{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MAHJAMAL NEIKZAD","gend":1,"add":"11800 SHADYWOOD CT APT C","city":"HENRICO","state":"VA","zip":"23233-9998","dob":"1956-12-31","age":"","mstatus":"","insh":"20038815*01","cliId":"","pno":8049160055,"cno":8049160055,"email":"","ename":"","eno":"","pphy":"BURTON, RACHAEL A DO","ppno":8046122980,"pcpadd":"12320 W BROAD ST STE 204,","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":"23233-9998","pcpcounty":"","pcpid":"","pcpname":"Bon Secours Short Pump Primary Care","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8043602437,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I48.0","J44.9","M81.0","M25.561","M25.562","M47.896","M70.52","G89.29","Z71.89","R91.8","A31.0","R09.02","I34.0","I48.91","H26.492","H26.491","H35.3221","H35.3112","J45.909","J96.21","K21.9","U07.1","J18.9","Z79.82","R07.9","Z00.00","Z12.31","M70.51","Z01.419","Z12.11","R73.9","Z13.220","Z68.23","R14.0","K59.09","R10.84","R35.0","R10.9","N28.9","J44.1","K59.00","NO DATA","I10.","R09.81","N26.1","B18.1","J60.","K58.9","Z68.24","R10.13","R10.30","K59.04","Z71.9","R07.89","R06.02","Z20.822","B34.9","J40.","R05.9","R76.11","Z99.81","Z79.51","R63.6","R06.2","R93.89","J10.1","K58.1","Z04.9","Z23.","E55.9","E53.8","J42.","I95.9","E53.9","Z79.899","Z88.8","Z13.6","J96.11","Z86.19","R76.8","H61.23","K52.9","M25.552","E86.0","R50.9"],"date":["2022-12-04","2023-05-31","2022-12-01","2023-06-20","2023-06-20","2021-10-27","2021-10-27","2023-06-20","2021-02-09","2023-05-22","2023-02-27","2023-05-22","2022-12-05","2022-12-05","2023-04-13","2023-04-20","2023-01-30","2023-01-30","2022-02-28","2022-12-05","2022-12-01","2022-12-30","2022-12-30","2023-05-29","2023-05-12","2021-05-17","2021-12-27","2021-10-27","2021-05-17","2021-12-27","2021-05-17","2021-05-17","2021-05-17","2022-01-05","2022-01-05","2022-05-19","2022-03-01","2022-03-01","2022-03-01","2023-03-04","2022-12-03","2023-05-18","2023-05-29","2023-03-04","2022-04-18","2022-07-18","2022-07-18","2022-04-18","2022-04-18","2022-05-19","2022-05-19","2022-05-19","2023-05-22","2022-12-01","2022-12-01","2023-02-14","2023-02-14","2023-02-14","2023-02-14","2023-05-22","2022-02-18","2022-12-01","2022-12-29","2023-02-14","2022-10-10","2022-12-05","2023-05-18","2022-12-30","2021-12-27","2022-12-01","2021-12-27","2022-02-18","2022-12-01","2022-12-01","2022-12-01","2022-12-01","2023-05-12","2023-05-18","2023-05-18","2023-05-18","2023-05-10","2023-05-29","2023-06-20","2023-05-29","2023-05-29"],"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":[["","00378797052","IPRATROPIUM","SOL 0.02%INH","250","Select","Select",""],["","45802046564","KETOCONAZOLE","2 %","120","Select","Select",""],["","31604001870","VITAMIN D","TAB 1000UNIT","30","Select","Select",""],["","00186037020","SYMBICORT","160-4.5MCG","10.2","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","30","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","40985022309","B-12","TAB 500MCG","30","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","57237016199","OMEPRAZOLE","CAP 20MG","90","Select","Select",""],["","80777027399","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","54629058501","VITAMIN B-12","TAB 500MCG","30","Select","Select",""],["","00456120330","LINZESS","72 MCG","30","Select","Select",""],["","00143312601","DICYCLOMINE","CAP 10MG","60","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","72789010814","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","80681016801","VITAMIN D3","TAB 25MCG","30","Select","Select",""],["","43386031214","GAVILAX","POW ","510","Select","Select",""],["","70461042110","FLUCLVX QUAD","INJ 2021-22","0","Select","Select",""],["","00254302902","LUBIPROSTONE","CAP 24MCG","60","Select","Select",""],["","45802048678","DOCUSATE SOD","CAP 100MG","60","Select","Select",""],["","00378827052","ALBUTEROL","NEB 0.00083","75","Select","Select",""],["","49281012265","FLUZONE HD","INJ 