{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"IVETH MONTENEGRO","gend":1,"add":"11921 BEECHWOOD FOREST DR","city":"CHESTERFIELD","state":"VA","zip":"23838-9998","dob":"1975-06-30","age":"","mstatus":"","insh":"2317310*01","cliId":"","pno":8043063043,"cno":8043063043,"email":"","ename":"","eno":"","pphy":"CHEEMA, RAZA M MD","ppno":8047962373,"pcpadd":"12901 BRIGGS RD,","pcpcity":"CHESTER","pcpstate":"VA","pcpzip":"23831-9998","pcpcounty":"","pcpid":"","pcpname":"Bon Secours - Southside Internal Medicine","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8047489160,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O03.4","R17.","F41.9","R00.0","Z80.0","Z12.11","Z01.411","N76.0","N81.6","Z32.01","N39.3","R39.15","R06.02","R07.9","E86.0","I47.1","R06.00","R00.2","Z68.24","Z20.828","H10.023","M54.2","M47.812","M25.50","M54.12","M70.61","M79.7","M89.49","M70.62","Z68.23","Z12.31","N39.0","F41.1","F32.9","Z91.89","H00.11","O02.1","N30.00","J01.90","N30.01","R30.0","N94.6","Z76.89","L40.9","Z13.29","Z13.220","Z12.12","Z12.9","N92.6","L29.9","M62.838","S30.861A","W57.XXXA","Z01.419"],"date":["2021-06-15","2021-08-30","2021-10-14","2023-09-14","2023-08-31","2023-08-31","2023-03-20","2021-03-04","2021-03-04","2021-05-21","2022-08-16","2023-06-22","2021-09-27","2021-10-06","2021-09-27","2021-10-19","2021-10-19","2023-09-12","2021-10-19","2021-01-14","2021-09-01","2021-06-09","2021-06-09","2021-08-02","2021-06-09","2021-08-02","2023-09-12","2021-08-02","2021-08-02","2021-08-02","2021-10-06","2023-06-22","2021-06-04","2021-06-04","2022-02-11","2023-09-06","2021-06-22","2023-05-30","2021-01-13","2021-12-03","2021-12-03","2023-02-15","2023-02-15","2023-02-15","2023-02-15","2023-02-15","2023-02-15","2023-03-20","2023-03-20","2023-03-20","2023-07-12","2023-07-12","2023-07-12","2022-03-11"],"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":[["","00093532862","JUNEL FE 24","TAB 43831","28","Select","Select",""],["","68462073129","HAILEY 24","TAB FE","28","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","10","Select","Select",""],["","70010002703","TROSPIUM CHL","CAP 60MG ER","30","Select","Select",""],["","00469260130","MYRBETRIQ","TAB 25MG","30","Select","Select",""],["","65162068210","PHENAZOPYRID","TAB 200MG","30","Select","Select",""],["","23155053006","TROSPIUM CL","TAB 20MG","60","Select","Select",""],["","51862048601","TRIMETHOPRIM","TAB 100MG","30","Select","Select",""],["","29300042010","AMITRIPTYLINE HCL","25 MG","30","Select","Select",""],["","75826011410","PHENAZOPYRIDINE HCL","100 MG","30","Select","Select",""],["","68382005005","MELOXICAM","7.5 MG","30","Select","Select",""],["","23155053006","TROSPIUM CHLORIDE","20 MG","60","Select","Select",""],["","43386009019","GAVILYTE-G","236-22.74G","4000","Select","Select",""],["","60846050101","PYRIDIUM","100 MG","30","Select","Select",""],["","42806031250","DOXYCYCLINE HYCLATE","100 MG","20","Select","Select",""],["","47781030301","NITROFURANTOIN MONO-MACRO","100 MG","10","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":""}]}]}