{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARY  M MCLEAN","gend":1,"add":"2 W MARSHALL ST UNIT 113","city":"RICHMOND","state":"VA","zip":"23220-9998","dob":"1998-04-29","age":"","mstatus":"","insh":"2343845*01","cliId":"","pno":7038013925,"cno":"5714054293","email":"","ename":"","eno":"","pphy":"MANTZOURIS, TAMMY J MD","ppno":8048285883,"pcpadd":"401 N 11TH STREET","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":"23219-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"2600 Chariot ST, Glen Allen, VA","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":["Z20.828","P07.26","Z23.","Z39.1","Z34.82","Z34.83","O13.4","Z37.0","Z3A.38","O69.81X0","O70.1","O24.420","O99.52","J45.909","R00.0","Z20.822","O90.6","F31.89","R73.03","F31.81","F41.1","F41.0","F33.1","O34.42","Z3A.18","M54.89","R10.2","R31.9","Z01.419","F31.2","D72.829","E78.5","O99.613","K60.2","Z3A.30","P07.38","O24.419","O99.343","F41.9","Z3A.37","O21.2","O26.892","R51.9","R42.","O99.612","K21.9","Z3A.22","O99.891","Z79.899","Z3A.32","Z39.2","O86.12","O24.439","Z34.90","P92.5","Z93.1","N92.6","Z86.32","O42.92","Z03.71","R03.0","H53.143","R11.0","F17.200","F31.32"],"date":["2021-01-11","2021-03-08","2022-01-11","2021-05-20","2021-05-20","2021-05-20","2021-05-28","2021-05-28","2021-05-28","2021-05-28","2021-05-28","2021-05-28","2021-05-27","2021-05-27","2021-05-27","2021-05-27","2022-04-21","2022-11-22","2022-06-02","2022-10-11","2023-04-05","2022-10-11","2023-04-05","2021-01-08","2021-01-08","2021-05-31","2021-06-24","2021-06-24","2022-07-26","2023-04-05","2023-01-26","2023-01-26","2021-04-01","2021-04-01","2021-04-01","2021-05-13","2021-05-20","2021-05-20","2021-05-20","2021-05-20","2021-02-05","2021-02-05","2022-07-08","2021-02-05","2021-02-05","2021-02-05","2021-02-05","2021-05-26","2021-04-13","2021-04-13","2021-07-08","2021-07-01","2021-07-08","2021-04-16","2021-08-19","2021-08-19","2022-04-07","2022-04-07","2021-05-26","2021-05-26","2021-05-26","2022-07-08","2022-07-08","2022-07-08","2023-02-20"],"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":[["","00536440601","VITAMIN B-6","TAB 25MG","14","Select","Select",""],["","55111015330","ONDANSETRON","TAB 4MG","20","Select","Select",""],["","00113044164","SLEEP AID","TAB 25MG","30","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","1","Select","Select",""],["","57896030401","STOOL SOFTNR","TAB 8.6-50MG","56","Select","Select",""],["","70677006801","SM SLEEP AID","TAB 25MG","30","Select","Select",""],["","53885004401","ONE TOUCH","KIT VERIO FL","1","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","100","Select","Select",""],["","99073012101","FREESTYLE","TES ","100","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","100","Select","Select",""],["","41163047532","FIBER THERAP","TAB 500MG","100","Select","Select",""],["","21292000616","TRUE METRIX","TES GLUCOSE","100","Select","Select",""],["","65162047810","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","59267100002","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","65162046510","IBUPROFEN","TAB 600MG","60","Select","Select",""],["","00143924920","AMOX\/K CLAV","TAB 875-125","28","Select","Select",""],["","00904198760","MAPAP","CAP 500MG","60","Select","Select",""],["","00378727253","NORETHINDRON","TAB 0.35MG","84","Select","Select",""],["","65162027210","SMZ\/TMP DS","TAB 800-160","28","Select","Select",""],["","11822046713","PAIN RELIEF","TAB 325MG","60","Select","Select",""],["","68382080510","TRAZODONE","TAB 50MG","30","Select","Select",""],["","69584009250","BUSPIRONE","TAB 10MG","60","Select","Select",""],["","42806016005","HYDROXYZ HCL","TAB 25MG","120","Select","Select",""],["","68382003416","VENLAFAXINE","CAP 37.5 ER","30","Select","Select",""],["","00642747001","SLYND","TAB 4MG","84","Select","Select",""],["","54092038701","ADDERALL XR","CAP 20MG","14","Select","Select",""],["","00781235201","AMPHET\/DEXTR","CAP 20MG ER","14","Select","Select",""],["","43547030303","ARIPIPRAZOLE","5 MG","30","Select","Select",""],["","13668013501","ESCITALOPRAM","TAB 5MG","30","Select","Select",""],["","69584009250","BUSPIRONE HCL","10 MG","90","Select","Select",""],["","42806016005","HYDROXYZINE HCL","25 MG","240","Select","Select",""],["","68382003416","VENLAFAXINE HCL ER","37.5 MG","30","Select","Select",""],["","64764072030","TRINTELLIX","5 MG","30","Select","Select",""],["","70436001002","BUPROPION XL","150 MG","30","Select","Select",""],["","80681017401","VITAMIN D","3 1250 MCG","4","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA","90 MCG","8.5","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":""}]}]}