{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SAMANTHA J MOORE","gend":1,"add":"9208 MONARCH CRES","city":"HENRICO","state":"VA","zip":"23228-9998","dob":"1993-05-21","age":"","mstatus":"","insh":"2195299*01","cliId":"","pno":8049313366,"cno":8049313366,"email":"","ename":"","eno":"","pphy":"GOODE, LAUREN MD","ppno":8042179091,"pcpadd":"12018 W BROAD STREET SUITE 101","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":"23233-9998","pcpcounty":"","pcpid":"","pcpname":"Primary Health Group - Short Pump","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8043607155,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01.812","Z11.59","K64.9","K62.5","R19.7","F32.0","F41.1","N30.00","Z23.","M45.7","K51.90","Z79.899","F41.9","D27.0","R10.31","Z01.419","J02.9","Z20.822","J06.9","H10.33","Z20.828","J01.00","K51.00","K51.811"],"date":["2021-01-09","2021-01-09","2021-01-13","2021-01-13","2021-01-13","2022-01-21","2022-01-21","2022-11-02","2021-04-08","2023-05-19","2023-05-19","2023-05-19","2023-05-19","2022-03-02","2022-02-14","2022-03-02","2022-04-14","2023-01-26","2023-01-26","2023-01-26","2022-04-10","2022-04-10","2021-05-06","2021-01-13"],"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":[["","00074024302","HUMIRA","INJ 40\/0.4ML","2","Select","Select",""],["","00378113401","KETOROLAC","TAB 10MG","14","Select","Select",""],["","57237002901","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","00591224522","MESALAMINE","1.2 G","120","Select","Select",""],["","00185012201","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","59267030401","PFIZER BIVAL","INJ BA4\/BA5","0","Select","Select",""],["","70461032203","FLUCLVX QUAD","INJ 2022-23","0","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","6","Select","Select",""],["","00074024302","HUMIRA(CF)","40MG\/0.4ML","2","Select","Select",""],["","72647033104","METHYLPREDNISOLONE","4 MG","21","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE","50 MCG","16","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":""}]}]}