{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KENDRA GARRETT","gend":1,"add":"2110 REDD ST APT H114","city":"RICHMOND","state":"VA","zip":"23223-9998","dob":"1988-07-18","age":"","mstatus":"","insh":"20027729*01","cliId":"","pno":8043064622,"cno":8043064622,"email":"","ename":"","eno":"","pphy":"GUPTA, CHARU PA","ppno":8049685700,"pcpadd":"SUITE 100 5000 COX ROAD,","pcpcity":"GLEN ALLEN","pcpstate":"VA","pcpzip":"23060-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8049685739,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M79.645","Z76.0","R10.9","I10.","J45.909","K21.9","G47.30","G40.909","E11.9","E66.9","Z87.448","Z86.2","Z68.41","Z79.899","F41.1","F33.9","S63.602A","R42.","S76.911A","R10.10","R07.89","N39.0","V58.89","V54.12","M79.672","J06.9","Z20.822","Z86.16","R09.81","M54.2","M54.12","M25.542","Z20.828","B34.9","R05.","R10.33","R94.31","S93.602A","N30.00","R11.2","J01.00","R11.0"],"date":["2021-08-02","2022-12-17","2022-12-17","2023-08-23","2022-12-17","2022-12-17","2022-12-17","2022-12-17","2022-12-17","2022-12-17","2022-12-17","2022-12-17","2022-12-17","2022-12-17","2023-02-06","2023-02-06","2021-06-28","2023-05-05","2022-08-28","2021-03-15","2022-08-24","2021-03-15","2021-03-10","2022-05-26","2022-05-26","2022-09-08","2022-09-08","2022-05-26","2022-05-26","2022-11-14","2022-11-14","2021-06-23","2021-01-04","2021-01-04","2021-01-29","2021-01-29","2021-03-15","2022-05-27","2022-08-24","2022-09-08","2023-07-31","2023-08-23"],"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":[["","57896020110","PAIN RELIEF","TAB 500MG","20","Select","Select",""],["","57896010410","ACETAMINOPHE","TAB 325MG","20","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","68382004101","PROMETHAZINE","TAB 25MG","12","Select","Select",""],["","54838020940","SILTUSSIN-DM","SYP ALC FREE","118","Select","Select",""],["","00591079501","DICYCLOMINE","TAB 20MG","20","Select","Select",""],["","11822333230","RA TUSSIN DM","LIQ 100-10\/5","118","Select","Select",""],["","65162046650","IBUPROFEN","TAB 800MG","21","Select","Select",""],["","65862018730","ONDANSETRON","TAB 4MG","20","Select","Select",""],["","00185012201","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","43547035311","LISINOPRIL","10 MG","30","Select","Select",""],["","21922000909","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","53746010905","HYDROCO\/APAP","TAB 5-325MG","15","Select","Select",""],["","16571066101","MECLIZINE","TAB 25MG","10","Select","Select",""],["","31722053405","METHOCARBAM","TAB 750MG","10","Select","Select",""],["","42195095510","BUT\/APAP\/CAF","CAP ","12","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","67877022210","GABAPENTIN","CAP 100MG","15","Select","Select",""],["","65862001905","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","6","Select","Select",""],["","00121077516","GG\/CODEINE","SOL 100-10\/5","60","Select","Select",""],["","00093342210","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","42806031250","DOXYCYCL HYC","TAB 100MG","14","Select","Select",""],["","42195095510","BUT\/APAP\/CAF CAP","","12","Select","Select",""],["","00591352530","LIDOCAINE PAD","5%","30","Select","Select",""],["","67877022210","GABAPENTIN CAP","100MG","15","Select","Select",""],["","00093342210","CYCLOBENZAPR TAB","10MG","15","Select","Select",""],["","68382004101","PROMETHAZINE TAB","25MG","12","Select","Select",""],["","68180096301","ALBUTEROL AER HFA","","8","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","65862001905","CEPHALEXIN CAP","500MG","28","Select","Select",""],["","42858010201","OXYCOD\/APAP TAB","5-325MG","6","Select","Select",""],["","00121077516","GG\/CODEINE SOL","100-10\/5","60","Select","Select",""],["","42806031250","DOXYCYCL HYC TAB","100MG","14","Select","Select",""],["","53746010905","HYDROCO\/APAP TAB","5-325MG","15","Select","Select",""],["","31722053405","METHOCARBAM TAB","750MG","10","Select","Select",""],["","65862018730","ONDANSETRON TAB","4MG","20","Select","Select",""],["","00185012201","NITROFURANTN CAP","100MG","10","Select","Select",""],["","57896010410","ACETAMINOPHE TAB","325MG","20","Select","Select",""],["","68180098103","LISINOPRIL TAB","20MG","30","Select","Select",""],["","51224002230","AZITHROMYCIN","250 MG","6","Select","Select",""],["","68462015713","ONDANSETRON ODT","4 MG","2","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":""}]}]}