{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANDREA ZEIGLER","gend":1,"add":"6530 W DENNY CT","city":"CHESTERFIELD","state":"VA","zip":"23832-9998","dob":"1989-08-19","age":"","mstatus":"","insh":"2345240*01","cliId":"","pno":3135581833,"cno":3135581833,"email":"","ename":"","eno":"","pphy":"HOFFMAN, RICHARD H MD","ppno":8042769305,"pcpadd":"2500 POCOSHOCK PL,","pcpcity":"NORTH CHESTERFIELD","pcpstate":"VA","pcpzip":"23235-9998","pcpcounty":"","pcpid":"","pcpname":"Bon Secours St Francis Family Medicine Center","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8046744145,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G93.2","I66.9","E03.9","R51.9","Z68.34","Z20.828","Z03.818","E55.9","J32.1","L70.9","Z09.","H47.10","G44.40","T39.95XA","H47.11","Z68.33","N92.0","Z32.02","H93.8X2","Z01.419","J45.20","G89.29","R87.619","N76.0","Z68.32","G44.89","R11.2","R19.7","Z68.35","N76.2","B35.1","R05.","Z20.822","E87.6","M19.071","R00.0","F41.9","I67.9","N94.6","N39.9","R87.610","R87.810","E66.9","N89.8","NO DATA","Z16.29","L50.9","H00.015","J01.90","B96.89","I15.8","G44.211","N85.00","G43.909","N93.9","I67.2","J45.909","Q05.9","K21.9","Z72.0","Z79.899","Q05.4","I87.309","G44.221","E78.00"],"date":["2023-05-24","2022-04-20","2023-04-13","2023-03-25","2023-03-26","2021-03-07","2021-03-07","2021-12-01","2021-12-01","2023-01-19","2021-12-01","2023-03-01","2022-02-24","2022-02-24","2022-07-29","2022-06-22","2023-04-13","2023-02-24","2021-07-13","2022-07-25","2022-05-19","2022-07-19","2021-12-27","2023-05-08","2022-10-20","2023-01-27","2021-07-19","2021-07-19","2021-07-22","2021-04-01","2021-08-03","2021-03-08","2021-03-08","2022-03-11","2021-08-03","2022-03-11","2022-04-20","2023-03-26","2022-12-12","2022-12-12","2021-10-13","2021-10-13","2022-07-19","2022-10-14","2022-10-14","2022-10-14","2023-01-19","2023-01-03","2023-01-03","2023-01-03","2023-03-25","2023-03-25","2023-04-13","2023-04-13","2023-04-13","2022-04-20","2022-04-20","2022-04-20","2022-04-20","2022-04-20","2022-04-20","2023-04-13","2023-03-26","2023-03-26","2023-03-26"],"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":[["","70710113908","FLUCONAZOLE","150 MG","3","Select","Select",""],["","70710122600","AMITRIPTYLIN","TAB 25MG","90","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","40","Select","Select",""],["","59762305102","AZITHROMYCIN","POW 1GM PAK","1","Select","Select",""],["","21922000221","CLINDAMYCIN","SOL 0.01","30","Select","Select",""],["","00472016630","NYSTATIN","OIN 100000","30","Select","Select",""],["","00168000615","TRIAMCINOLON","OIN 0.001","30","Select","Select",""],["","23155014201","DOXYCYCL HYC","TAB 100MG DR","14","Select","Select",""],["","69097012403","TOPIRAMATE","TAB 100MG","180","Select","Select",""],["","23155028801","ACETAZOLAMID","TAB 250MG","120","Select","Select",""],["","00093220305","METOCLOPRAM","TAB 10MG","20","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","20","Select","Select",""],["","59779043262","NASAL DECONG","TAB 30MG","12","Select","Select",""],["","69097073102","TERBINAFINE","TAB 250MG","90","Select","Select",""],["","64980042712","TINIDAZOLE","TAB 500MG","10","Select","Select",""],["","17772010430","TROKENDI XR","CAP 200MG","30","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","69452015120","VITAMIN