{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHONTRESE QUARLES","gend":1,"add":"4319 SHACKLESORD ROAD","city":"RICHMOND","state":"VA","zip":"23234-9998","dob":"1988-01-29","age":"","mstatus":"","insh":"2192279*01","cliId":"","pno":8043195393,"cno":8043195393,"email":"","ename":"","eno":"","pphy":"MANTZOURIS, TAMMY J MD","ppno":8048285883,"pcpadd":"401 N 11TH STREET,","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":"23219-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8048285399,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G47.33","H53.9","H52.13","Z23.","M25.572","M25.571","R26.2","V58.89","M25.671","M25.672","R29.3","V89.2XXD","Z73.6","I10.","NO DATA","E66.9","Z79.82","R60.0","M79.604","M79.605","M25.579","M76.811","M79.671","G93.2","H52.203","F31.10","E78.5","E55.9","J30.9","N76.0","M77.52","A59.01","H04.123","M21.41","M21.42","M72.2","M24.571","M24.572","I08.1","M76.821","M76.822","M79.672","R41.0","F32.9","Z01.411","N72.","Z97.5","Z11.51","Z11.3","R60.9","F33.1","F33.3","J06.9","E78.6","M72.9","H04.129","K59.00","F17.210","Z68.44","Z79.899","Z11.59","R05.9","E11.9","H47.10","G43.909","H53.459","M79.661","M79.662","R60.1","F20.9","H53.413","H47.11","H53.40","G89.29","M21.40","F17.200","I34.0","Z11.52","Z20.822","H35.039","G47.30","E66.01","G47.9"],"date":["2023-06-13","2021-03-24","2023-03-22","2022-09-13","2021-12-09","2021-12-09","2021-11-05","2022-07-05","2021-11-05","2021-11-05","2021-11-05","2021-11-05","2021-11-05","2023-05-03","2023-05-03","2021-11-05","2021-11-05","2022-06-28","2022-06-28","2022-06-28","2022-03-11","2022-07-05","2022-07-05","2023-05-03","2023-03-22","2023-06-16","2023-05-03","2023-05-03","2023-05-03","2021-11-15","2021-03-30","2021-08-26","2021-09-22","2021-09-28","2021-09-28","2022-03-07","2022-02-01","2022-02-01","2022-06-20","2022-06-22","2022-06-22","2022-06-22","2021-03-09","2021-10-06","2021-03-22","2021-03-22","2021-11-15","2021-03-22","2021-11-15","2022-03-07","2022-03-07","2022-12-16","2022-12-16","2022-12-16","2021-10-06","2021-10-06","2021-10-06","2021-10-06","2021-10-06","2021-10-06","2022-01-13","2022-01-13","2021-01-28","2021-07-08","2021-12-09","2021-06-29","2022-02-11","2022-02-11","2022-07-05","2022-11-30","2021-12-09","2021-12-09","2021-12-09","2021-12-09","2021-12-09","2022-02-11","2022-06-20","2021-09-28","2021-09-28","2021-10-22","2021-10-22","2021-10-22","2021-10-22"],"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":[["","45802086803","POLYETH GLYC POW","3350 NF","510","Select","Select",""],["","16714061305","SERTRALINE TAB","100MG","30","Select","Select",""],["","00904675180","ASPIRIN LOW TAB","81MG EC","30","Select","Select",""],["","67877019910","AMLODIPINE TAB","10MG","30","Select","Select",""],["","42806040021","METHYLPRED TAB","4MG","21","Select","Select",""],["","42571024301","ACETAZOLAMID CAP","500MG ER","60","Select","Select",""],["","60505083305","AZELASTINE SPR","0.1%","30","Select","Select",""],["","65162083366","DICLOFENAC GEL","1%","100","Select","Select",""],["","69097012212","TOPIRAMATE TAB","25MG","60","Select","Select",""],["","16729028517","ROSUVASTATIN TAB","10MG","30","Select","Select",""],["","67877024910","QUETIAPINE TAB","50MG","30","Select","Select",""],["","55111025860","ZIPRASIDONE CAP","60MG","180","Select","Select",""],["","77333030810","FISH OIL CAP","1000MG","90","Select","Select",""],["","42806071401","BENZONATATE CAP","100MG","30","Select","Select",""],["","49035028338","EQ","12 HR MUC TAB 600MG","28","Select","Select",""],["","49035007021","EQ MUCUS ER TAB","600MG","28","Select","Select",""],["","10135068260","GUAIFENESIN TAB","400MG","60","Select","Select",""],["","55111025960","ZIPRASIDONE HCL","80 MG","180","Select","Select",""],["","00065041928","BION TEARS","0.1%-0.3%","28","Select","Select",""],["","00904675180","ASPIRIN EC","81 MG","30","Select","Select",""],["","70377000712","ROSUVASTATIN CALCIUM","10 MG","90","Select","Select",""],["","69097012212","TOPIRAMATE","25 MG","60","Select","Select",""],["","59651021430","AZELASTINE HCL","137 MCG","30","Select","Select",""],["","57237002801","AMOXICILLIN","500 MG","21","Select","Select",""],["","67877019910","AMLODIPINE BESYLATE","10 MG","30","Select","Select",""],["","74312052807","VITAMIN D","3 50 MCG","90","Select","Select",""],["","68645056354","IBUPROFEN","800 MG","21","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":""}]}]}