{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TAQUAWN BELL","gend":0,"add":"700 DINWIDDIE AVE","city":"RICHMOND","state":"VA","zip":"23224-9998","dob":"1986-01-10","age":"","mstatus":"","insh":"20071404*01","cliId":"","pno":5402459658,"cno":5402459658,"email":"","ename":"","eno":"","pphy":"EDDY, JANET MD","ppno":8047862505,"pcpadd":"700 DINWIDDIE AVE,","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":8047832514,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z20.822","F41.9","J20.9","M62.838","F25.0","G43.909","R11.0","K21.9","R03.0","F25.9","F11.20","F12.20","F33.2","F33.1","F43.10","F13.20","F99.","R51.9","I10.","R94.8","S51.811A","R45.0","I49.1","R00.0","G43.919","H53.9","F11.129","R36.9","Z11.3","F29.","F19.10","NO DATA","R05.9","F31.81","J18.9","Z79.899","F34.9","F17.210","Z88.5","J03.90","Z59.00","F17.200","F41.8","R45.1","H53.149","F41.1","R68.89","F11.23","J45.20","S09.90XA","F31.75","F11.21","F43.23","Z76.0","M54.12","N34.2","V62.84","Z51.81","T40.2X1A","S01.81XA","R69.","R53.81","Z20.2","K59.00","S41.112A","T50.901A","F14.120","F11.10","F12.90","R41.0","X58.XXXA","R11.2","R42.","F19.94","F13.239","F31.9","Z86.59","M54.5","M79.604","F90.9","R39.9","N52.9","R05.8","J44.9","E66.9","G43.809","Z68.35","Z72.0","Z00.00","Z13.1","Z13.0","Z11.4","Z13.21","Z13.29","Z13.220","R31.9","G43.009"],"date":["2022-06-04","2022-09-12","2021-05-25","2021-05-25","2022-07-28","2022-11-17","2022-09-12","2022-05-03","2022-05-03","2022-05-03","2022-11-17","2022-09-06","2022-09-10","2022-09-18","2022-11-16","2022-11-17","2022-11-17","2022-12-17","2022-12-17","2022-12-17","2022-08-19","2022-09-10","2022-09-10","2022-09-12","2022-12-16","2022-09-11","2022-09-12","2022-06-02","2022-06-02","2022-06-07","2022-06-05","2022-11-07","2022-01-30","2022-06-17","2021-12-09","2022-06-13","2021-12-17","2022-12-30","2022-06-13","2022-07-16","2022-09-11","2022-09-11","2022-09-11","2022-09-12","2022-09-12","2022-09-19","2022-12-27","2022-12-30","2022-02-11","2022-09-11","2022-09-27","2022-09-27","2022-11-16","2021-04-09","2021-06-24","2021-06-24","2022-06-04","2022-08-11","2022-09-12","2022-09-12","2022-11-07","2022-11-07","2022-07-31","2022-08-05","2022-08-19","2022-09-12","2022-11-07","2022-11-07","2022-11-07","2022-09-12","2022-09-11","2022-09-12","2022-09-12","2022-12-30","2022-12-30","2022-12-30","2022-12-30","2021-09-03","2021-09-14","2021-09-03","2021-09-14","2021-09-14","2022-01-24","2022-01-24","2022-01-24","2022-01-24","2022-01-24","2022-01-30","2022-08-05","2022-08-05","2022-08-05","2022-08-05","2022-08-05","2022-08-05","2022-08-05","2022-08-05","2022-08-05"],"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":[["","00781543920","CEFPODOXIME","TAB 200MG","20","Select","Select",""],["","00228202750","ALPRAZOLAM","TAB 0.25MG","12","Select","Select",""],["","50383080216","PROMETH\/PE","SYP 6.25-5\/5","210","Select","Select",""],["","00121092716","PROMETHAZINE","SOL 6.25\/5ML","473","Select","Select",""],["","43547030403","ARIPIPRAZOLE","TAB 10MG","30","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","28","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","30","Select","Select",""],["","69097084507","CYCLOBENZAPR","TAB 5MG","21","Select","Select",""],["","59762444002","METHYLPRED","TAB 4MG","21","Select","Select",""],["","57664049983","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","60505025103","TIZANIDINE","TAB 2MG","30","Select","Select",""],["","62756052169","SUMATRIPTAN","TAB 50MG","9","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","7","Select","Select",""],["","24658031205","DOXYCYCL