{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ARSHELIA  S HARRIS","gend":1,"add":"5611 GOLDEN WHEEL ROAD 5611 GOLDEN WHEEL RD","city":"PROVIDENCE FORGE","state":"VA","zip":23140,"dob":"1978-09-24","age":"","mstatus":"","insh":"5864100*01","cliId":"","pno":"804\/982-2003","cno":"","email":"","ename":"","eno":"","pphy":"Route,  barbara","ppno":"804\/733-5591","pcpadd":"5424 Discovery Park Blvd BLDB A STE 201","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23140,"pcpcounty":"","pcpid":"","pcpname":"CENTRAL VIRGINIA HEALTH SERVICES INC","plan":"OHP","program":"Medicaid","lob":"M4","region":"CENTRAL","aligned":"","ano":8049822105,"add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/733-3506","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","E11.9","K21.9","R30.0","Z71.3","Z71.89","Z23.","B35.1","J45.40","M71.21","Z20.828","Z01.419","Z12.4","N39.3","M25.561","K02.9","K08.89","Z11.59","N89.8","Z12.31","R19.7","M17.11","E66.9","F17.200","S63.610A","S60.221A","M54.32","G89.29","F17.210","Z79.82","Z79.84","Z79.899","M54.31","R42.","M79.602","Z79.51","U07.1","Z20.822","M79.604","S83.241A","Z04.3"],"date":["2022-06-15","2022-06-15","2019-08-22","2019-08-22","2021-10-25","2021-10-25","2021-10-25","2019-08-22","2019-08-22","2019-08-22","2022-05-16","2021-10-25","2021-10-25","2021-10-25","2019-04-23","2019-05-09","2019-05-09","2021-03-11","2019-02-08","2019-02-08","2019-02-08","2019-08-28","2019-08-28","2021-04-01","2021-05-11","2021-05-11","2019-04-12","2019-05-09","2022-06-15","2022-06-15","2022-06-15","2022-06-15","2022-11-10","2022-06-15","2022-06-15","2022-06-15","2022-02-15","2022-01-22","2022-11-10","2022-11-14","2022-11-10"],"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":[["","68382075810","METFORMIN","TAB 500MG","60","Select","Select",""],["","43547035410","LISINOPRIL","TAB 20MG","30","Select","Select",""],["","00378395005","ATORVASTATIN","TAB 10MG","30","Select","Select",""],["","00591034705","HYDROCHLOROT","CAP 12.5MG","30","Select","Select",""],["","00254100752","ALBUTEROL","AER HFA","7","Select","Select",""],["","00085433301","ASMANEX","AER 100 MCG","13","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00085113204","PROVENTIL","AER HFA","7","Select","Select",""],["","80777027310","MODERNA","INJ COVID-19","0","Select","Select",""],["","00173060102","FLOVENT","AER 250MCG","120","Select","Select",""],["","59746012106","MECLIZINE","TAB 25MG","20","Select","Select",""],["","50228043605","NAPROXEN","TAB 500MG","20","Select","Select",""],["","31722053401","METHOCARBAM","TAB 750MG","20","Select","Select",""],["","43598013901","KETOROLAC","TAB 10MG","10","Select","Select",""],["","00781707787","METRONIDAZOL","GEL 0.75%VAG","70","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","46122059848","ASPIRIN","TAB 81MG EC","30","Select","Select",""],["","00143993905","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","00093598627","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","29300022019","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","11917010300","WAL-ITIN","TAB 10MG","30","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":""}]}]}