{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DOMINIQUE  M GALIWANGO","gend":0,"add":"1419 HARWOOD ST","city":"RICHMOND","state":"VA","zip":"23223-9998","dob":"2002-10-06","age":"","mstatus":"","insh":"20042786*01","cliId":"","pno":8049689384,"cno":8049689384,"email":"","ename":"","eno":"","pphy":"PAUL, CHRISTINE E MD","ppno":8042307777,"pcpadd":"4730 N SOUTHSIDE PLAZA,","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":"23224-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8042302071,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F90.0","F90.2","F32.1","F33.3","F33.1","F33.2","F41.1","F33.9","F32.0","S50.812A","S60.413A","S70.312A","M79.645","M79.632","M79.652","Z23.","T07.XXXA","F31.32","F31.10","R69.","F32.9","F25.0","S82.201B","V03.10XA","F31.5","W18.30XA","Y93.51","S82.251B","F31.81","F20.9","S70.211A","S50.311A","S50.312A","S60.512A","V09.20XA","T14.90XA","S82.251C","S00.81XA","S82.221C","S82.421C","S50.811A","S60.511A","S82.301B","Z09.","F70.","S82.451B"],"date":["2022-06-19","2022-10-22","2022-02-21","2023-06-05","2022-09-20","2023-04-11","2023-04-13","2023-04-13","2023-01-17","2023-02-23","2023-02-16","2023-02-16","2023-02-16","2023-02-16","2023-02-16","2023-02-16","2023-02-22","2023-03-01","2023-01-26","2023-03-17","2023-05-09","2023-06-25","2023-02-23","2023-02-23","2022-12-11","2023-02-16","2023-02-16","2023-02-24","2023-05-24","2022-04-28","2023-02-23","2023-02-23","2023-02-23","2023-02-23","2023-02-23","2023-02-24","2023-02-23","2023-02-23","2023-02-23","2023-02-23","2023-02-23","2023-02-23","2023-02-23","2023-07-10","2021-03-19","2023-02-22"],"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":[["","50580072697","ZYRTEC ALLGY TAB","10MG","30","Select","Select",""],["","67877043003","ARIPIPRAZOLE","2 MG","30","Select","Select",""],["","60505265301","TRAZODONE HCL","50 MG","15","Select","Select",""],["","68180035103","SERTRALINE HCL","25 MG","30","Select","Select",""],["","43547028110","ESCITALOPRAM OXALATE","10 MG","30","Select","Select",""],["","00406055201","OXYCODONE HCL","5 MG","20","Select","Select",""],["","00548560100","ENOXAPARIN SODIUM","30MG\/0.3ML","18","Select","Select",""],["","49483008010","SENNA","8.6 MG","28","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":""}]}]}