HYC","TAB 100MG","14","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","27241006803","SILDENAFIL","TAB 50MG","10","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","21","Select","Select",""],["","50111078810","AZITHROMYCIN","TAB 500MG","3","Select","Select",""],["","00173068220","VENTOLIN HFA","AER ","18","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","14","Select","Select",""],["","59651000305","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","00378064110","PREDNISONE","TAB 10MG","20","Select","Select",""],["","43598016630","OLANZAPINE","TAB 10MG","14","Select","Select",""],["","59779038421","CVS COUGH DM","SUS 30MG\/5ML","89","Select","Select",""],["","00093083205","CLONAZEPAM","TAB 0.5MG","60","Select","Select",""],["","68382080510","TRAZODONE","TAB 50MG","30","Select","Select",""],["","00067203924","EXCEDRIN","TAB MIGRAINE","60","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","29300046805","CLONIDINE","TAB 0.1MG","30","Select","Select",""],["","62011031001","ALLERGY RELF","TAB 25MG","30","Select","Select",""],["","16714061205","SERTRALINE","TAB 50MG","30","Select","Select",""],["","50428050854","CVS PURELAX","PAK ","3","Select","Select",""],["","00093506201","HYDROXYZ HCL","TAB 50MG","14","Select","Select",""],["","16714029904","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","59651017401","DOXEPIN HCL","CAP 25MG","60","Select","Select",""],["","67877019710","AMLODIPINE","TAB 2.5MG","30","Select","Select",""],["","47781035703","BUPREN\/NALOX","MIS 8-2MG","7","Select","Select",""],["","52569014167","HM MELATONIN","SUB 10MG","30","Select","Select",""],["","45963055650","GABAPENTIN","300 MG","30","Select","Select",""],["","27241000350","RISPERIDONE","TAB 0.5MG","30","Select","Select",""],["","00093216568","NALOXONE HCL","SPR 4MG","2","Select","Select",""],["","65862052790","VENLAFAXINE","CAP 37.5 ER","30","Select","Select",""],["","00781717612","NALOXONE","SPR ","2","Select","Select",""],["","50428030129","MELATONIN","SUB QUIK DIS","30","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","65862055990","PANTOPRAZOLE","TAB 20MG","30","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","00904515460","GUAIFENESIN","TAB 200MG","30","Select","Select",""],["","67618010160","COLACE","CAP 100MG","90","Select","Select",""],["","12496120803","SUBOXONE","MIS 8-2MG","7","Select","Select",""],["","00904699860","DOCUSATE SOD","CAP 100MG","90","Select","Select",""],["","70954002010","PRAZOSIN HCL","CAP 2MG","60","Select","Select",""],["","13668013601","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","69543042610","NAPROXEN DR","TAB 500MG","30","Select","Select",""],["","00591079501","DICYCLOMINE","TAB 20MG","12","Select","Select",""],["","13107015590","PAROXETINE","TAB 20MG","30","Select","Select",""],["","65862014736","SUMATRIPTAN SUCCINATE","50 MG","8","Select","Select",""],["","70408014634","PROMETHAZINE HCL","6.25MG\/5ML","690","Select","Select",""],["","50111056101","TRAZODONE HCL","100 MG","60","Select","Select",""],["","68462010530","ONDANSETRON HCL","4 MG","15","Select","Select",""],["","00904699860","DOCUSATE SODIUM","100 MG","90","Select","Select",""],["","65862052790","VENLAFAXINE HCL ER","37.5 MG","60","Select","Select",""],["","57237007710","ONDANSETRON ODT","4 MG","10","Select","Select",""],["","29300046810","CLONIDINE HCL","0.1 MG","6","Select","Select",""],["","00527128201","DICYCLOMINE HCL","20 MG","12","Select","Select",""],["","62011046301",""," ","60","Select","Select",""],["","00115180301","HYDROXYZINE