{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALEXIS S WILLIAMS","gend":1,"add":"211 ENGLESIDE DR APT 2B","city":"RICHMOND","state":"VA","zip":"23222-9998","dob":"1988-10-23","age":"","mstatus":"","insh":"20082169*01","cliId":"","pno":8049440383,"cno":8049440383,"email":"","ename":"","eno":"","pphy":"PEEBLES II, RICHARD MD","ppno":8048223480,"pcpadd":"SUITE 400 110 NORTH ROBINSON STREET,","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":"23220-9998","pcpcounty":"","pcpid":"","pcpname":"Primary Health Group - Retreat","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8043589477,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z71.2","R82.998","C49.5","Z92.3","Z98.890","Z01.810","Z01.812","N89.8","K21.9","I10.","C55.","D70.9","R50.81","D70.1","C54.2","Z85.831","Z92.21","Z90.710","Z90.79","Z90.722","D53.9","E66.01","Z68.44","Z79.899","N89.9","Z51.0","Z68.43","Z20.822","Z79.1","E66.9","R00.0","R94.6","D28.1","R51.9","Z53.21","R59.0","Z00.00","Z71.3","E66.3","D50.0","E11.9","R73.09","Z13.1","Z13.220","Z12.11","Z12.31","Z12.4","R10.13","E28.2","Z86.79","C49.9","N64.4","E11.65","R80.9"],"date":["2022-10-07","2022-10-07","2022-12-14","2023-01-17","2022-10-19","2023-01-09","2023-01-09","2023-01-17","2023-01-26","2023-07-26","2022-04-05","2022-04-28","2022-04-28","2022-05-01","2023-08-25","2023-01-17","2023-01-17","2023-01-17","2023-01-17","2023-01-17","2023-01-17","2023-01-17","2023-06-19","2023-01-17","2023-01-17","2022-03-15","2022-04-28","2022-04-28","2022-04-28","2023-05-23","2022-04-28","2022-09-13","2023-01-17","2023-03-17","2023-03-17","2023-05-23","2023-05-25","2023-05-25","2023-05-25","2023-05-25","2023-05-25","2023-05-25","2023-05-25","2023-05-25","2023-05-25","2023-05-25","2023-05-25","2023-05-25","2023-06-19","2023-06-19","2023-06-19","2023-08-25","2023-07-26","2023-07-26"],"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":[["","65862042005","SMZ\/TMP DS","TAB 800-160","20","Select","Select",""],["","55513020910","NEUPOGEN","INJ 480\/0.8","3","Select","Select",""],["","45963053930","ONDANSETRON","TAB 8MG","30","Select","Select",""],["","65162052111","PROMETHAZINE","TAB 25MG","30","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","67108356509","MESNEX","TAB 400MG","9","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","12","Select","Select",""],["","42806054701","VITAMIN D","CAP 1.25MG","4","Select","Select",""],["","59746033790","LOSARTAN\/HCT","TAB 50-12.5","30","Select","Select",""],["","45802009735","ESTRADIOL","CRE 0.0001","42","Select","Select",""],["","00245010810","FERROUS SULF","TAB 325MG EC","12","Select","Select",""],["","68645059459","FAMOTIDINE","20 MG","120","Select","Select",""],["","59746033890","LOSARTAN-HYDROCHLOROTHIAZIDE","100-12.5MG","90","Select","Select",""],["","68645051554","AMLODIPINE BESYLATE","5 MG","90","Select","Select",""],["","55111064530","OMEPRAZOLE","40 MG","30","Select","Select",""],["","65862042005","SMZ\/TMP DS TAB","800-160","20","Select","Select",""],["","55513020910","NEUPOGEN INJ","480\/0.8","6","Select","Select",""],["","65162052111","PROMETHAZINE TAB","25MG","30","Select","Select",""],["","65862050320","AMOX\/K CLAV TAB","875-125","12","Select","Select",""],["","70710113908","FLUCONAZOLE TAB","150MG","1","Select","Select",""],["","67108356509","MESNEX TAB","400MG","9","Select","Select",""],["","45963053930","ONDANSETRON TAB","8MG","30","Select","Select",""],["","00245010810","FERROUS SULF TAB","325MG EC","12","Select","Select",""],["","66993000210","ESTRADIOL CRE","0.01%","42","Select","Select",""],["","59746033790","LOSARTAN\/HCT TAB","50-12.5","30","Select","Select",""],["","42806054701","VITAMIN D CAP","1.25MG","4","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":""}]}]}