2022-23","1","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","65649000330","TRULANCE","TAB 3MG","30","Select","Select",""],["","59267102504","PFIZER VACC","INJ ADLT RTU","0","Select","Select",""],["","64380094906","PREDNISONE","50 MG","5","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","31604002683","D3","TAB 1000UNIT","30","Select","Select",""],["","59779046708","ASPIRIN LOW","CHW 81MG","30","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","42","Select","Select",""],["","68180086211","AZITHROMYCIN","500 MG","3","Select","Select",""],["","64380071207","BENZONATATE","100 MG","50","Select","Select",""],["","12843039324","MILK OF MAGN","SUS 400\/5ML","355","Select","Select",""],["","67877054360","CEFDINIR","CAP 300MG","4","Select","Select",""],["","00054418625","DEXAMETHASON","TAB 6MG","10","Select","Select",""],["","57664050658","METOPROL TAR","TAB 25MG","60","Select","Select",""],["","00378797052","IPRATROPIUM BROMIDE","0.2 MG\/ML","250","Select","Select",""],["","65862057490","MONTELUKAST SODIUM","10 MG","30","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","00597007541","SPIRIVA HANDIHALER","18 MCG","30","Select","Select",""],["","00310737020","BUDESONIDE-FORMOTEROL FUMARATE","160-4.5MCG","10.2","Select","Select",""],["","70436015542","PROMETHAZINE-DM","6.25-15\/5","240","Select","Select",""],["","65862039010","ONDANSETRON ODT","4 MG","12","Select","Select",""],["","68180072003","AMLODIPINE BESYLATE","5 MG","90","Select","Select",""],["","68180098003","LISINOPRIL","10 MG","30","Select","Select",""],["","00254302902","LUBIPROSTONE CAP","24MCG","60","Select","Select",""],["","45802048678","DOCUSATE SOD CAP","100MG","120","Select","Select",""],["","45802046564","KETOCONAZOLE SHA","2%","120","Select","Select",""],["","57237016199","OMEPRAZOLE CAP","20MG","30","Select","Select",""],["","00378797052","IPRATROPIUM SOL","0.02%INH","250","Select","Select",""],["","00186037020","SYMBICORT AER","160-4.5","10","Select","Select",""],["","00597007541","SPIRIVA CAP HANDIHLR","","30","Select","Select",""],["","69097052444","DICLOFENAC GEL","1%","100","Select","Select",""],["","70461042110","FLUCLVX QUAD INJ","2021-22","0","Select","Select",""],["","49281012265","FLUZONE HD INJ","2022-23","1","Select","Select",""],["","00310737020","BUDES\/FORMOT AER","160-4.5","31","Select","Select",""],["","59267102504","PFIZER VACC INJ ADLT RTU","","0","Select","Select",""],["","76204020030","ALBUTEROL NEB","0.083%","90","Select","Select",""],["","00093317431","ALBUTEROL AER HFA","","8","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","65862057490","MONTELUKAST TAB","10MG","30","Select","Select",""],["","00378064110","PREDNISONE TAB","10MG","50","Select","Select",""],["","00143312601","DICYCLOMINE CAP","10MG","60","Select","Select",""],["","65649000330","TRULANCE TAB","3MG","30","Select","Select",""],["","31604001870","VITAMIN D TAB","1000UNIT","30","Select","Select",""],["","40985022309","B-","12 TAB 500MCG","30","Select","Select",""],["","00456120230","LINZESS CAP","290MCG","30","Select","Select",""],["","31604002683","D","3 TAB 1000UNIT","30","Select","Select",""],["","67877054360","CEFDINIR CAP","300MG","4","Select","Select",""],["","68180016011","AZITHROMYCIN TAB","250MG","6","Select","Select",""],["","57664050658","METOPROL TAR TAB","25MG","60","Select","Select",""],["","59779046708","ASPIRIN LOW CHW","81MG","30","Select","Select",""],["","12843039324","MILK OF MAGN SUS","400\/5ML","355","Select","Select",""],["","64380071307","BENZONATATE CAP","200MG","30","Select","Select",""],["","00093310905","AMOXICILLIN CAP","500MG","42","Select","Select",""],["","00054418625","DEXAMETHASON TAB","6MG","10","Select","Select",""],["","69097052444","DICLOFENAC SODIUM","1 %","100","Select","Select",""],["","66993096045","METRONIDAZOLE","0.75 %","45","Select","Select",""],["","76385012450","METHOCARBAMOL","750 MG","20","Select","Select",""],["","59746000103","METHYLPREDNISOLONE","4 MG","21","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":""}]}]}