PAMOATE","25 MG","30","Select","Select",""],["","68180065208","DOXYCYCLINE MONOHYDRATE","100 MG","14","Select","Select",""],["","13107008405","LORAZEPAM","1 MG","10","Select","Select",""],["","65862014736","SUMATRIPTAN TAB","50MG","14","Select","Select",""],["","00228202750","ALPRAZOLAM TAB","0.25MG","12","Select","Select",""],["","43598016630","OLANZAPINE TAB","10MG","14","Select","Select",""],["","00093083205","CLONAZEPAM TAB","0.5MG","60","Select","Select",""],["","70408014634","PROMETHAZINE SOL","6.25\/5ML","690","Select","Select",""],["","68180096301","ALBUTEROL AER HFA","","8","Select","Select",""],["","59779038421","CVS COUGH DM SUS","30MG\/5ML","89","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","59651000305","OMEPRAZOLE CAP","40MG","30","Select","Select",""],["","27241006803","SILDENAFIL TAB","50MG","10","Select","Select",""],["","50111033401","METRONIDAZOL TAB","500MG","14","Select","Select",""],["","24658031205","DOXYCYCL HYC TAB","100MG","14","Select","Select",""],["","67877019710","AMLODIPINE TAB","2.5MG","30","Select","Select",""],["","00093506201","HYDROXYZ HCL TAB","50MG","14","Select","Select",""],["","29300046810","CLONIDINE TAB","0.1MG","6","Select","Select",""],["","16714029904","AMOXICILLIN CAP","500MG","30","Select","Select",""],["","10702000350","PROMETHAZINE TAB","25MG","14","Select","Select",""],["","50111056101","TRAZODONE TAB","100MG","30","Select","Select",""],["","62011031001","ALLERGY RELF TAB","25MG","30","Select","Select",""],["","47781035703","BUPREN\/NALOX MIS","8-2MG","7","Select","Select",""],["","50111078810","AZITHROMYCIN TAB","500MG","3","Select","Select",""],["","65862055990","PANTOPRAZOLE TAB","20MG","30","Select","Select",""],["","59762444002","METHYLPRED TAB","4MG","21","Select","Select",""],["","12496120803","SUBOXONE MIS","8-2MG","7","Select","Select",""],["","50428050854","CVS PURELAX PAK","","3","Select","Select",""],["","00781717612","NALOXONE SPR","","2","Select","Select",""],["","00067203924","EXCEDRIN TAB MIGRAINE","","60","Select","Select",""],["","16714061205","SERTRALINE TAB","50MG","30","Select","Select",""],["","60432060816","PROMETHAZINE SYP","6.25\/5ML","130","Select","Select",""],["","59779030602","CVS PURELAX POW","","238","Select","Select",""],["","45963055650","GABAPENTIN CAP","300MG","30","Select","Select",""],["","00904515460","GUAIFENESIN TAB","200MG","30","Select","Select",""],["","11917017023","MELATONIN TAB","10MG","30","Select","Select",""],["","65862052790","VENLAFAXINE CAP","37.5 ER","60","Select","Select",""],["","00904699860","DOCUSATE SOD CAP","100MG","90","Select","Select",""],["","57237007710","ONDANSETRON TAB","4MG ODT","10","Select","Select",""],["","27241000350","RISPERIDONE TAB","0.5MG","30","Select","Select",""],["","68180012202","CEPHALEXIN CAP","500MG","28","Select","Select",""],["","52569014167","HM MELATONIN SUB","10MG","30","Select","Select",""],["","67618010160","COLACE CAP","100MG","90","Select","Select",""],["","59651017401","DOXEPIN HCL CAP","25MG","60","Select","Select",""],["","00093216568","NALOXONE HCL SPR","4MG","2","Select","Select",""],["","50428030129","MELATONIN SUB QUIK DIS","","30","Select","Select",""],["","00591079501","DICYCLOMINE TAB","20MG","12","Select","Select",""],["","13107015590","PAROXETINE TAB","20MG","30","Select","Select",""],["","70954002010","PRAZOSIN HCL CAP","2MG","60","Select","Select",""],["","13668013601","ESCITALOPRAM TAB","10MG","30","Select","Select",""],["","69543042610","NAPROXEN DR TAB","500MG","30","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":""}]}]}