{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KEITH SWINSON","gend":0,"add":"709 SAVANNAH AVE","city":"RICHMOND","state":"VA","zip":"23222-9998","dob":"1965-08-25","age":"","mstatus":"","insh":"1720638*01","cliId":"","pno":8044269032,"cno":8044269032,"email":"","ename":"","eno":"","pphy":"JENNINGS, TORINO RAVON MD","ppno":8047800840,"pcpadd":"2809 N AVE STE 206,","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":"23222-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8044201140,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.42","E78.5","Z79.82","Z21.","M54.5","T63.441A","T50.904A","R40.20","Z23.","R05.9","R50.9","J02.9","Z20.822","I10.","NO DATA","E55.9","R79.89","Z79.899","B20.","T50.901A","Z12.11","Z86.010","K62.5","F17.200","R14.0","T40.2X1A","E78.00","F17.210","R40.4","U07.1"],"date":["2021-09-17","2023-09-22","2023-09-22","2023-09-22","2021-09-17","2021-10-14","2022-02-12","2022-02-12","2022-12-05","2023-09-22","2022-03-22","2022-03-22","2022-03-22","2023-05-05","2022-06-08","2022-12-05","2022-06-08","2023-05-05","2022-12-05","2022-02-12","2023-01-31","2023-01-31","2023-02-02","2023-09-22","2023-02-02","2023-05-05","2023-05-05","2023-05-05","2023-05-05","2023-09-22"],"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":[["","53191036201","VITAMIN D3","CAP 50000UNT","4","Select","Select",""],["","43547035311","LISINOPRIL","10 MG","30","Select","Select",""],["","68462019790","PRAVASTATIN","TAB 40MG","30","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","61958250101","BIKTARVY","50-200-25","30","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","70010077001","METHOCARBAM","TAB 750MG","30","Select","Select",""],["","57896044101","BISACODYL","5 MG","4","Select","Select",""],["","45802086802","POLYETH GLYC","POW 3350 NF","238","Select","Select",""],["","59746017306","PREDNISONE","TAB 10MG","31","Select","Select",""],["","53191036201","D3-50","CAP 50000UNT","2","Select","Select",""],["","65162011510","HYDROCO\/APAP","TAB 7.5-325","20","Select","Select",""],["","62332025118","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","00536105224","PEG3350","POW ","238","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","68180096301","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","00093720298","PRAVASTATIN SODIUM","40 MG","30","Select","Select",""],["","53191036201","D3","50 1250 MCG","2","Select","Select",""],["","00536105224","POLYETHYLENE GLYCOL","3350 17 G\/DOSE","238","Select","Select",""],["","53191036201","D","3-50 1250 MCG","2","Select","Select",""],["","43547035311","LISINOPRIL TAB","10MG","30","Select","Select",""],["","00093720298","PRAVASTATIN TAB","40MG","30","Select","Select",""],["","00054327099","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","61958250101","BIKTARVY TAB","","30","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","62332025118","AZITHROMYCIN TAB","250MG","6","Select","Select",""],["","00093317431","ALBUTEROL AER HFA","","8","Select","Select",""],["","00536105224","PEG","3350 POW","238","Select","Select",""],["","57896044101","BISACODYL TAB","5MG EC","4","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":""}]}]}