{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SAMIRA A NOUS","gend":1,"add":"7840 VERMEIL ST APT 1210","city":"RICHMOND","state":"VA","zip":"23237-9998","dob":"1965-01-25","age":"","mstatus":"","insh":"2266671*01","cliId":"","pno":7573038975,"cno":7573038975,"email":"","ename":"","eno":"","pphy":"BRENNAN, SHANNON M NP","ppno":8045608965,"pcpadd":"9000 STONY POINT PARKWAY,","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":"23235-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8045607340,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z23.","G47.33","Z79.899","M79.89","M54.6","NO DATA","G89.29","N32.81","I49.1","I49.9","R00.2","R07.89","K11.8","Z04.9","M25.511","R51.9","J45.20","D64.9","M25.561","M25.562","K21.9","G47.30","E78.5","Z80.3","R06.02","Z86.711","Z79.01","Z86.718","D50.9","K59.00","Z79.51","E66.9","H33.322","H53.10","H52.203","H52.4","Z00.00","Z68.31","I49.3","E66.01","R07.9","J45.40","Z20.822","L65.9","R10.11","K43.9","I82.401","I26.99","R06.09","M51.34","M47.815","M51.36","F19.10","Z90.49","R29.898","M47.816","R07.0","R12.","H43.811","H52.13","M41.84","R05.9","R06.00","M85.80","M47.814","R20.2","D16.02","M75.90","M54.9","M25.519","Z99.89","I10.","I82.4Y9","Z48.89","Z48.815","K43.2","M62.08","Z68.34","R30.0","R22.31","D11.0","J45.909","Z12.31","R06.03","Z90.710","Z68.35","J45.30","R60.0","I20.0","Z01.818","Z11.59","K43.0","K74.60","K76.0","G89.18","R63.5","K64.8","R22.30"],"date":["2023-04-14","2023-09-21","2022-05-17","2023-01-30","2022-09-01","2022-09-01","2022-09-01","2022-12-19","2023-08-16","2023-02-22","2023-04-26","2023-08-16","2022-09-06","2021-11-19","2022-01-21","2022-01-21","2022-07-26","2022-03-16","2022-01-21","2022-01-21","2023-04-14","2022-01-21","2022-05-17","2022-05-17","2022-03-16","2023-07-25","2022-05-17","2022-05-17","2023-08-02","2022-05-17","2022-05-17","2023-04-14","2022-11-18","2022-11-18","2022-11-18","2022-11-18","2023-04-14","2023-04-14","2023-08-02","2023-05-10","2021-01-29","2023-07-25","2022-03-16","2021-07-16","2021-07-16","2021-07-16","2021-07-16","2021-07-16","2021-07-16","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2022-03-16","2021-12-10","2022-02-24","2022-09-06","2022-10-14","2021-06-02","2021-06-02","2022-01-25","2022-01-25","2021-05-07","2021-10-07","2021-11-02","2021-10-07","2021-10-07","2021-10-07","2021-10-07","2021-10-07","2023-01-09","2023-05-26","2023-07-25","2021-03-22","2021-04-19","2021-01-27","2021-01-27","2021-01-27","2021-04-16","2021-10-05","2021-10-05","2021-10-05","2022-01-21","2022-03-16","2022-03-16","2022-03-16","2023-01-24","2023-08-02","2023-08-02","2021-01-25","2021-01-25","2021-01-27","2021-01-27","2021-01-27","2021-01-27","2021-05-07","2021-05-26","2021-10-05"],"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":[["","00904759180","FEROSUL","325(65) MG","30","Select","Select",""],["","80681016800","VITAMIN D3","TAB 25MCG","60","Select","Select",""],["","57664050318","TIZANIDINE","TAB 4MG","30","Select","Select",""],["","00003089421","ELIQUIS","5 MG","60","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","67877084210","FAMOTIDINE","20 MG","90","Select","Select",""],["","51991001406","MELATONIN","3 MG","34","Select","Select",""],["","24979003703","METOPROL SUC","TAB 25MG ER","30","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","400","Select","Select",""],["","00904699880","DOCUSATE SOD","CAP 100MG","60","Select","Select",""],["","11845014775","D 1000","CAP 1000UNIT","60","Select","Select",""],["","00591352530","LIDOCAINE","5 %","30","Select","Select",""],["","55111012205","ATORVASTATIN","TAB 20MG","90","Select","Select",""],["","00536100901","FERROUS SULF","TAB 325MG","30","Select","Select",""],["","00173069600","ADVAIR DISKU","AER 250\/50","60","Select","Select",""],["","49483008010","SENNA-TIME","TAB 8.6MG","30","Select","Select",""],["","68462038730","SOLIFENACIN","TAB 10MG","30","Select","Select",""],["","00904671760","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","37205066710","NATURL FIBER","POW 0.586","283","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","68382041201","OMEPRAZOLE","20 MG","30","Select","Select",""],["","00093322397","ESTRADIOL","TAB 10MCG","24","Select","Select",""],["","49483008010","SENNA","8.6 MG","30","Select","Select",""],["","57664050318","TIZANIDINE HCL","4 MG","120","Select","Select",""],["","50383070016","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","68180096301","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","00904699880","DOCUSATE SODIUM","100 MG","60","Select","Select",""],["","29300032913","SOLIFENACIN SUCCINATE","10 MG","90","Select","Select",""],["","80681016800","VITAMIN D","3 25 MCG","180","Select","Select",""],["","00378395105","ATORVASTATIN CALCIUM","20 MG","90","Select","Select",""],["","00781155601","ISOSORBIDE DINITRATE","10 MG","180","Select","Select",""],["","00904671760","CETIRIZINE HCL","10 MG","30","Select","Select",""],["","00378459510","METOPROLOL SUCCINATE","25 MG","30","Select","Select",""],["","00173069600","ADVAIR DISKUS","250-50 MCG","60","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":""}]}]}