{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JESSIE  L DURAND","gend":1,"add":"5136 OLD WARWICK RD APT 3B","city":"RICHMOND","state":"VA","zip":"23224-9998","dob":"1983-03-15","age":"","mstatus":"","insh":"20026786*01","cliId":"","pno":7572421288,"cno":7572421288,"email":"","ename":"","eno":"","pphy":"PENDYAL, KAUSALYA MD","ppno":8045600490,"pcpadd":"SUITE 4 681 HIOAKS ROAD,","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":"23225-9998","pcpcounty":"","pcpid":"","pcpname":"Primary Health Group - Chippenham","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8045603424,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F32.2","R05.9","M79.671","NO DATA","H10.33","J45.40","Z68.26","J30.1","J30.81","F90.9","L98.9","J06.9","B97.89","J45.909","Z86.69","F17.200","Z20.822","R06.02","V58.89","Z48.02","Z30.42","Z32.02","J30.89","Z71.9","H10.13","J45.30","J45.41","Z68.23","Z01.419","H10.45","R05.3","J32.9","Z71.3","E66.3","Z20.828","U07.1","G43.909","R07.9","D72.829","H10.9","R25.2","B37.0","Z09.","Z51.81","K21.9","Z68.27","J41.1","R63.4","S81.012A","F43.12","Z23.","S50.01XA","S60.122A","S02.2XXA","M54.16","M51.36","M47.816","G89.4","Z79.899","D23.71","R05.","J30.9","M54.17","M80.08XA","M54.2","M80.88XA"],"date":["2023-06-07","2022-01-21","2022-03-29","2022-11-10","2022-03-29","2022-03-29","2022-11-10","2022-12-13","2022-12-20","2023-03-23","2022-10-04","2022-11-10","2022-11-03","2022-11-03","2022-11-03","2022-11-03","2022-11-03","2022-11-03","2021-10-05","2021-10-05","2023-02-27","2023-02-27","2022-01-21","2022-01-21","2022-05-17","2022-12-20","2022-11-10","2021-03-03","2021-05-19","2023-03-07","2023-03-07","2023-03-07","2023-03-07","2023-03-07","2021-01-15","2022-01-25","2022-01-25","2022-01-25","2022-04-26","2023-01-30","2022-04-26","2022-04-26","2022-11-10","2023-01-30","2023-01-30","2023-01-30","2021-01-15","2021-01-15","2021-09-17","2021-04-21","2021-09-17","2021-11-23","2021-11-23","2021-11-23","2022-08-19","2022-07-28","2022-07-28","2022-08-19","2022-08-19","2023-02-14","2021-04-07","2021-04-14","2022-07-29","2022-07-29","2022-07-29","2022-07-29"],"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":[["","00186037220","SYMBICORT AER","80-4.5","10","Select","Select",""],["","47781091601","DEXAMETHASON TAB","6MG","15","Select","Select",""],["","59310058020","PROAIR RESPI AER","","1","Select","Select",""],["","00378247401","DICLOFEN POT TAB","50MG","21","Select","Select",""],["","27808023302","DOXYCYCL HYC CAP","100MG","21","Select","Select",""],["","00093317431","ALBUTEROL AER HFA","","8","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","50111033402","METRONIDAZOL TAB","500MG","14","Select","Select",""],["","65862014836","SUMATRIPTAN TAB","100MG","9","Select","Select",""],["","60505082901","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","00378668977","PANTOPRAZOLE TAB","40MG","90","Select","Select",""],["","00527551337","AMPHET\/DEXTR CAP","20MG ER","60","Select","Select",""],["","54092038701","ADDERALL XR CAP","20MG","60","Select","Select",""],["","00310737020","BUDES\/FORMOT AER","160-4.5","10","Select","Select",""],["","31722072690","MONTELUKAST TAB","10MG","90","Select","Select",""],["","52817033200","CYCLOBENZAPR TAB","10MG","10","Select","Select",""],["","69238137403","TOBRA\/DEXAME SUS","0.3-0.1%","5","Select","Select",""],["","00591544243","PREDNISONE