{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KATIA E SURICATA","gend":1,"add":"17 E GRACE STREET APT C ALEXIS STRONG","city":"RICHMOND","state":"VA","zip":"23219-9998","dob":"1994-03-24","age":"","mstatus":"","insh":"20057042*01","cliId":"","pno":8042003812,"cno":8042003812,"email":"","ename":"","eno":"","pphy":"SHERRIER-EDWARDS, YORLENY A PA","ppno":4343249150,"pcpadd":"527 POCKET RD,","pcpcity":"HURT","pcpstate":"VA","pcpzip":"24563-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4343248248,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D64.9","F43.12","F33.9","F90.2","F33.1","F90.9","F64.9","R10.2","R35.0","Q79.60","M35.7","R29.3","M54.9","M53.2X2","Q79.62","R43.2","K14.0","H69.92","H93.293","H04.123","L71.0","R13.10","K21.9","G47.00","M26.623","H92.03","H93.299","F41.9","K59.00","K31.84","R13.19","R21.","S93.601A","X50.1XXA","Y92.832","B35.3","L30.9","Z13.9","Z20.822","Z00.00","D61.9","G62.89","NO DATA"],"date":["2022-05-24","2022-07-19","2022-03-29","2022-03-29","2023-01-16","2023-01-16","2023-01-16","2021-01-11","2021-01-11","2021-11-18","2021-01-18","2021-11-08","2021-11-08","2021-11-08","2021-11-08","2021-03-23","2021-03-23","2021-11-18","2021-11-18","2022-05-03","2022-10-05","2021-04-27","2021-04-27","2021-08-03","2021-11-18","2021-11-18","2021-11-18","2022-03-29","2022-04-04","2022-04-04","2021-03-29","2023-01-06","2021-10-03","2021-10-03","2021-10-03","2021-08-26","2022-03-26","2021-03-22","2021-03-22","2022-02-22","2022-02-22","2023-08-30","2023-08-30"],"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":[["","00555088702","ESTRADIOL","2 MG","270","Select","Select",""],["","53746051501","SPIRONOLACT","TAB 100MG","60","Select","Select",""],["","68180035306","SERTRALINE","TAB 100MG","60","Select","Select",""],["","68382050010","OMEPRAZOLE","40 MG","90","Select","Select",""],["","00378001805","METOPROL TAR","TAB 25MG","60","Select","Select",""],["","57664037708","TRAMADOL HCL","50 MG","90","Select","Select",""],["","54092054701","MOTEGRITY","TAB 2MG","90","Select","Select",""],["","00469260130","MYRBETRIQ","TAB 25MG","30","Select","Select",""],["","16729031801","OXYBUTYNIN","TAB 10MG ER","30","Select","Select",""],["","54092038701","ADDERALL XR","CAP 20MG","30","Select","Select",""],["","00456120130","LINZESS","CAP 145MCG","30","Select","Select",""],["","00406895601","AMPHET\/DEXTR","CAP 30MG ER","30","Select","Select",""],["","00527131301","PILOCARPINE","TAB 5MG","90","Select","Select",""],["","59417010410","VYVANSE","CAP 40MG","30","Select","Select",""],["","60505470203","SOLIFENACIN","TAB 5MG","30","Select","Select",""],["","68462029855","CLOTRIM\/BETA","CRE DIPROP","45","Select","Select",""],["","49281042150","FLUZONE QUAD","INJ 2021-22","0","Select","Select",""],["","65862015901","ZOLPIDEM","TAB 5MG","30","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","60","Select","Select",""],["","59267102503","PFIZER VACC","INJ ADLT RTU","0","Select","Select",""],["","50458058801","CONCERTA","27 MG","30","Select","Select",""],["","13811070810","METHYLPHENID","TAB 36MG ER","30","Select","Select",""],["","82607066026","FLOWFLEX","KIT TEST","8","Select","Select",""],["","68462031417","NYSTAT\/TRIAM","CRE ","15","Select","Select",""],["","67877043103","ARIPIPRAZOLE","5 MG","30","Select","Select",""],["","67877025115","TRIAMCINOLON","CRE 0.001","15","Select","Select",""],["","00713063337","METRONIDAZOL","CRE 0.0075","45","Select","Select",""],["","59267030402","PFIZER BIVAL","INJ BA4\/BA5","0","Select","Select",""],["","11877001140","BINAXNOW COV","KIT HOME TES","8","Select","Select",""],["","58160089052","FLUARIX QUAD","INJ 2022-23","0","Select","Select",""],["","62175031137","METHYLPHENIDATE ER","27 MG","30","Select","Select",""],["","00378001805","METOPROLOL TARTRATE","25 MG","60","Select","Select",""],["","50111056003","TRAZODONE HCL","50 MG","60","Select","Select",""],["","00472037945","CLOTRIMAZOLE-BETAMETHASONE","1 %-0.05 %","45","Select","Select",""],["","53746051505","SPIRONOLACTONE","100 MG","180","Select","Select",""],["","68180035302","SERTRALINE HCL","100 MG","60","Select","Select",""],["","50458058601","CONCERTA TAB","36MG","30","Select","Select",""],["","60505265301","TRAZODONE TAB","50MG","135","Select","Select",""],["","13811070810","METHYLPHENID TAB","36MG ER","30","Select","Select",""],["","00555088702","ESTRADIOL TAB","2MG","270","Select","Select",""],["","00378001805","METOPROL TAR TAB","25MG","60","Select","Select",""],["","68180035306","SERTRALINE TAB","100MG","180","Select","Select",""],["","57664037708","TRAMADOL HCL TAB","50MG","30","Select","Select",""],["","68382050010","OMEPRAZOLE CAP","40MG","90","Select","Select",""],["","82607066026","FLOWFLEX KIT TEST","","8","Select","Select",""],["","68462031417","NYSTAT\/TRIAM CRE","","15","Select","Select",""],["","00456120130","LINZESS CAP","145MCG","30","Select","Select",""],["","16729022701","SPIRONOLACT TAB","100MG","180","Select","Select",""],["","67877025115","TRIAMCINOLON CRE","0.1%","15","Select","Select",""],["","67877043103","ARIPIPRAZOLE TAB","5MG","90","Select","Select",""],["","59267102503","PFIZER VACC INJ ADLT RTU","","0","Select","Select",""],["","58160089052","FLUARIX QUAD INJ","2022-23","0","Select","Select",""],["","00713063337","METRONIDAZOL CRE","0.75%","45","Select","Select",""],["","59267030402","PFIZER BIVAL INJ BA","4\/BA5","0","Select","Select",""],["","11877001140","BINAXNOW COV KIT HOME TES","","8","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":""}]}]}