{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KARINA M MALDONADO","gend":1,"add":"2209 RUFFIN RD APT G","city":"RICHMOND","state":"VA","zip":"23224-9998","dob":"1991-11-19","age":"","mstatus":"","insh":"1353914*01","cliId":"","pno":8048229657,"cno":8048229657,"email":"","ename":"","eno":"","pphy":"BROOKS WILLIAMS, MALINDA A MD","ppno":8047800840,"pcpadd":"2740 BENSLEY COMMONS BLVD,","pcpcity":"NORTH CHESTERFIELD","pcpstate":"VA","pcpzip":"23237-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8047800862,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.11","V58.89","Z48.02","N76.0","R30.0","F33.1","F43.10","F31.9","A54.9","Z20.2","N89.8","S80.211A","A56.01","R41.3","M79.641","S61.411A","N39.0","Z11.3","A74.9","F17.200","S20.211A","W01.0XXA","F33.9","R10.84","M54.9","R11.10","H66.91","R51.9","A59.01","R35.0","S61.012A","W22.8XXA","A59.9","W25.XXXA","S61.412A","W26.0XXA","Z48.00","R68.84","R00.0","R22.0","R10.33","R11.2","N10.","J06.9","K02.9","I49.8","R94.31","H92.02","B96.89","S40.012A","S30.0XXA","M25.512","R41.82","J18.9","R07.9","S60.922A","S66.422A","F44.89","N12.","R10.9","R45.89","S89.91XA","M25.572","M79.672","S93.402A"],"date":["2021-05-30","2021-04-30","2021-10-25","2023-06-17","2021-12-15","2022-02-23","2022-08-15","2022-08-15","2022-06-03","2022-09-15","2022-12-06","2022-12-09","2023-06-17","2021-10-06","2021-10-25","2021-10-25","2022-12-05","2022-12-05","2022-12-06","2022-12-06","2021-02-12","2021-02-12","2021-10-07","2022-02-18","2022-02-18","2022-02-18","2022-04-14","2022-07-09","2022-06-02","2022-06-02","2021-10-02","2021-10-02","2021-01-07","2021-04-17","2021-10-02","2021-10-02","2021-10-20","2022-10-23","2022-01-25","2022-01-25","2022-02-19","2022-02-19","2022-02-19","2022-07-09","2022-07-23","2021-10-05","2021-10-05","2022-07-23","2022-09-15","2022-10-23","2022-10-23","2022-10-23","2021-10-05","2021-10-05","2021-10-05","2021-06-06","2021-10-02","2021-10-05","2022-02-19","2022-02-19","2022-12-09","2022-12-09","2023-08-31","2023-08-31","2023-08-31"],"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":[["","57237000830","MIRTAZAPINE TAB","15MG","30","Select","Select",""],["","31722082030","ARIPIPRAZOLE TAB","5MG","30","Select","Select",""],["","16714008310","HYDROXYZ HCL TAB","50MG","30","Select","Select",""],["","65162046510","IBUPROFEN TAB","600MG","90","Select","Select",""],["","67877021905","CEPHALEXIN CAP","500MG","14","Select","Select",""],["","65862039010","ONDANSETRON TAB","4MG ODT","15","Select","Select",""],["","00093031401","KETOROLAC TAB","10MG","20","Select","Select",""],["","50383002505","OFLOXACIN DRO","0.3%OTIC","10","Select","Select",""],["","16571066401","METRONIDAZOL TAB","500MG","14","Select","Select",""],["","11822333230","RA TUSSIN DM LIQ","100-10\/5","118","Select","Select",""],["","82607066026","FLOWFLEX KIT TEST","","8","Select","Select",""],["","00093310953","AMOXICILLIN CAP","500MG","21","Select","Select",""],["","68180044101","CEPHALEXIN SUS","250\/5ML","500","Select","Select",""],["","11822034952","SINUS\/CONGES TAB","120MG","20","Select","Select",""],["","00135061502","FLONASE SENS SUS","27.5MCG","6","Select","Select",""],["","69238110005","DOXYCYCL HYC CAP","100MG","14","Select","Select",""],["","57237000511","FLUCONAZOLE TAB","150MG","2","Select","Select",""],["","63304061650","DOXYCYC MONO CAP","100MG","14","Select","Select",""],["","70010075401","METHOCARBAM TAB","500MG","30","Select","Select",""],["","27808023302","DOXYCYCLINE HYCLATE","100 MG","20","Select","Select",""],["","50111033401","METRONIDAZOLE","500 MG","14","Select","Select",""],["","31722082030","ARIPIPRAZOLE","TAB 5MG","30","Select","Select",""],["","57237000830","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","16714008310","HYDROXYZ HCL","TAB 50MG","30","Select","Select",""],["","65162046510","IBUPROFEN","TAB 600MG","90","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","15","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","15","Select","Select",""],["","67877021901","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","50383002505","OFLOXACIN","DRO 0.3%OTIC","10","Select","Select",""],["","16571066401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","11822034952","SINUS\/CONGES","TAB 120MG","20","Select","Select",""],["","00093310953","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","82607066026","FLOWFLEX","KIT TEST","8","Select","Select",""],["","11822333230","RA TUSSIN DM","LIQ 100-10\/5","118","Select","Select",""],["","00135061502","FLONASE SENS","SUS 27.5MCG","6","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","30","Select","Select",""],["","69238110005","DOXYCYCL HYC","CAP 100MG","14","Select","Select",""],["","63304061650","DOXYCYC MONO","CAP 100MG","14","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":""}]}]}