PAK","10MG","48","Select","Select",""],["","00781185220","AMOX\/K CLAV TAB","875-125","14","Select","Select",""],["","60432053760","NYSTATIN SUS","100000","180","Select","Select",""],["","60505057804","AZELASTINE DRO","0.05%","6","Select","Select",""],["","60432060416","PROMETHAZINE SYP DM","","100","Select","Select",""],["","00406052201","OXYCOD\/APAP TAB","7.5-325","28","Select","Select",""],["","00172392670","DIAZEPAM TAB","5MG","20","Select","Select",""],["","00023031204","REFRESH LACR OIN OP","","4","Select","Select",""],["","24208079535","NEO\/POLY\/DEX OIN","0.1% OP","4","Select","Select",""],["","70069000701","OLOPATADINE DRO","0.1%","5","Select","Select",""],["","72578008601","DESONIDE CRE","0.05%","15","Select","Select",""],["","00574402435","ERYTHROMYCIN OIN","5MG\/GM","4","Select","Select",""],["","42806040021","METHYLPRED TAB","4MG","21","Select","Select",""],["","60505083305","AZELASTINE SPR","0.1%","30","Select","Select",""],["","57237007710","ONDANSETRON TAB","4MG ODT","15","Select","Select",""],["","42806071501","BENZONATATE CAP","200MG","42","Select","Select",""],["","00781713593","MOXIFLOXACIN SOL HCL","0.5%","3","Select","Select",""],["","69842087651","CVS ACETAMIN TAB","325MG","32","Select","Select",""],["","65162018810","NAPROXEN TAB","250MG","24","Select","Select",""],["","70954006020","PREDNISONE TAB","20MG","10","Select","Select",""],["","00781808926","AZITHROMYCIN TAB","250MG","6","Select","Select",""],["","73796039150","AIR TUBE MIS \/PLUGS","","1","Select","Select",""],["","76204060030","IPRATROPIUM\/ SOL ALBUTER","","360","Select","Select",""],["","17478071311","OFLOXACIN DRO","0.3% OP","10","Select","Select",""],["","00378113401","KETOROLAC TAB","10MG","20","Select","Select",""],["","42806031250","DOXYCYCLINE HYCLATE","100 MG","14","Select","Select",""],["","66685100100","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","14","Select","Select",""],["","00186037220","SYMBICORT","80-4.5 MCG","10.2","Select","Select",""],["","00023031204","REFRESH LACRI-LUBE","42.5-56.8%","3.5","Select","Select",""],["","00781235201","DEXTROAMPHETAMINE-AMPHET ER","20 MG","60","Select","Select",""],["","64980051505","OFLOXACIN","0.3 %","15","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","00378668977","PANTOPRAZOLE SODIUM","40 MG","90","Select","Select",""],["","42806071501","BENZONATATE","200 MG","42","Select","Select",""],["","42806040021","METHYLPREDNISOLONE","4 MG","21","Select","Select",""],["","72578008601","DESONIDE","0.05 %","15","Select","Select",""],["","50111033402","METRONIDAZOLE","500 MG","14","Select","Select",""],["","31722071730","ATOMOXETINE HCL","40 MG","30","Select","Select",""],["","63824002335","MUCINEX","1200 MG","10","Select","Select",""],["","00310737020","BUDESONIDE-FORMOTEROL FUMARATE","160-4.5MCG","10.2","Select","Select",""],["","61314030802","AZELASTINE HCL","0.05 %","6","Select","Select",""],["","76204060030","IPRATROPIUM-ALBUTEROL","0.5-3MG\/3","360","Select","Select",""],["","65862014836","SUMATRIPTAN SUCCINATE","100 MG","9","Select","Select",""],["","57237000511","FLUCONAZOLE","150 MG","1","Select","Select",""],["","00406851001","OXYCODONE HCL","10 MG","20","Select","Select",""],["","70069000701","OLOPATADINE HCL","0.1 %","5","Select","Select",""],["","65862042005","SULFAMETHOXAZOLE-TRIMETHOPRIM","800-160 MG","6","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":""}]}]}