{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KANDYCE CARTER","gend":1,"add":"105 CLAYMAN ROAD","city":"SANDSTON","state":"VA","zip":"23150-9998","dob":"1990-09-02","age":"","mstatus":"","insh":"5073979*01","cliId":"","pno":"804\/441-2959","cno":"","email":"","ename":"","eno":"","pphy":"CRUZ, IVONNE NP","ppno":"804\/968-5700","pcpadd":"500 COX ROAD SUITE 100","pcpcity":"GLEN ALLEN","pcpstate":"VA","pcpzip":23060,"pcpcounty":"","pcpid":"","pcpname":"PATIENT FIRST RICHMOND MEDICAL GROUP PLLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/968-5739","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J10.1","F17.200","F32.9","F31.30","F41.1","F43.10","F11.21","R41.0","R41.3","R00.2","M79.671","F33.2","T84.84XA","G89.18","T84.293A","M19.90","J45.909","F11.20","Z72.0","R11.0","M62.838","K59.00","G43.009","F32.1","Z20.828","NO DATA","R11.2","R05.","R00.0","I63.9","Z68.25","F33.1","R39.14","R35.0","N39.3","H61.002","I78.1","L81.4","D22.9","Z12.83","Z80.8","L85.3","R21.","Z68.22","T85.848A","Z89.431","G83.22","J40.","M32.9","M35.00","Z20.822","H92.02","V58.89","R53.1","B34.9","N30.01","Z01.818","E55.9","R40.4","S40.012A","L98.9","K59.04","F17.210","F31.9","Z68.23","S70.02XA","K59.09","R10.33","K42.9","Z71.9","F90.2","R19.7","K21.9","M54.2","S23.3XXA","L93.0","L73.9","L02.214","D64.9","J45.21","G47.9","J20.9","R51."],"date":["2020-01-17","2020-01-17","2020-08-24","2021-12-21","2021-12-21","2021-12-21","2021-07-20","2020-06-14","2021-04-08","2020-08-27","2020-09-11","2021-04-25","2020-09-11","2020-09-11","2020-09-11","2020-09-11","2020-09-11","2021-12-27","2021-12-21","2021-12-21","2021-12-21","2021-12-21","2021-05-12","2021-11-30","2021-04-14","2020-06-02","2020-06-02","2020-06-02","2020-12-19","2021-01-05","2021-01-05","2020-08-11","2020-10-30","2020-10-30","2020-10-30","2020-02-13","2020-02-13","2020-02-13","2020-02-13","2020-02-13","2020-02-13","2020-02-13","2020-02-13","2020-02-13","2020-09-03","2020-09-03","2020-12-19","2021-02-19","2021-04-06","2021-04-06","2021-04-14","2021-08-18","2020-09-11","2020-12-20","2020-06-01","2020-06-01","2020-09-04","2020-09-04","2021-04-08","2020-01-04","2020-01-04","2020-08-27","2020-08-27","2020-08-27","2020-09-18","2021-05-25","2021-11-11","2021-11-11","2021-11-11","2021-11-11","2019-01-16","2019-05-29","2019-01-30","2019-11-24","2019-11-24","2019-03-11","2019-07-15","2019-07-15","2019-07-15","2019-10-16","2019-05-29","2019-06-18","2019-06-18"],"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":[["","65862039110","ONDANSETRON","TAB 8MG ODT","60","Select","Select",""],["","00054018913","BUPREN\/NALOX","SUB 8-2MG","14","Select","Select",""],["","00469260130","MYRBETRIQ","TAB 25MG","30","Select","Select",""],["","65862049501","QUETIAPINE","TAB 400MG","30","Select","Select",""],["","69238207807","PROPRANOLOL","TAB 20MG","60","Select","Select",""],["","70436001002","BUPROPN","TAB 150MG XL","30","Select","Select",""],["","60505025203","TIZANIDINE","TAB 4MG","135","Select","Select",""],["","12496120803","SUBOXONE","MIS 8-2MG","21","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","50111045001","TRAZODONE","TAB 150MG","30","Select","Select",""],["","65162052210","PROMETHAZINE","TAB 50MG","120","Select","Select",""],["","59651000305","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","65862052305","GABAPENTIN","TAB 600MG","180","Select","Select",""],["","73480024290","DICLOFENAC","CAP 35MG","90","Select","Select",""],["","65862023060","LAMOTRIGINE","TAB 200MG","30","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","11534018701","BUT\/APAP\/CAF","CAP ","10","Select","Select",""],["","00904645760","DOK","CAP 100MG","30","Select","Select",""],["","00121087316","LACTULOSE","SOL 10GM\/15","473","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00069047103","CHANTIX","PAK 0.5& 1MG","53","Select","Select",""],["","57237004705","DIVALPROEX","TAB 250MG DR","90","Select","Select",""],["","69238126601","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","31722070430","VALACYCLOVIR","TAB 500MG","10","Select","Select",""],["","62332025050","DOXYCYC","CAP 100MG","20","Select","Select",""],["","67877021560","CEFUROXIME","TAB 250MG","20","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":""}]}]}