{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JASMINE WASHINGTON","gend":1,"add":"1117 N 27TH ST","city":"RICHMOND","state":"VA","zip":"23223-9998","dob":"1990-11-28","age":"","mstatus":"","insh":"1458024*01","cliId":"","pno":7575824296,"cno":7575824296,"email":"","ename":"","eno":"","pphy":"BLACKBURN, MAURICE LEE MD","ppno":8047300990,"pcpadd":"9376 ATLEE STATION ROAD,","pcpcity":"MECHANICSVILLE","pcpstate":"VA","pcpzip":"23116-9998","pcpcounty":"","pcpid":"","pcpname":"VPI - Hanover Family Physicians","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8047308752,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["P07.38","F31.81","F14.20","Z34.93","Z39.2","Z30.46","F31.30","F41.1","F31.9","L98.9","L65.9","O76.","O99.323","Z3A.38","Z37.0","S39.012A","M54.31","H65.02","H60.392","K13.0","F17.210","Z88.1","Z88.0","E66.9","Z68.31","F31.62","O99.213","E66.01","F14.21","Z3A.36","V23.9","G47.33","O99.320","F14.90","K02.9","F31.32","F51.04","Z11.4","F14.10","F15.10","F12.10","Z20.822","Z33.1","Z72.0","O99.212","O99.322","Z3A.21","O99.340","Z3A.13","NO DATA","G40.101","Q25.0","Q21.1","Q24.1","I08.3","D68.9","R16.0","K04.7","F17.200","Z79.1","Z79.899","H92.01","K08.89","Z11.3","Z20.2","F31.75","F43.10","F90.2","O26.893","R10.2","Z3A.31","Z87.891","Z30.09","Q24.9","G40.109","P52.4","P90.","P61.0","Z99.11","P91.60","Z13.89","G89.18","F41.9","U07.1","Z20.828","O26.899","R10.9","O26.93","P94.1","P84.","P81.9","K72.90","D72.829","G47.30","L02.411","F32.9","R22.0","F43.23","F14.14","O14.13","Z12.4","Z80.41","F31.70","K21.9","Z01.84","Z00.00","Z23.","Z68.42","Z13.1","S46.812A","M54.32","L91.0","Z3A.25","O34.211","K56.7","O99.324","O40.3XX0","O99.214","O99.344","O77.0","O99.63","O14.04","O34.13","P52.9","P78.89","P83.39","K72.00","R60.1","R63.39","I62.9","E78.5","R73.03","Z79.84","R10.30","R06.02","O99.343","R60.0","R03.0","Z3A.34","O77.9","Z3A.39","O36.8330","P59.9","Z01.812","F12.90","Z86.59","Z30.011","T50.904A","F11.23","E87.6","Z3A.32","R06.83","F90.9","P83.2","R26.9"],"date":["2022-10-17","2023-03-12","2023-07-10","2022-10-07","2022-11-10","2022-11-10","2022-10-17","2022-10-17","2023-09-11","2023-05-09","2023-05-09","2021-02-25","2022-09-23","2022-09-23","2022-09-23","2021-11-11","2021-11-11","2022-03-06","2022-03-06","2022-03-06","2023-05-09","2022-03-06","2022-08-09","2023-05-09","2022-03-06","2023-08-23","2022-09-08","2022-11-10","2022-09-23","2022-09-08","2022-09-16","2022-09-08","2022-09-16","2022-09-16","2021-09-29","2022-03-11","2021-04-26","2021-11-17","2022-11-10","2022-02-04","2022-02-04","2022-03-08","2022-08-19","2022-02-04","2022-06-23","2022-05-26","2022-06-23","2022-06-01","2022-05-26","2022-06-01","2022-09-26","2022-09-27","2022-09-27","2022-09-27","2022-09-27","2022-10-17","2022-10-17","2021-06-10","2022-11-10","2021-06-10","2023-05-09","2021-06-10","2021-09-29","2021-11-15","2021-11-15","2021-11-18","2021-11-18","2021-11-18","2022-08-30","2022-08-09","2022-08-09","2022-08-09","2022-09-24","2022-09-27","2022-09-30","2022-09-27","2022-09-27","2022-10-15","2022-09-30","2022-09-30","2022-10-27","2021-02-26","2022-09-23","2022-05-16","2022-03-15","2022-08-09","2022-08-09","2022-09-23","2022-09-23","2022-09-23","2022-10-03","2022-10-03","2022-10-03","2023-02-07","2023-03-09","2021-03-15","2021-03-15","2021-09-28","2022-