{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CRYSTAL CRAWFORD","gend":1,"add":"900 AZALEA LN","city":"COLONIAL HEIGHTS","state":"VA","zip":"23834-9998","dob":"1967-03-04","age":"","mstatus":"","insh":"1142664*01","cliId":"","pno":8044791738,"cno":8044791738,"email":"","ename":"","eno":"","pphy":"JIN, XIAO HONG MD","ppno":8047320648,"pcpadd":"15 GOODRICH AVE,","pcpcity":"PETERSBURG","pcpstate":"VA","pcpzip":"23805-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8048616846,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M72.2","G60.8","S83.91XA","M21.6X2","K59.00","S30.0XXA","R55.","F17.200","N18.9","M53.3","E11.43","G47.30","J44.9","Z79.4","Z79.82","Z79.899","F17.210","Z88.0","Z95.5","K62.89"],"date":["2022-04-20","2022-04-20","2022-04-02","2022-04-26","2022-07-07","2021-11-30","2021-11-30","2021-11-30","2021-11-30","2021-11-30","2022-07-07","2022-07-07","2022-07-07","2022-07-07","2022-07-07","2022-07-07","2022-07-07","2022-07-07","2022-07-07","2022-07-07"],"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":[["","00002879959","HUMALOG KWIK","INJ 100\/ML","15","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","57599000101","FREESTYLE","KIT SENSOR","2","Select","Select",""],["","00002822259","INSULIN LISP","INJ 100\/ML","6","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","16571040210","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","27808003503","HYDROCO\/APAP","TAB 5-325MG","6","Select","Select",""],["","42571025201","CLINDAMYCIN","CAP 300MG","40","Select","Select",""],["","51079007220","FUROSEMIDE","TAB 20MG","14","Select","Select",""],["","00406051262","OXYCOD\/APAP","TAB 5-325MG","12","Select","Select",""],["","69452015120","VITAMIN D","CAP 50000UNT","4","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","72205000530","ROSUVASTATIN","TAB 40MG","30","Select","Select",""],["","42806015134","AZITHROMYCIN","SUS 200\/5ML","30","Select","Select",""],["","00093220401","METOCLOPRAM","TAB 5MG","45","Select","Select",""],["","55111032105","GLIMEPIRIDE","TAB 2MG","30","Select","Select",""],["","00169266015","TRESIBA FLEX","INJ 100UNIT","6","Select","Select",""],["","62332012190","PREGABALIN","CAP 75MG","60","Select","Select",""],["","68382004001","PROMETHAZINE","TAB 12.5MG","30","Select","Select",""],["","49483062281","METFORMIN","TAB 500MG","60","Select","Select",""],["","00378910493","NITROGLYCER","DIS 0.2MG\/HR","30","Select","Select",""],["","57599000101","FREESTYLE LIBRE","14 DAY SENSOR ","2","Select","Select",""],["","42571025101","CLINDAMYCIN HCL","150 MG","40","Select","Select",""],["","00002822259","INSULIN LISPRO KWIKPEN U-","100 100\/ML","6","Select","Select",""],["","57896022110","ACETAMINOPHEN","500 MG","30","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","00002822259","INSULIN LISP INJ","100\/ML","6","Select","Select",""],["","00597007541","SPIRIVA CAP HANDIHLR","","30","Select","Select",""],["","57599000101","FREESTYLE KIT SENSOR","","2","Select","Select",""],["","00002879959","HUMALOG KWIK INJ","100\/ML","6","Select","Select",""],["","16571040210","CETIRIZINE TAB","10MG","30","Select","Select",""],["","60505082901","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","27808003503","HYDROCO\/APAP TAB","5-325MG","6","Select","Select",""],["","42571025201","CLINDAMYCIN CAP","300MG","40","Select","Select",""],["","51079007220","FUROSEMIDE TAB","20MG","14","Select","Select",""],["","00406051262","OXYCOD\/APAP TAB","5-325MG","12","Select","Select",""],["","42806015134","AZITHROMYCIN SUS","200\/5ML","30","Select","Select",""],["","00093317431","ALBUTEROL AER HFA","","8","Select","Select",""],["","62332012190","PREGABALIN CAP","75MG","60","Select","Select",""],["","69452015120","VITAMIN D CAP","50000UNT","4","Select","Select",""],["","00093220401","METOCLOPRAM TAB","5MG","45","Select","Select",""],["","55111032105","GLIMEPIRIDE TAB","2MG","30","Select","Select",""],["","69452017213","AZITHROMYCIN TAB","500MG","5","Select","Select",""],["","72205000530","ROSUVASTATIN TAB","40MG","30","Select","Select",""],["","00169266015","TRESIBA FLEX INJ","100UNIT","6","Select","Select",""],["","68382004001","PROMETHAZINE TAB","12.5MG","30","Select","Select",""],["","49483062281","METFORMIN TAB","500MG","60","Select","Select",""],["","00378910493","NITROGLYCER DIS","0.2MG\/HR","30","Select","Select",""],["","73070040315","INSULIN DEGLUDEC PEN (U-","100) 100\/ML (3)","3","Select","Select",""],["","00597010061","SPIRIVA RESPIMAT","2.5 MCG","4","Select","Select",""],["","00169266015","TRESIBA FLEXTOUCH U-","100 100\/ML (3)","3","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":""}]}]}