{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MONICA  D MINOR","gend":1,"add":"3513 BRIEL ST UNIT 106","city":"RICHMOND","state":"VA","zip":"23223-9998","dob":"1964-04-23","age":"","mstatus":"","insh":"20038565*01","cliId":"","pno":8049390944,"cno":8049390944,"email":"","ename":"","eno":"","pphy":"ELLIOTT, CHARMAINE N MD","ppno":8046441665,"pcpadd":"SUITE 308 1510 N 28TH STREET","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":"23223-9998","pcpcounty":"","pcpid":"","pcpname":"Primary Healthcare Associates","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8046445285,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K52.9","Z68.30","F25.0","S90.121A","M79.674","M50.30","M79.602","S63.502A","R21.","Z86.010","K21.9","K59.09","R10.11","K29.70","K22.2","K44.9","K64.8","J39.2","R12.","R14.3","R14.0","R19.5","R63.4","B96.81","R59.1","M25.532","Z98.890","J45.909","I10.","M19.90","Z79.899","G56.02","R05.9","Z01.810","D17.22","F31.30","S00.03XA","M19.032","S09.90XA","Z87.440","N81.9","R31.29","R30.9","N89.9","R31.9","Z01.812","U07.1","Z20.822","M79.675","E66.9","Z68.29","V58.89","Z68.34","Z20.828","M17.0","R10.13","Z11.3","R35.0","M79.671","G44.229","F31.9","R73.03","Z86.79","D17.1","Z68.32","S90.31XA","L50.9","L29.9","R30.0","N76.0","R05.1","J45.20","L73.9","Z12.31","B00.9","S93.402A","Y93.89","G56.01","Z01.411","N39.0","Z12.9","Z01.419","N76.4","B37.3","M54.5","L03.313","Z68.31","K92.1","K59.00","R10.9","M20.41","M20.42","B07.0","J20.8","G47.01","NO DATA","N90.89","R11.10","R93.5","I44.0","R10.31","K03.89","N30.00","L03.032","V54.12","S52.532S","M25.512","M95.8","M25.572","G89.29"],"date":["2022-07-25","2022-10-24","2023-03-17","2022-07-24","2022-07-24","2022-10-31","2022-10-31","2023-02-20","2021-06-03","2021-02-08","2023-01-06","2021-02-08","2021-05-14","2021-04-05","2021-04-05","2021-04-05","2021-04-05","2021-05-13","2021-05-13","2021-05-13","2021-05-13","2021-05-13","2021-07-28","2021-11-02","2021-06-23","2023-03-10","2021-12-22","2022-07-24","2023-02-15","2021-12-10","2022-07-24","2023-04-14","2022-01-01","2022-10-27","2022-11-08","2022-11-08","2023-02-04","2023-02-20","2023-02-22","2022-01-07","2022-01-07","2022-11-14","2022-05-23","2021-06-07","2022-08-25","2022-01-06","2022-01-06","2023-02-28","2022-04-29","2022-04-29","2022-04-29","2023-04-03","2023-02-15","2021-12-29","2022-07-24","2021-10-08","2022-11-14","2022-05-23","2022-07-25","2023-01-06","2023-01-06","2023-01-06","2023-01-06","2021-12-27","2021-12-27","2022-08-11","2022-09-22","2022-09-22","2023-01-24","2023-01-24","2023-02-28","2021-01-21","2021-01-21","2021-01-21","2022-08-25","2022-09-06","2022-09-06","2022-10-31","2022-11-28","2022-11-28","2022-11-28","2021-01-28","2021-03-31","2021-05-03","2021-05-03","2021-07-20","2021-07-28","2021-11-02","2021-11-02","2021-11-02","2022-06-01","2022-06-01","2022-06-01","2022-12-28","2022-02-04","2022-02-04","2022-01-07","2021-10-01","2021-10-01","2021-06-10","2021-08-16","2022-05-14","2022-05-14","2022-05-14","2023-04-14","2023-03-20","2023-04-26","2023-04-14","2023-04-14","2023-04-14"],"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":[["","69097082607","BENZTROPINE","TAB 0.5MG","60","Select","Select",""],["","00115180301","HYDROXYZ PAM","CAP 25MG","60","Select","Select",""],["","00378033401","HALOPERIDOL","10 MG","60","Select","Select",""],["","60505265401","TRAZODONE","TAB 100MG","30","Select","Select",""],["","60505015801","BUPROPION","TAB 75MG","60","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","00173068220","VENTOLIN HFA","AER ","54","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","54","Select","Select",""],["","45802006336","TRIAMCINOLON","CRE 0.00025","80","Select","Select",""],["","33342007107","OLANZAPINE","15 MG","30","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","14","Select","Select",""],["","68382050010","OMEPRAZOLE","40 MG","90","Select","Select",""],["","51079030630","POLYETH GLYC","POW 3350 NF","30","Select","Select",""],["","59762040101","SUCRALFATE","TAB 1GM","120","Select","Select",""],["","00363052812","ANTACID MAX","SUS ANTI-GAS","300","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","20","Select","Select",""],["","65162062711","TRAMADOL HCL","TAB 50MG","15","Select","Select",""],["","10572030201","PEG-3350\/KCL","SOL \/SODIUM","4000","Select","Select",""],["","75834002012","VITAMIN D3","CAP 50000UNT","8","Select","Select",""],["","00378668977","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","00363031901","SOOTHE","CHW 262MG","56","Select","Select",""],["","00781707787","METRONIDAZOL","GEL 0.75%VAG","70","Select","Select",""],["","00591247501","TETRACYCLINE","CAP 500MG","56","Select","Select",""],["","00168034646","TERCONAZOLE","CRE 0.004","45","Select","Select",""],["","45802009735","ESTRADIOL","CRE 0.0001","42","Select","Select",""],["","70700026894","FOSFOMYCIN","POW 3GM","1","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","30","Select","Select",""],["","57237007810","ONDANSETRON","TAB 8MG ODT","15","Select","Select",""],["","59267102501","PFIZER VACC","INJ ADLT RTU","0","Select","Select",""],["","00378161001","DICYCLOMINE","CAP 10MG","120","Select","Select",""],["","51293061201","PHENAZOPYRID","TAB 200MG","9","Select","Select",""],["","00143992701","CIPROFLOXACN","TAB 250MG","14","Select","Select",""],["","60846050201","PYRIDIUM","TAB 200MG","9","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","6","Select","Select",""],["","00527169505","BUT\/APAP\/CAF","TAB ","20","Select","Select",""],["","70010077001","METHOCARBAM","TAB 750MG","20","Select","Select",""],["","68462019005","NAPROXEN","500 MG","20","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","1","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","30","Select","Select",""],["","64980018106","DIFLUNISAL","TAB 500MG","20","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","21","Select","Select",""],["","33332032101","AFLURIA QUAD","INJ 2021-22","0","Select","Select",""],["","00406048410","APAP\/CODEINE","TAB 300-30MG","8","Select","Select",""],["","27808023302","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","62542030117","HYD POL\/CPM","SUS 10-8\/5ML","50","Select","Select",""],["","64380080707","IBUPROFEN","800 MG","20","Select","Select",""],["","00378427577","VALACYCLOVIR","500 MG","90","Select","Select",""],["","00168009930","KETOCONAZOLE","CRE 0.02","30","Select","Select",""],["","23155050001","HYDROXYZ HCL","TAB 10MG","90","Select","Select",""],["","10135014901","DIPHENHYDRAM","CAP 25MG","20","Select","Select",""],["","49502010202","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","00406051205","OXYCOD\/APAP","TAB 5-325MG","21","Select","Select",""],["","00093083205","CLONAZEPAM","0.5 MG","45","Select","Select",""],["","59746017506","PREDNISONE","TAB 20MG","21","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","15","Select","Select",""],["","00006483703","PNEUMOVAX 23","INJ 25\/0.5","0","Select","Select",""],["","00406324301","HYDROMORPHON","TAB 2MG","28","Select","Select",""],["","58160089052","FLUARIX QUAD","INJ 2022-23","0","Select","Select",""],["","60432060416","PROMETHAZINE","SYP DM","240","Select","Select",""],["","19515080852","FLULAVAL QUA","INJ 2022-23","0","Select","Select",""],["","00126007292","PREVDNT 5000","PST 0.011","100","Select","Select",""],["","00406012305","HYDROCODONE-ACETAMINOPHEN","5 MG-325MG","20","Select","Select",""],["","45802013970","METRONIDAZOLE","0.75 %","70","Select","Select",""],["","23155050001","HYDROXYZINE HCL","10 MG","90","Select","Select",""],["","16571020210","DICLOFENAC SODIUM","50 MG","20","Select","Select",""],["","60505265401","TRAZODONE HCL","100 MG","30","Select","Select",""],["","42806071401","BENZONATATE","100 MG","15","Select","Select",""],["","42806040021","METHYLPREDNISOLONE","4 MG","21","Select","Select",""],["","00406051205","OXYCODONE-ACETAMINOPHEN","5 MG-325MG","8","Select","Select",""],["","00536132701","ACETAMINOPHEN","325 MG","56","Select","Select",""],["","68382005105","MELOXICAM","15 MG","90","Select","Select",""],["","00185012201","NITROFURANTOIN MONO-MACRO","100 MG","14","Select","Select",""],["","57237007710","ONDANSETRON ODT","4 MG","10","Select","Select",""],["","55111017915","TIZANIDINE HCL","2 MG","60","Select","Select",""],["","60505015801","BUPROPION HCL","75 MG","60","Select","Select",""],["","00603243721","BENZTROPINE MESYLATE","0.5 MG","60","Select","Select",""],["","55111034001","AMLODIPINE BESYLATE-BENAZEPRIL","5 MG-20 MG","90","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":""}]}]}