{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JAMAIL D BOLLING","gend":0,"add":"3436 MAURY ST APT E","city":"RICHMOND","state":"VA","zip":"23224-9998","dob":"1980-03-12","age":"","mstatus":"","insh":"2281792*01","cliId":"","pno":8045061703,"cno":8045061703,"email":"","ename":"","eno":"","pphy":"BRITZ, JACQUELINE B MD","ppno":8042307777,"pcpadd":"4730 N SOUTHSIDE PLAZA ST,","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":"23224-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8042302071,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B20.","Z79.899","F17.210","S93.401A","V89.2XXA","Y92.89","Y93.89","NO DATA","F64.0","Z86.73","Z23.","H65.01","Z21.","H92.01","Z02.89","R11.2","S02.402A","V86.95XA","V49.59XA","R21.","G45.9","J03.90","S39.012A","F17.200","Z79.1","M54.5"],"date":["2022-12-07","2022-05-24","2022-05-24","2021-07-24","2021-07-24","2021-07-24","2021-07-24","2021-11-30","2021-10-26","2022-01-20","2021-10-26","2022-01-18","2022-05-24","2022-05-24","2021-12-07","2021-12-07","2021-07-19","2021-07-19","2021-07-19","2023-02-20","2022-01-04","2022-05-24","2021-04-10","2021-04-10","2021-04-10","2021-04-10"],"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":[["","61958190101","GENVOYA","TAB ","30","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","21","Select","Select",""],["","59651036105","IBUPROFEN","TAB 600MG","20","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","20","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","6","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","20","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","20","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","68180035202","SERTRALINE","TAB 50MG","30","Select","Select",""],["","45802020625","NICOTINE POL","GUM 2MG MINT","110","Select","Select",""],["","55111012105","ATORVASTATIN","TAB 10MG","90","Select","Select",""],["","00536100836","ASPIRIN","CHW 81MG","30","Select","Select",""],["","00363021807","ASPIRIN-81","CHW 81MG","30","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","10","Select","Select",""],["","61958250101","BIKTARVY","50-200-25","30","Select","Select",""],["","42806016105","HYDROXYZINE HCL","50 MG","20","Select","Select",""],["","51672128402","TRIAMCINOLONE ACETONIDE","0.1 %","30","Select","Select",""],["","68180035202","SERTRALINE TAB","50MG","30","Select","Select",""],["","65862050320","AMOX\/K CLAV TAB","875-125","20","Select","Select",""],["","61958190101","GENVOYA TAB","","30","Select","Select",""],["","59651036105","IBUPROFEN TAB","600MG","20","Select","Select",""],["","57237002801","AMOXICILLIN TAB","500MG","10","Select","Select",""],["","65862001705","AMOXICILLIN CAP","500MG","10","Select","Select",""],["","00406012305","HYDROCO\/APAP TAB","5-325MG","6","Select","Select",""],["","61958250101","BIKTARVY TAB","","30","Select","Select",""],["","63736003751","AMERICAINE HEMORRHOIDAL","20 %-0.1 %","28","Select","Select",""],["","42806031250","DOXYCYCLINE HYCLATE","100 MG","14","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":""}]}]}