{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PATRICE ALSTON","gend":1,"add":"3501 HOWARD RD APT 2","city":"RICHMOND","state":"VA","zip":"23223-9998","dob":"1983-04-21","age":"","mstatus":"","insh":"2213749*01","cliId":"","pno":8042989379,"cno":8042989379,"email":"","ename":"","eno":"","pphy":"PEEL, CAROLYN A MD","ppno":8048285883,"pcpadd":"401 N 11TH ST,","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":["V58.89","Z30.49","Z53.8","N76.0","B96.89","Z30.09","Z30.432","Z30.431","Z97.5","R53.1","I10.","J01.00","H68.002","M54.2","R42.","J30.89","G44.89","F41.9","H65.02","E66.01","Z98.84","Z68.36","Z20.822","J03.90","J34.2","K21.9","R09.82","R51.9","J32.9","J34.3","H93.8X2","M26.609","J34.89","Z20.828","G89.29","N39.0","J98.9","N30.01","R03.0","N30.10","N89.8","R30.0","R07.89","R63.5","F41.8","K58.2","NO DATA","Z79.899","K08.9","M26.69"],"date":["2022-01-12","2022-01-12","2022-01-12","2023-05-08","2023-05-08","2022-01-12","2022-01-12","2022-01-12","2022-01-12","2021-12-23","2023-06-15","2023-01-12","2021-12-01","2023-03-15","2023-03-15","2023-03-15","2022-07-05","2023-06-15","2022-07-05","2022-03-23","2023-05-08","2022-03-23","2023-02-24","2022-09-20","2023-03-15","2023-03-15","2023-03-15","2023-03-15","2023-03-15","2023-03-15","2023-03-15","2023-06-15","2023-03-15","2021-09-07","2023-03-15","2022-12-28","2023-02-24","2023-02-24","2023-02-24","2023-01-30","2023-01-30","2023-06-21","2022-10-04","2023-05-08","2023-05-08","2023-05-08","2023-06-21","2023-06-15","2023-08-11","2023-08-11"],"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":[["","50111033401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","6","Select","Select",""],["","75826011410","PHENAZOPYRID","TAB 100MG","10","Select","Select",""],["","70710113908","FLUCONAZOLE","150 MG","1","Select","Select",""],["","57237016199","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","69452015120","VITAMIN D","2 1250 MCG","4","Select","Select",""],["","42571016242","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","59267102504","PFIZER VACC","INJ ADLT RTU","0","Select","Select",""],["","11534018701","BUT\/APAP\/CAF","CAP ","15","Select","Select",""],["","62332049241","TIZANIDINE","CAP 4MG","90","Select","Select",""],["","16571066001","MECLIZINE","TAB 12.5MG","90","Select","Select",""],["","59746017506","PREDNISONE","20 MG","21","Select","Select",""],["","66267008115","DIPHENHYDRAM","CAP 50MG","1","Select","Select",""],["","55111078401","FEXOFENADINE","TAB 180MG","30","Select","Select",""],["","16729018201","HYDROCHLOROT","TAB 12.5MG","30","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","16571041250","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","49483070210","FLUOXETINE HCL","20 MG","30","Select","Select",""],["","42571016242","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","20","Select","Select",""],["","50111033401","METRONIDAZOLE","500 MG","14","Select","Select",""],["","72578009010","TRIAMTERENE-HYDROCHLOROTHIAZID","37.5-25 MG","30","Select","Select",""],["","42806016105","HYDROXYZINE HCL","50 MG","30","Select","Select",""],["","77333080050","SACCHAROMYCES BOULARDII","250 MG","60","Select","Select",""],["","68462019005","NAPROXEN","500 MG","20","Select","Select",""],["","50111033401","METRONIDAZOL TAB","500MG","14","Select","Select",""],["","70710113908","FLUCONAZOLE TAB","150MG","1","Select","Select",""],["","65862042005","SMZ\/TMP DS TAB","800-160","6","Select","Select",""],["","75826011410","PHENAZOPYRID TAB","100MG","10","Select","Select",""],["","42571016242","AMOX\/K CLAV TAB","875-125","20","Select","Select",""],["","69452015120","VITAMIN D CAP","50000UNT","4","Select","Select",""],["","57237016199","OMEPRAZOLE CAP","20MG","30","Select","Select",""],["","59267102504","PFIZER VACC INJ ADLT RTU","","0","Select","Select",""],["","11534018701","BUT\/APAP\/CAF CAP","","15","Select","Select",""],["","00904205661","DIPHENHYDRAM CAP","50MG","1","Select","Select",""],["","55111078401","FEXOFENADINE TAB","180MG","30","Select","Select",""],["","00054001925","PREDNISONE TAB","50MG","3","Select","Select",""],["","62332049241","TIZANIDINE CAP","4MG","90","Select","Select",""],["","16571066001","MECLIZINE TAB","12.5MG","90","Select","Select",""],["","00054327099","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","16729018201","HYDROCHLOROT TAB","12.5MG","30","Select","Select",""],["","16571041250","CIPROFLOXACN TAB","500MG","14","Select","Select",""],["","67877032105","IBUPROFEN","800 MG","30","Select","Select",""],["","00093310905","AMOXICILLIN","500 MG","30","Select","Select",""],["","63304069301","CLINDAMYCIN HCL","300 MG","30","Select","Select",""],["","69097084507","CYCLOBENZAPRINE HCL","5 MG","5","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":""}]}]}