{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JAMIE BANKS","gend":1,"add":"9331 THE NEW RD","city":"CHARLES CITY","state":"VA","zip":"23030-9998","dob":"1981-05-31","age":"","mstatus":"","insh":"1370665*01","cliId":"","pno":8048292827,"cno":8048292827,"email":"","ename":"","eno":"","pphy":"ALLGOOD, SHERRY NP","ppno":8042262444,"pcpadd":"4620 S LABURNUM AVE,","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":"23231-9998","pcpcounty":"","pcpid":"","pcpname":"Laburnum Medical Center","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8042220458,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R94.31","F43.20","Z63.4","K76.9","K85.90","S80.852A","Z90.49","Z88.0","Z88.6","Z88.8","R07.89","Z01.411","R10.31","D39.11","D64.9","V58.89","F10.99","R82.81","I10.","A60.09","D69.6","E87.1","Z30.09","R00.2","G47.00","R79.89","Z79.899","N89.8","R10.9","E87.2","K72.00","A60.00","R10.13","R74.8","R11.0","E87.6","E55.9","F10.10","J30.2","J45.909","Z87.891","E03.9","K85.20","S36.118A","Z20.822","Z72.89","J06.9","M62.838","E83.42","D13.4"],"date":["2021-12-12","2022-08-31","2022-08-31","2023-08-21","2022-05-30","2022-09-29","2022-09-29","2022-09-29","2022-09-29","2022-09-29","2021-04-07","2022-09-12","2021-08-17","2021-08-17","2021-12-13","2021-12-13","2021-12-13","2021-12-13","2023-06-04","2021-12-13","2021-12-13","2021-12-13","2021-03-22","2022-08-02","2022-08-02","2022-08-02","2022-08-02","2022-09-12","2021-12-11","2021-12-11","2021-12-11","2021-12-11","2021-12-11","2021-12-11","2021-12-11","2023-06-04","2022-02-16","2022-05-30","2022-02-16","2023-06-04","2023-06-04","2021-04-27","2021-12-11","2021-12-11","2023-04-11","2021-12-11","2023-04-11","2023-06-04","2023-06-04","2023-08-21"],"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":[["","55111046801","METOPROL SUC","TAB 100MG ER","45","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","62037099901","POT CL MICRO","TAB 20MEQ ER","60","Select","Select",""],["","60219106901","POT CHLORIDE","TAB 20MEQ ER","60","Select","Select",""],["","29300039710","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","00378427577","VALACYCLOVIR","500 MG","30","Select","Select",""],["","00054418125","DEXAMETHASON","TAB 1MG","1","Select","Select",""],["","42806054701","VITAMIN D","2 1250 MCG","4","Select","Select",""],["","00378727253","NORETHINDRON","TAB 0.35MG","28","Select","Select",""],["","00054429731","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","11917017023","MELATONIN","TAB 10MG","30","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","6","Select","Select",""],["","68462043518","ACAMPRO CAL","TAB 333MG","180","Select","Select",""],["","00406051205","OXYCOD\/APAP","TAB 5-325MG","6","Select","Select",""],["","65862018730","ONDANSETRON","TAB 4MG","12","Select","Select",""],["","00115180301","HYDROXYZ PAM","CAP 25MG","30","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","11917017023","MELATONIN-LEMON BALM","10 MG-1 MG","30","Select","Select",""],["","29300039710","AMLODIPINE BESYLATE","5 MG","30","Select","Select",""],["","00115180301","HYDROXYZINE PAMOATE","25 MG","30","Select","Select",""],["","45963067711","METOPROLOL SUCCINATE","100 MG","45","Select","Select",""],["","50228013690","LEVOCETIRIZINE DIHYDROCHLORIDE","5 MG","30","Select","Select",""],["","42806071401","BENZONATATE","100 MG","21","Select","Select",""],["","31722053301","METHOCARBAMOL","500 MG","20","Select","Select",""],["","55111046801","METOPROL SUC TAB","100MG ER","45","Select","Select",""],["","62037099901","POT CL MICRO TAB","20MEQ ER","180","Select","Select",""],["","29300039710","AMLODIPINE TAB","5MG","30","Select","Select",""],["","69452015120","VITAMIN D CAP","50000UNT","4","Select","Select",""],["","11917017023","MELATONIN TAB","10MG","30","Select","Select",""],["","00378427577","VALACYCLOVIR TAB","500MG","30","Select","Select",""],["","00406051205","OXYCOD\/APAP TAB","5-325MG","6","Select","Select",""],["","00406055201","OXYCODONE TAB","5MG","6","Select","Select",""],["","65862018730","ONDANSETRON TAB","4MG","12","Select","Select",""],["","00115180301","HYDROXYZ PAM CAP","25MG","40","Select","Select",""],["","50111033402","METRONIDAZOL TAB","500MG","14","Select","Select",""],["","57237000511","FLUCONAZOLE TAB","150MG","2","Select","Select",""],["","74312052802","MELATONIN SUB","10MG","30","Select","Select",""],["","74312019491","MELATONIN CAP","10MG","30","Select","Select",""],["","68001036500","METRONIDAZOLE","500 MG","14","Select","Select",""],["","70436015301","POTASSIUM CHLORIDE","20 MEQ","60","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":""}]}]}