{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"QUBILAH MUHAMMAD","gend":1,"add":"950 SLEDD ST APT 503","city":"RICHMOND","state":"VA","zip":"23220-9998","dob":"1962-11-20","age":"","mstatus":"","insh":"1429931*01","cliId":"","pno":8044263138,"cno":8044263138,"email":"","ename":"","eno":"","pphy":"LAKE, JULIA C MD","ppno":8042877570,"pcpadd":"5899 BREMO ROAD STE 202,","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":"23226-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8042827394,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E83.51","NO DATA","J96.01","U07.1","E87.1","N17.9","E20.9","E55.9","E66.01","E87.6","K21.9","Z68.42","Z90.49","R94.31","R29.0","R56.9","E03.9","Z76.89","E89.0","D50.9","I10.","R51.9","M17.11","M25.561","I45.81","E05.00","A08.4","R19.7","E05.90","Z85.850","R53.83"],"date":["2022-11-29","2022-01-29","2022-01-29","2022-02-07","2022-01-29","2022-01-30","2022-02-07","2022-03-26","2022-01-29","2022-01-29","2023-04-24","2022-01-29","2022-01-29","2022-01-31","2022-01-29","2022-01-29","2022-03-26","2022-02-07","2022-11-29","2022-11-29","2023-04-24","2023-04-24","2021-07-05","2021-07-05","2022-01-31","2023-04-24","2022-01-22","2022-01-22","2023-04-24","2023-04-24","2023-04-24"],"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":[["","65862039010","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","50428028724","CVS CALCIUM","TAB 600MG","10","Select","Select",""],["","00093031101","LOPERAMIDE","CAP 2MG","20","Select","Select",""],["","00054418625","DEXAMETHASON","TAB 6MG","8","Select","Select",""],["","50428836320","ANTACID","CHW 750MG","60","Select","Select",""],["","69452015120","VITAMIN D","CAP 50000UNT","4","Select","Select",""],["","00536100715","CAL-GEST","CHW 500MG","180","Select","Select",""],["","00378181377","LEVOTHYROXIN","TAB 125MCG","90","Select","Select",""],["","62011022901","CALC ANTACID","CHW 750MG","60","Select","Select",""],["","00378181377","LEVOTHYROXINE SODIUM","125 MCG","90","Select","Select",""],["","50428028756","ANTACID EXTRA STRENGTH","300MG(750)","90","Select","Select",""],["","69097012605","AMLODIPINE BESYLATE","2.5 MG","15","Select","Select",""],["","00766073921","TUMS","300MG(750)","60","Select","Select",""],["","00093031101","LOPERAMIDE CAP","2MG","20","Select","Select",""],["","65862039010","ONDANSETRON TAB","4MG ODT","20","Select","Select",""],["","50428028724","CVS CALCIUM TAB","600MG","10","Select","Select",""],["","00054418625","DEXAMETHASON TAB","6MG","8","Select","Select",""],["","50428836320","ANTACID CHW","750MG","60","Select","Select",""],["","69452015120","VITAMIN D CAP","50000UNT","4","Select","Select",""],["","00536100715","CAL-GEST CHW","500MG","180","Select","Select",""],["","00378181377","LEVOTHYROXIN TAB","125MCG","90","Select","Select",""],["","62011022901","CALC ANTACID CHW","750MG","180","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":""}]}]}