{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KIM L WILSON","gend":1,"add":"5409 HULL STREET RD APT 3","city":"RICHMOND","state":"VA","zip":"23224-9998","dob":"1969-01-28","age":"","mstatus":"","insh":"20072537*01","cliId":"","pno":8049384901,"cno":8049384901,"email":"","ename":"","eno":"","pphy":"DEBOER, SARAH E MD","ppno":8047800840,"pcpadd":"719 N 25th St,","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":"23223-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8044201140,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["T40.601A","R45.1","F17.200","Z21.","F43.9","F33.3","F33.1","B20.","Z91.89","B37.0","J98.01","F32.9","L98.499","M25.50","G43.009","M25.551","L89.152","R52.","R41.82","F10.129","R56.9","R51.9","F19.10","F32.3","Z04.9","F31.9","Z76.0","F25.1"],"date":["2021-05-30","2021-05-30","2021-05-30","2021-05-30","2021-05-30","2021-09-12","2021-12-06","2022-09-21","2021-09-09","2021-09-09","2022-01-25","2021-05-21","2021-05-21","2022-01-25","2022-01-25","2021-05-10","2021-05-10","2021-05-10","2021-05-30","2021-05-30","2021-06-03","2021-06-03","2021-06-03","2021-08-05","2021-05-10","2022-09-21","2022-09-21","2023-08-01"],"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":[["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","00173068220","VENTOLIN HFA","AER ","18","Select","Select",""],["","70010077001","METHOCARBAM","TAB 750MG","15","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","55111014430","FLUCONAZOLE","100 MG","30","Select","Select",""],["","55111015330","ONDANSETRON","TAB 4MG","60","Select","Select",""],["","59267100001","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","14","Select","Select",""],["","16571020210","DICLOFENAC","TAB 50MG DR","20","Select","Select",""],["","50111078910","AZITHROMYCIN","TAB 600MG","8","Select","Select",""],["","65862041901","SMZ-TMP","TAB 400-80MG","30","Select","Select",""],["","49702022813","TIVICAY","50 MG","30","Select","Select",""],["","61958200201","DESCOVY","TAB 200\/25MG","30","Select","Select",""],["","59676057530","PREZCOBIX","800-150 MG","30","Select","Select",""],["","61958250101","BIKTARVY","50-200-25","30","Select","Select",""],["","29300034905","ALLOPURINOL","TAB 100MG","30","Select","Select",""],["","16714033002","GABAPENTIN","600 MG","90","Select","Select",""],["","65862014636","SUMATRIPTAN","TAB 25MG","9","Select","Select",""],["","69238152301","TETRACYCLINE HCL","500 MG","28","Select","Select",""],["","65862041901","SULFAMETHOXAZOLE-TRIMETHOPRIM","400MG-80MG","12","Select","Select",""],["","68462012605","GABAPENTIN TAB","600MG","270","Select","Select",""],["","65862041901","SMZ-TMP TAB","400-80MG","30","Select","Select",""],["","61958250101","BIKTARVY TAB","","30","Select","Select",""],["","55111015330","ONDANSETRON TAB","4MG","60","Select","Select",""],["","50111078910","AZITHROMYCIN TAB","600MG","8","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","65862014636","SUMATRIPTAN TAB","25MG","18","Select","Select",""],["","00378563059","SUMATRIPTAN SUCCINATE","25 MG","18","Select","Select",""],["","70074040711","ENSURE LIQUID","","14220","Select","Select",""],["","67877024201","QUETIAPINE FUMARATE","25 MG","30","Select","Select",""],["","57237007710","ONDANSETRON ODT","4 MG","21","Select","Select",""],["","66685100100","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","14","Select","Select",""],["","27241009803","DULOXETINE HCL","30 MG","30","Select","Select",""],["","13107003105","MIRTAZAPINE","15 MG","30","Select","Select",""],["","29300042010","AMITRIPTYLINE HCL","25 MG","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":""}]}]}