{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NANCY KNIGHT","gend":1,"add":"1810 N 21 ST APT B","city":"RICHMOND","state":"VA","zip":"23223-9998","dob":"1966-01-14","age":"","mstatus":"","insh":"20063350*01","cliId":"","pno":8044421550,"cno":8044421550,"email":"","ename":"","eno":"","pphy":"WALLACE, NANCY V NP","ppno":8047832505,"pcpadd":"517 WEST GRACE ST,","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":"23220-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8047832514,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F20.0","J02.9","NO DATA","F17.200","F20.9","M17.11","F31.9","F41.1","R06.02","R52.","S05.02XA","Y99.9","S29.011A","J45.909","Z87.891","R05.9","X03.1XXA","T26.40XA","M25.561","R32.","J39.2","R51.9","R11.0","Z20.822","J34.89","R31.9","N39.3","R35.0","F25.1","Z76.0"],"date":["2022-08-02","2023-03-09","2023-02-11","2023-03-09","2021-05-03","2022-05-23","2022-03-20","2022-03-20","2023-03-09","2023-02-11","2021-05-10","2021-05-07","2022-12-07","2022-12-07","2022-12-07","2023-03-09","2021-05-10","2021-05-10","2022-06-01","2023-01-11","2023-01-11","2023-01-11","2023-01-11","2023-03-09","2023-03-09","2021-12-21","2023-07-30","2021-12-21","2022-09-25","2023-07-30"],"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":[["","69238168101","FLUPHENAZINE","TAB 10MG","60","Select","Select",""],["","00713067831","NYSTATIN","CRE 100000","30","Select","Select",""],["","68001025344","FLUCONAZOLE","150 MG","1","Select","Select",""],["","76385010401","BENZTROPINE","TAB 1MG","60","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","69784050001","EC-NAPROXEN","TAB 500MG","60","Select","Select",""],["","69543042610","NAPROXEN DR","TAB 500MG","60","Select","Select",""],["","69437041601","EC-NAPROSYN","TAB 500MG","60","Select","Select",""],["","82607066026","FLOWFLEX","KIT TEST","2","Select","Select",""],["","00228255106","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","68462019001","NAPROXEN","500 MG","60","Select","Select",""],["","00173068220","VENTOLIN HFA","AER ","18","Select","Select",""],["","51672127502","CLOTRIMAZOLE","1 %","60","Select","Select",""],["","00228255106","DICLOFENAC SODIUM","75 MG","60","Select","Select",""],["","00603243832","BENZTROPINE MESYLATE","1 MG","30","Select","Select",""],["","61269073063","MICONAZOLE","7 2 %","45","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","90 MCG","18","Select","Select",""],["","51224000150","BENZONATATE","200 MG","42","Select","Select",""],["","69238168101","FLUPHENAZINE HCL","10 MG","60","Select","Select",""],["","82607066026","FLOWFLEX COVID-","19 AG HOME TEST","2","Select","Select",""],["","63736044704","MONISTAT","7 100 MG-2 %","44","Select","Select",""],["","00904676320","ROBAFEN","100 MG\/5ML","118","Select","Select",""],["","76385010401","BENZTROPINE TAB","1MG","30","Select","Select",""],["","00713067831","NYSTATIN CRE","100000","30","Select","Select",""],["","68001025320","FLUCONAZOLE TAB","150MG","2","Select","Select",""],["","69238168101","FLUPHENAZINE TAB","10MG","60","Select","Select",""],["","69543042610","NAPROXEN DR TAB","500MG","60","Select","Select",""],["","69437041601","EC-NAPROSYN TAB","500MG","60","Select","Select",""],["","00591352530","LIDOCAINE PAD","5%","30","Select","Select",""],["","69784050001","EC-NAPROXEN TAB","500MG","60","Select","Select",""],["","82607066026","FLOWFLEX KIT TEST","","2","Select","Select",""],["","50228043605","NAPROXEN TAB","500MG","60","Select","Select",""],["","00228255106","DICLOFENAC TAB","75MG DR","60","Select","Select",""],["","00173068220","VENTOLIN HFA AER","","18","Select","Select",""],["","00536131628","ZINC OXIDE","20 %","60","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":""}]}]}