh":"2284032*01","cliId":"","pno":"804\/761-9578","cno":"","email":"","ename":"","eno":"","pphy":"TANKERSLEY, CAROLYN J NP","ppno":"804\/443-5378","pcpadd":"1362 TAPPAHANNOCK BLVD","pcpcity":"TAPPAHANNOCK","pcpstate":"VA","pcpzip":22560,"pcpcounty":"","pcpid":"","pcpname":"BON SECOURS MEDICAL GROUP RICHMOND PRIMARY CARE LLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/443-9667","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F32.9","N92.6","R03.0","Z32.02","M54.9","R06.02","R00.0","R51.9","R07.9","O21.9","O26.21","Z3A.01","F31.81","O99.341","F41.9","Z3A.11","Z32.01","F43.12","I88.0","D72.829","E11.9","Z87.891","R10.33","Z20.2","F17.200","K92.0","R10.13","N89.8","B37.3","R11.2","R11.0","E66.9","Z68.42","Z11.59","Z76.89","O26.891","O24.419","O99.331","Z3A.08","N76.0","S31.41XA","B96.89","Y92.89","R55.","R45.86","Z3A.12","V23.2","F31.9","Z86.32","O26.811","R10.84"],"date":["2021-10-28","2021-11-10","2021-11-19","2021-11-10","2020-04-24","2020-04-24","2020-04-24","2022-11-21","2022-08-13","2020-03-30","2020-03-30","2020-03-30","2021-12-02","2020-04-24","2022-11-06","2020-04-24","2020-03-17","2022-11-07","2022-03-06","2022-03-06","2022-03-06","2022-03-06","2022-03-06","2022-08-11","2022-08-13","2022-08-13","2022-08-13","2022-08-13","2022-08-13","2022-08-13","2022-08-11","2022-08-11","2022-08-11","2022-08-11","2022-08-11","2022-10-11","2022-10-11","2022-10-11","2022-10-11","2022-06-03","2022-06-03","2022-06-03","2022-06-03","2022-11-06","2022-11-05","2022-11-06","2022-11-06","2022-11-06","2022-11-06","2022-10-11","2022-11-21"],"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":[["","","ONDANSETRON","TAB 4MG","","Select","Select",""],["","69238110002","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","00536406301","CL","TAB 28-0.8MG","30","Select","Select",""],["","68645059459","FAMOTIDINE","TAB 20MG","20","Select","Select",""],["","00143122701","DICYCLOMINE","TAB 20MG","20","Select","Select",""],["","68645056259","IBUPROFEN","TAB 600MG","20","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","55111014512","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","16714008210","HYDROXYZ","TAB 25MG","12","Select","Select",""],["","70710112307","DOXYCYC","TAB 100MG","20","Select","Select",""],["","63402030230","LATUDA","TAB 20MG","30","Select","Select",""],["","","PRENATAL","TAB 27-0.8MG","","Select","Select",""],["","","NIFEDIPINE","TAB 60MG ER","","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":""}]}]}