{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SELENA HERRERA","gend":1,"add":"2523 LARRYVALE DR","city":"CHESTER","state":"VA","zip":"23831-9998","dob":"1995-11-19","age":"","mstatus":"","insh":"6821979*01","cliId":"","pno":"804\/666-1828","cno":"","email":"","ename":"","eno":"","pphy":"MADISON, ASENA L MD","ppno":"804\/362-7372","pcpadd":"9549 AMBERDALE DRIVE","pcpcity":"NORTH CHESTERFIELD","pcpstate":"VA","pcpzip":23236,"pcpcounty":"","pcpid":"","pcpname":"PC THE GARDEN OF EDEN HEALTH CENTER","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"866\/834-5648","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O34.211","O41.03X0","D62.","O32.1XX0","O36.5930","O69.81X0","Z30.2","Z37.0","Z3A.37","O99.02","O13.4","O34.03","Z20.828","J06.9","F39.","S00.83XA","W10.8XXA","J40.","Z20.822","R09.81","O99.012","V23.7","Z3A.26","O82.","Z30.09","Z39.2","R19.7","H10.45","R05.","R51.9","R43.9","Z3A.36","Z98.891","O26.843","Z36.85","R10.9","O26.899","Z39.1","R00.0","R94.31"],"date":["2019-08-12","2019-08-12","2019-08-12","2019-08-12","2019-08-12","2019-08-12","2019-08-12","2019-08-12","2019-08-12","2019-08-12","2019-08-12","2019-08-12","2021-08-25","2021-05-10","2019-01-08","2020-11-25","2020-11-25","2021-11-22","2021-11-22","2021-11-22","2019-05-23","2019-05-23","2019-05-23","2019-08-12","2019-08-12","2019-09-26","2019-12-01","2021-08-02","2021-09-27","2021-09-27","2021-09-27","2019-08-05","2019-08-05","2019-08-05","2019-08-05","2019-08-05","2019-08-05","2019-08-15","2021-11-22","2021-11-22"],"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":[["","","CITALOPRAM"," CITALOPRAM ","27","Select","Select",""],["","","IBUPROFEN"," IBUPROFEN ","28","Select","Select",""],["","","LABETALOL"," LABETALOL ","30","Select","Select",""],["","","FEROSUL"," FEROSUL ","30","Select","Select",""],["","","TERCONAZOLE"," TERCONAZOLE ","20","Select","Select",""],["","","DOCUSATE"," DOCUSATE ","60","Select","Select",""],["","","RA"," RA ","60","Select","Select",""],["","","DOK"," DOK ","60","Select","Select",""],["","","OXYCOD\/APAP"," OXYCOD\/APAP ","20","Select","Select",""],["","","LOPERAMIDE"," LOPERAMIDE ","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":""}]}]}