{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHELBY  I SEAY","gend":1,"add":"1910 WAKEFIELD AVE","city":"COLONIAL HEIGHTS","state":"VA","zip":"23834-9998","dob":"1990-07-09","age":"","mstatus":"","insh":"1919583*01","cliId":"","pno":8045030223,"cno":8045030223,"email":"","ename":"","eno":"","pphy":"QUARSHIE, GEORGE MD","ppno":"","pcpadd":"20901 CHESTERFIELD AVENUE,","pcpcity":"SOUTH CHESTERFIELD","pcpstate":"VA","pcpzip":"23803-9998","pcpcounty":"","pcpid":"","pcpname":"Bon Secours - South Chesterfield Family Medicine","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.2","V43.52XA","N13.2","Z87.440","I10.","J45.909","E03.9","Z79.899","R10.9","Z01.419","E28.2","N20.2","Z68.32","J06.9","Z20.822","J20.9","R05.1","B34.9","N30.00","E78.2","E66.09","NO DATA","Z90.49","S70.12XA","V89.2XXA","G44.201","K08.89","G47.01","Z68.31","N20.1","G43.901","Z30.430","A74.9","A49.3","N39.0","S09.90XA","S29.9XXA","S39.91XA","S20.219A","S30.1XXA","S70.02XA","R51.9","R10.32","R10.31","R10.814","M25.552","E05.00","Z97.5","Q76.49","D73.89","N20.0","Z30.431","G47.00","E89.0","F33.1","F41.9","G43.101","Z68.30","Z79.890","D50.8","R53.83","R53.81","Z87.442","R05.9","K21.9","R11.0","R13.10","R14.0","R19.4","S29.8XXA","V48.0XXA","Y92.410","M54.5","G89.29","F43.23","E66.9","Z68.33","Z30.433","Z32.02","G43.909","R42.","N76.0"],"date":["2022-04-11","2022-04-10","2022-07-12","2022-07-11","2022-07-11","2022-07-11","2022-12-31","2022-11-11","2022-07-11","2022-08-29","2022-08-29","2022-08-05","2022-07-12","2022-09-29","2022-09-29","2022-12-31","2022-12-31","2022-12-31","2021-08-11","2022-11-11","2022-07-29","2022-11-11","2022-04-11","2022-04-19","2022-04-19","2022-04-19","2022-04-19","2022-04-19","2022-04-19","2022-08-18","2023-01-05","2022-11-04","2022-02-09","2022-02-09","2022-02-09","2022-04-11","2022-04-11","2022-04-11","2022-04-11","2022-04-11","2022-04-11","2022-04-11","2022-04-11","2022-04-11","2022-04-11","2022-04-11","2022-04-11","2022-04-11","2022-04-11","2022-04-11","2022-08-18","2023-06-16","2022-07-29","2022-04-06","2022-07-29","2022-07-29","2022-07-29","2022-07-15","2022-11-11","2022-07-29","2022-07-29","2022-07-29","2022-12-31","2022-12-31","2022-04-07","2022-04-07","2022-04-07","2022-04-07","2022-04-07","2022-04-10","2022-04-10","2022-04-10","2021-01-11","2021-01-11","2022-11-11","2022-11-11","2022-11-11","2022-11-18","2022-11-18","2023-01-05","2023-01-05","2023-06-16"],"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":[["","31722088390","ROSUVASTATIN","TAB 10MG","30","Select","Select",""],["","00378623201","CITALOPRAM","TAB 20MG","90","Select","Select",""],["","69238183801","LEVOTHYROXIN","TAB 150MCG","30","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","3","Select","Select",""],["","57237015630","MOXIFLOXACIN","TAB 400MG","10","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","10","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","10","Select","Select",""],["","00009766701","CLEOCIN","SUP 100MG","3","Select","Select",""],["","31722072320","LEVOFLOXACIN","TAB 750MG","5","Select","Select",""],["","00378668977","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","00378113401","KETOROLAC","TAB 10MG","20","Select","Select",""],["","29300041319","CYCLOBENZAPR","TAB 5MG","30","Select","Select",""],["","68382013201","TAMSULOSIN","CAP 0.4MG","30","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","10","Select","Select",""],["","11917009215","FERROUS SULF","TAB 325MG","30","Select","Select",""],["","10135012310","ACETAMIN","TAB 325MG","20","Select","Select",""],["","59651036105","IBUPROFEN","600 MG","30","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","30","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","43598083105","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","50419042301","MIRENA","IUD SYSTEM","1","Select","Select",""],["","10702025350","BUTALBITAL-ACETAMINOPHEN-CAFFE","50-325-40","10","Select","Select",""],["","00121077504","GUAIFENESIN-CODEINE","10-100MG\/5","30","Select","Select",""],["","72205002305","ATORVASTATIN CALCIUM","20 MG","30","Select","Select",""],["","13668001005","CITALOPRAM HBR","20 MG","90","Select","Select",""],["","69238183801","LEVOTHYROXINE SODIUM","150 MCG","30","Select","Select",""],["","00378668977","PANTOPRAZOLE SODIUM","40 MG","90","Select","Select",""],["","00378427677","VALACYCLOVIR","1000 MG","6","Select","Select",""],["","00378623201","CITALOPRAM TAB","20MG","90","Select","Select",""],["","31722072320","LEVOFLOXACIN TAB","750MG","5","Select","Select",""],["","00009766701","CLEOCIN SUP","100MG","3","Select","Select",""],["","00378668977","PANTOPRAZOLE TAB","40MG","90","Select","Select",""],["","70010075401","METHOCARBAM TAB","500MG","10","Select","Select",""],["","00378113401","KETOROLAC TAB","10MG","20","Select","Select",""],["","29300041319","CYCLOBENZAPR TAB","5MG","30","Select","Select",""],["","69238183801","LEVOTHYROXIN TAB","150MCG","30","Select","Select",""],["","68382013201","TAMSULOSIN CAP","0.4MG","30","Select","Select",""],["","11917009215","FERROUS SULF TAB","325MG","30","Select","Select",""],["","00406012305","HYDROCO\/APAP TAB","5-325MG","10","Select","Select",""],["","00904759080","FEROSUL TAB","325MG","30","Select","Select",""],["","57237007710","ONDANSETRON TAB","4MG ODT","12","Select","Select",""],["","10135012310","ACETAMIN TAB","325MG","20","Select","Select",""],["","64380080707","IBUPROFEN TAB","800MG","20","Select","Select",""],["","43598083105","ATORVASTATIN TAB","20MG","30","Select","Select",""],["","50419042301","MIRENA IUD SYSTEM","","1","Select","Select",""],["","00781808926","AZITHROMYCIN TAB","250MG","6","Select","Select",""],["","45802013970","METRONIDAZOLE","0.75 %","70","Select","Select",""],["","57237002801","AMOXICILLIN","500 MG","20","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":""}]}]}