{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANNY CABAS","gend":1,"add":"10119 CRAVENS FORD TERRACE","city":"MIDLOTHIAN","state":"VA","zip":"23112-9998","dob":"1986-11-20","age":"","mstatus":"","insh":"1638587*01","cliId":"","pno":8049383223,"cno":8049383223,"email":"","ename":"","eno":"","pphy":"VELASQUEZ, DAVID MD","ppno":8042568282,"pcpadd":"8006 DISCOVERY DR STE 400,","pcpcity":"HENRICO","pcpstate":"VA","pcpzip":"23229-9998","pcpcounty":"","pcpid":"","pcpname":"VitalCare Family, LLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8042568288,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I45.19","I45.10","R41.82","NO DATA","N39.41","Z97.5","R82.90","Z98.82","T50.901A","J96.01","F19.10","F31.9","S09.90XA","T46.6X4A","T43.224A","R55.","R77.8","R09.02","Z20.822","X58.XXXA","Y92.89","Y93.89","F41.1","F32.4","L70.9","M62.830","Z91.89","R10.84","K21.9","F41.9","F10.10","F32.9","F12.90","J45.909","Z79.899","Z91.51","R40.20","J20.9","R06.2","Z01.411","Z30.433","Z32.02","N65.1","Z30.09","Z30.431","R11.0","T43.221A","E87.2","R94.31","Z87.891","F43.23","M25.571","M79.641","S93.491A","S63.641A","Z01.419","N60.11","N60.12","R35.0","R87.610","H04.123"],"date":["2022-03-02","2022-03-31","2022-04-18","2021-08-13","2021-08-13","2023-08-16","2021-08-13","2023-08-16","2022-04-01","2022-04-01","2022-04-18","2022-04-18","2022-04-18","2022-04-18","2022-04-18","2022-04-18","2022-04-18","2022-04-18","2022-10-29","2022-04-18","2022-04-18","2022-04-18","2021-02-03","2021-02-03","2021-02-03","2021-02-03","2021-02-03","2022-03-02","2022-10-29","2022-04-01","2022-04-01","2022-04-01","2022-04-01","2022-04-01","2022-04-01","2022-04-01","2022-04-18","2022-10-29","2022-10-29","2021-09-01","2021-09-01","2021-10-19","2021-09-01","2021-09-01","2021-10-19","2022-03-02","2022-03-29","2022-03-29","2022-03-29","2022-03-29","2022-05-16","2023-09-20","2023-09-20","2023-09-20","2023-09-20","2023-08-16","2023-08-16","2023-08-16","2023-08-16","2023-08-16","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":[["","59762374301","CLINDAMYCIN","GEL 0.01","60","Select","Select",""],["","52817032010","BACLOFEN","TAB 10MG","30","Select","Select",""],["","50111064801","FLUOXETINE","CAP 20MG","90","Select","Select",""],["","45802073684","CLINDAMY\/BEN","GEL 1.2-5%","45","Select","Select",""],["","65862022701","LAMOTRIGINE","25 MG","30","Select","Select",""],["","00115180301","HYDROXYZ PAM","CAP 25MG","60","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","30","Select","Select",""],["","00781107710","ALPRAZOLAM","TAB 0.5MG","29","Select","Select",""],["","27241019230","TOLTERODINE","CAP 4MG ER","30","Select","Select",""],["","00555077702","AMPHET\/DEXTR","TAB 15MG","90","Select","Select",""],["","60505470203","SOLIFENACIN","TAB 5MG","30","Select","Select",""],["","59762500801","MISOPROSTOL","TAB 200MCG","1","Select","Select",""],["","58160089052","FLUARIX QUAD","INJ 2022-23","0","Select","Select",""],["","59267100001","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","76204020060","ALBUTEROL","NEB 0.00083","180","Select","Select",""],["","70700015010","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","00378113401","KETOROLAC","TAB 10MG","15","Select","Select",""],["","76204010060","IPRATROPIUM","SOL 0.02%INH","150","Select","Select",""],["","70954006020","PREDNISONE","TAB 20MG","12","Select","Select",""],["","59267030401","PFIZER BIVAL","INJ BA4\/BA5","0","Select","Select",""],["","27241019230","TOLTERODINE CAP","4MG ER","30","Select","Select",""],["","60505470203","SOLIFENACIN TAB","5MG","30","Select","Select",""],["","00781107710","ALPRAZOLAM TAB","0.5MG","29","Select","Select",""],["","70700015010","OMEPRAZOLE CAP","20MG","30","Select","Select",""],["","68462010530","ONDANSETRON TAB","4MG","30","Select","Select",""],["","00378113401","KETOROLAC TAB","10MG","15","Select","Select",""],["","76204020060","ALBUTEROL NEB","0.083%","180","Select","Select",""],["","58160089052","FLUARIX QUAD INJ","2022-23","0","Select","Select",""],["","76204010060","IPRATROPIUM SOL","0.02%INH","150","Select","Select",""],["","00093317431","ALBUTEROL AER HFA","","8","Select","Select",""],["","70954006020","PREDNISONE TAB","20MG","12","Select","Select",""],["","59267030401","PFIZER BIVAL INJ BA","4\/BA5","0","Select","Select",""],["","27241019130","TOLTERODINE TARTRATE ER","2 MG","90","Select","Select",""],["","00642747101","TYBLUME","0.1-0.02MG","84","Select","Select",""],["","00093532862","JUNEL FE","24 1MG-20(24)","84","Select","Select",""],["","13668034030","LAMOTRIGINE ER","50 MG","30","Select","Select",""],["","42806040021","METHYLPREDNISOLONE","4 MG","21","Select","Select",""],["","23155050105","HYDROXYZINE HCL","25 MG","90","Select","Select",""],["","33342006707","OLANZAPINE","2.5 MG","30","Select","Select",""],["","68382005105","MELOXICAM","15 MG","30","Select","Select",""],["","60505470203","SOLIFENACIN SUCCINATE","5 MG","90","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":""}]}]}