{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHARHONDA R SHERROD","gend":1,"add":"1101 ST PETER ST","city":"RICHMOND","state":"VA","zip":"23220-9998","dob":"1985-08-28","age":"","mstatus":"","insh":"2267763*01","cliId":"","pno":8043030454,"cno":8043030454,"email":"","ename":"","eno":"","pphy":"JACKSON, RICHARD A MD","ppno":8042257148,"pcpadd":"304 E LEIGH ST,","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":"23219-9998","pcpcounty":"","pcpid":"","pcpname":"Dominion Medical Associates, INC.","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8042257159,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.32","F10.20","M94.0","S99.922A","R09.81","Z20.822","F25.9","J06.9","K58.9","M06.9","Z79.3","Z79.899","S90.122A","K21.9","Z13.31","Z68.29","M54.5","I10.","R79.89","R06.02","Z92.29","E55.9","R68.89","H93.299","M77.52","Z01.419","Z11.3","N64.3","N76.0","Z30.432"],"date":["2023-08-31","2022-02-09","2022-01-17","2023-02-20","2021-12-31","2021-12-31","2021-11-24","2022-09-10","2022-09-10","2022-09-10","2022-09-10","2022-09-10","2023-02-10","2021-01-13","2021-01-13","2021-01-13","2021-01-13","2021-01-13","2021-01-13","2021-01-13","2022-01-21","2022-01-21","2022-01-21","2022-01-21","2023-03-01","2023-09-01","2023-09-01","2023-09-01","2023-09-01","2023-09-11"],"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":[["","43547030303","ARIPIPRAZOLE","5 MG","30","Select","Select",""],["","65862059401","DIVALPROEX","TAB 250MG ER","30","Select","Select",""],["","69452015120","VITAMIN D","2 1250 MCG","4","Select","Select",""],["","00168000615","TRIAMCINOLON","OIN 0.001","60","Select","Select",""],["","59267100002","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","00603533932","PREDNISONE","TAB 20MG","21","Select","Select",""],["","59651000305","OMEPRAZOLE","CAP 40MG","90","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","64380071306","BENZONATATE","CAP 200MG","21","Select","Select",""],["","50428038612","ACETAMINOPHN","TAB 500MG","20","Select","Select",""],["","59779035926","TUSSIN DM","LIQ 10-100\/5","118","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","6","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","7","Select","Select",""],["","53746010901","HYDROCODONE-ACETAMINOPHEN","5 MG-325MG","6","Select","Select",""],["","59746000103","METHYLPREDNISOLONE","4 MG","21","Select","Select",""],["","50111033401","METRONIDAZOLE","500 MG","14","Select","Select",""],["","00603533932","PREDNISONE TAB","20MG","21","Select","Select",""],["","43547030303","ARIPIPRAZOLE TAB","5MG","30","Select","Select",""],["","65862059401","DIVALPROEX TAB","250MG ER","30","Select","Select",""],["","00168000615","TRIAMCINOLON OIN","0.1%","30","Select","Select",""],["","49483060450","IBUPROFEN TAB","800MG","30","Select","Select",""],["","59651000305","OMEPRAZOLE CAP","40MG","90","Select","Select",""],["","31604001870","VITAMIN D TAB","1000UNIT","90","Select","Select",""],["","69097014260","ALBUTEROL AER HFA","","7","Select","Select",""],["","50428038612","ACETAMINOPHN TAB","500MG","20","Select","Select",""],["","59779035926","TUSSIN DM LIQ","10-100\/5","118","Select","Select",""],["","64380071306","BENZONATATE CAP","200MG","21","Select","Select",""],["","65862001501","AMOXICILLIN TAB","875MG","20","Select","Select",""],["","65862042005","SMZ\/TMP DS TAB","800-160","6","Select","Select",""],["","70710113908","FLUCONAZOLE TAB","150MG","2","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA","90 MCG","17","Select","Select",""],["","65862085901","FAMOTIDINE","20 MG","180","Select","Select",""],["","77333071510","PRENATAL","27MG-0.8MG","90","Select","Select",""],["","51672130406","TERCONAZOLE","0.4 %","45","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":""}]}]}