{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JACQUELYN D PAULETTE","gend":1,"add":"2305 GARRISON PLACE ROAD","city":"MIDLOTHIAN","state":"VA","zip":"23112-9998","dob":"1979-05-11","age":"","mstatus":"","insh":"1974946*01","cliId":"","pno":8047445992,"cno":8047445992,"email":"","ename":"","eno":"","pphy":"MAYFIELD, ROBERT MD","ppno":8047945598,"pcpadd":"13332 MIDLOTHIAN TURNPIKE,","pcpcity":"MIDLOTHIAN","pcpstate":"VA","pcpzip":"23113-9998","pcpcounty":"","pcpid":"","pcpname":"Bon Secours St Francis Family Medicine Center","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8043781954,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L03.116","L03.115","F31.9","F19.10","L03.119","L02.91","R01.1","Z76.89","Z86.19","NO DATA","Z09.","F11.20","F41.1","I35.1","F17.210","F14.20","M54.9","D17.1","R21.","F15.21","Z01.812","Z20.822","F10.20","F19.94","R00.1","R94.31","F11.21","C49.11","A41.9","F14.10","F12.10","F11.10","F33.0","J02.0","F43.21","M25.571","L30.9","D49.2","Z68.27","R65.10","J16.8","R52.","F17.200","Z53.29","N39.0","R65.20","Z90.49","R45.1","D72.829","D47.3","R51.9","R53.83","Z68.29","N61.1","S39.012A","R11.2","V89.2XXA","Y92.410","Y93.89","L03.90","F19.90","Z68.26","Z79.899","F11.23","B18.2","F32.9","Z98.891","Z72.0","F10.239"],"date":["2021-06-26","2021-06-26","2022-09-22","2021-06-28","2021-05-28","2021-05-28","2021-06-26","2021-05-28","2021-05-28","2021-05-28","2021-07-02","2022-09-20","2021-09-30","2021-06-27","2021-12-28","2022-09-20","2021-03-30","2021-03-30","2021-03-30","2022-08-25","2021-04-18","2022-08-18","2021-08-16","2021-08-16","2021-08-17","2021-08-17","2021-07-30","2021-04-22","2021-05-17","2021-08-16","2021-08-16","2021-08-16","2021-12-28","2022-08-18","2022-09-08","2021-03-30","2021-03-30","2021-04-22","2021-04-13","2021-06-28","2021-04-27","2021-04-27","2022-08-18","2021-04-27","2021-05-17","2021-05-17","2021-06-26","2021-06-26","2021-06-26","2021-06-26","2021-06-26","2022-08-18","2021-04-22","2021-08-03","2021-12-05","2021-12-05","2021-12-05","2021-12-05","2021-12-05","2021-05-19","2021-05-19","2021-07-30","2022-07-25","2021-06-26","2021-06-26","2021-06-26","2021-06-26","2021-06-26","2021-08-17"],"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":[["","65162019011","NAPROXEN","TAB 500MG","30","Select","Select",""],["","29300041519","CYCLOBENZAPR","TAB 10MG","20","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","69238110002","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","13668001990","VENLAFAXINE","CAP 75MG ER","30","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","1","Select","Select",""],["","45802004935","TRIAMCINOLON","OIN 0.005","30","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","30","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","10","Select","Select",""],["","29300013701","CLONIDINE","TAB 0.3MG","60","Select","Select",""],["","50111078710","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","67877021660","CEFUROXIME","TAB 500MG","14","Select","Select",""],["","12496120803","SUBOXONE","MIS 8-2MG","14","Select","Select",""],["","00143924920","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","47781035703","BUPREN\/NALOX","MIS 8-2MG","8","Select","Select",""],["","16729044416","BUPROPN HCL","TAB 300MG XL","30","Select","Select",""],["","80777027399","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","65162027250","SMZ\/TMP DS","TAB 800-160","28","Select","Select",""],["","42806016105","HYDROXYZ HCL","TAB 50MG","30","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","15","Select","Select",""],["","68645014059","FAMOTIDINE","TAB 20MG","20","Select","Select",""],["","13107000130","MIRTAZAPINE","TAB 7.5MG","30","Select","Select",""],["","00406117003","NALTREXONE","TAB 50MG","14","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","14","Select","Select",""],["","45802011222","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","29300013701","CLONIDINE TAB","0.3MG","60","Select","Select",""],["","16729044416","BUPROPN HCL TAB","300MG XL","30","Select","Select",""],["","12496120803","SUBOXONE MIS","8-2MG","14","Select","Select",""],["","00406117003","NALTREXONE TAB","50MG","14","Select","Select",""],["","13107000130","MIRTAZAPINE TAB","7.5MG","30","Select","Select",""],["","65862001501","AMOXICILLIN TAB","875MG","14","Select","Select",""],["","45802011222","MUPIROCIN OIN","2%","22","Select","Select",""],["","29300041519","CYCLOBENZAPR TAB","10MG","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":""}]}]}