03-08","2022-11-10","2022-11-10","2022-11-10","2022-11-10","2022-11-10","2022-11-10","2021-11-02","2022-09-23","2023-05-09","2021-11-02","2021-11-02","2021-11-11","2022-06-01","2022-06-23","2022-09-23","2022-09-23","2022-09-23","2022-09-23","2022-09-23","2022-09-23","2022-09-23","2022-09-23","2022-09-23","2022-09-23","2022-09-24","2022-09-24","2022-09-24","2022-10-17","2022-10-17","2022-10-17","2022-10-17","2023-05-09","2023-05-09","2023-05-09","2022-08-30","2022-08-30","2022-09-23","2022-08-30","2022-08-30","2022-08-30","2022-09-23","2022-09-23","2022-09-23","2022-10-15","2021-02-23","2021-02-25","2021-02-25","2021-02-25","2022-02-04","2022-03-10","2022-03-10","2022-08-26","2022-08-12","2022-08-19","2022-09-26","2022-09-28"],"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":[["","57896010410","ACETAMINOPHE","TAB 325MG","30","Select","Select",""],["","59148007280","ABILIFY MAIN","INJ 400MG","1","Select","Select",""],["","68001045508","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","00536589688","NICOTINE TD","DIS 21MG\/24H","14","Select","Select",""],["","57237001030","MIRTAZAPINE","45 MG","30","Select","Select",""],["","64980037503","ATOMOXETINE","CAP 25MG","30","Select","Select",""],["","00173068220","VENTOLIN HFA","AER ","18","Select","Select",""],["","00185064910","DIPHENHYDRAM","CAP 50MG","30","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","28","Select","Select",""],["","00536408501","PRENATAL","TAB 28-0.8MG","30","Select","Select",""],["","45963053830","ONDANSETRON","TAB 4MG","30","Select","Select",""],["","69547035302","NARCAN","SPR 4MG","2","Select","Select",""],["","62332009730","ARIPIPRAZOLE","TAB 2MG","30","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","60","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","00245010811","FERROUS SULF","TAB 325MG EC","90","Select","Select",""],["","49483034010","ACETAMIN","TAB 325MG","30","Select","Select",""],["","80777027399","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","00904699880","DOCUSATE SOD","CAP 100MG","30","Select","Select",""],["","43547040110","FUROSEMIDE","TAB 20MG","4","Select","Select",""],["","67877032105","IBUPROFEN","800 MG","20","Select","Select",""],["","42858000101","OXYCODONE","TAB 5MG","20","Select","Select",""],["","00904693126","PEG 3350","POW ","7","Select","Select",""],["","72205002790","ROSUVASTATIN","TAB 5MG","30","Select","Select",""],["","00172572880","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","63402030430","LATUDA","TAB 40MG","30","Select","Select",""],["","00904506860","MI-ACID GAS","CHW 80MG","20","Select","Select",""],["","00093354356","ATOMOXETINE HCL","18 MG","30","Select","Select",""],["","51224000760","METFORMIN HCL ER","500 MG","120","Select","Select",""],["","59148007280","ABILIFY MAINTENA","400 MG","1","Select","Select",""],["","69396000320","HYDROCORTISONE","1 %","28.4","Select","Select",""],["","72205002799","ROSUVASTATIN CALCIUM","5 MG","30","Select","Select",""],["","68001024604","ONDANSETRON ODT","4 MG","10","Select","Select",""],["","00115180402","HYDROXYZINE PAMOATE","50 MG","60","Select","Select",""],["","27808023301","DOXYCYCLINE HYCLATE","100 MG","20","Select","Select",""],["","63646001004","KETOCONAZOLE","2 %","120","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":""}]}]}