{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHERONDA JONES","gend":1,"add":"4127 W JEFFERSON DAVIS ST APT 4","city":"RICHMOND","state":"VA","zip":"23234-9998","dob":"1989-05-02","age":"","mstatus":"","insh":"5073057*01","cliId":"","pno":"804\/307-2563","cno":"","email":"","ename":"","eno":"","pphy":"HABIB, AYSHA MD","ppno":"804\/612-2980","pcpadd":"STE 204 12320 W BROAD ST","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23233,"pcpcounty":"","pcpid":"","pcpname":"BON SECOURS SHORT PUMP PRIMARY CARE","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/360-2437","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R05.","J45.909","E66.01","Z68.41","R10.2","R93.89","Z32.01","J18.9","O34.219","O99.210","Z37.0","M25.571","F41.9","G47.8","Z63.6","Z11.59","Z00.00","G89.29","F32.9","M25.572","Z68.43","R11.0","F41.0","J06.9","Z28.9","O20.9","Z3A.01","Z04.9","O36.60X0","O34.211","Z3A.39","O26.891","R10.84","O20.0","O47.1","O99.213","E66.9","O99.513","Z3A.37","J01.00","O03.9","U07.1","N39.0","O99.214","O99.52","O99.334","F17.210","M79.7","O99.89","O99.824","Z86.72","O75.9","J45.901","R10.31","Z3A.08","G89.18","Z3A.20","R10.32","R10.33","F43.21","O99.511","O99.211","R39.15","N83.209","R30.0","N20.0","M54.9","Z11.3","N83.201"],"date":["2019-10-11","2022-10-06","2022-10-06","2020-01-21","2022-04-27","2020-01-23","2020-01-23","2021-12-04","2019-03-05","2019-03-05","2019-03-05","2021-03-24","2022-06-07","2021-03-24","2021-03-24","2021-03-24","2021-03-24","2021-03-24","2021-07-29","2021-03-24","2021-03-24","2021-07-29","2021-07-29","2021-08-12","2021-08-12","2020-01-27","2020-01-27","2022-10-06","2019-03-05","2019-03-05","2019-03-05","2020-02-17","2020-01-25","2020-01-27","2019-02-14","2019-02-14","2019-03-05","2019-02-14","2019-02-14","2020-12-28","2022-04-27","2021-08-22","2022-09-22","2019-03-05","2019-03-05","2019-03-05","2019-03-05","2019-03-05","2019-03-05","2019-03-05","2019-03-05","2019-03-05","2020-01-21","2022-09-22","2020-02-17","2019-03-06","2020-01-24","2022-04-27","2022-04-27","2022-06-07","2022-04-27","2022-04-27","2022-09-22","2022-10-06","2022-10-06","2022-10-12","2022-02-16","2022-10-12","2022-10-12"],"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":[["","","PRENATAL"," PRENATAL ","30","Select","Select",""],["","69238110002","DOXYCYCL","CAP 100MG","14","Select","Select",""],["","","KETOROLAC","TAB 10MG","","Select","Select",""],["","00093005401","BUSPIRONE","TAB 10MG","90","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","6","Select","Select",""],["","","ONDANSETRON"," ONDANSETRON ","30","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","9","Select","Select",""],["","00781107710","ALPRAZOLAM","TAB 0.5MG","10","Select","Select",""],["","65162068110","PHENAZOPYRID","TAB 100MG","9","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","14","Select","Select",""],["","50111064701","FLUOXETINE","CAP 10MG","180","Select","Select",""],["","00406051201","OXYCOD\/APAP","TAB 5-325MG","20","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","20","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","","BENZONATATE","CAP 200MG","","Select","Select",""],["","65862017760","CEFDINIR","CAP 300MG","20","Select","Select",""],["","","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","","METHYLPRED","TAB 4MG","","Select","Select",""],["","","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","","AMOXICILLIN","TAB 875MG","","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":""}]}]}