D","CAP 50000UNT","4","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","20","Select","Select",""],["","00536123201","ASPIRIN","TAB 325MG EC","30","Select","Select",""],["","59779060027","CVS ASPIRIN","TAB 81MG EC","30","Select","Select",""],["","65862035790","CLOPIDOGREL","TAB 75MG","30","Select","Select",""],["","27241009809","DULOXETINE","CAP 30MG","30","Select","Select",""],["","16571040250","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","45802048678","DOCUSATE SOD","CAP 100MG","30","Select","Select",""],["","67618011128","COLACE CLEAR","CAP 50MG","60","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","12843053637","BAYER LOW","TAB 81MG EC","30","Select","Select",""],["","50428038612","ACETAMINOPHN","TAB 500MG","30","Select","Select",""],["","21922001704","CLOBETASOL","OIN 0.0005","15","Select","Select",""],["","50428032084","GENUINE ASPR","TAB 325MG","30","Select","Select",""],["","00574079001","METHAZOLAMID","TAB 25MG","60","Select","Select",""],["","12843055565","BAYER ASA","TAB 325MG","90","Select","Select",""],["","62559026530","TRANEX ACID","TAB 650MG","30","Select","Select",""],["","00603533815","PREDNISONE","10 MG","21","Select","Select",""],["","62559026530","TRANEXAMIC ACID","650 MG","30","Select","Select",""],["","45802048678","DOCUSATE SODIUM","100 MG","60","Select","Select",""],["","21922000201","CLINDAMYCIN PHOSPHATE","1 %","60","Select","Select",""],["","00574079101","METHAZOLAMIDE","50 MG","60","Select","Select",""],["","65862050320","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","14","Select","Select",""],["","12843053637","LOW DOSE ASPIRIN EC","81 MG","30","Select","Select",""],["","24208091055","ERYTHROMYCIN","5 MG\/GRAM","3.5","Select","Select",""],["","64980030550","DENTA","5000 PLUS 1.1 %","153","Select","Select",""],["","68682045570","METRONIDAZOLE","0.75 %","70","Select","Select",""],["","69097012403","TOPIRAMATE TAB","100MG","180","Select","Select",""],["","69452015120","VITAMIN D CAP","50000UNT","4","Select","Select",""],["","21922000221","CLINDAMYCIN SOL","1%","30","Select","Select",""],["","69097094312","GABAPENTIN CAP","300MG","90","Select","Select",""],["","17772010430","TROKENDI XR CAP","200MG","30","Select","Select",""],["","00536123201","ASPIRIN TAB","325MG EC","30","Select","Select",""],["","59779060027","CVS ASPIRIN TAB","81MG EC","30","Select","Select",""],["","00054327099","FLUTICASONE SPR","50MCG","48","Select","Select",""],["","16571040250","CETIRIZINE TAB","10MG","90","Select","Select",""],["","45802048678","DOCUSATE SOD CAP","100MG","30","Select","Select",""],["","00093031401","KETOROLAC TAB","10MG","20","Select","Select",""],["","65862039010","ONDANSETRON TAB","4MG ODT","40","Select","Select",""],["","66993001968","ALBUTEROL AER HFA","","18","Select","Select",""],["","67618011128","COLACE CLEAR CAP","50MG","60","Select","Select",""],["","65862035790","CLOPIDOGREL TAB","75MG","30","Select","Select",""],["","27241009809","DULOXETINE CAP","30MG","30","Select","Select",""],["","50428038612","ACETAMINOPHN TAB","500MG","30","Select","Select",""],["","12843053637","BAYER LOW TAB","81MG EC","30","Select","Select",""],["","59746000103","METHYLPRED TAB","4MG","21","Select","Select",""],["","50428032084","GENUINE ASPR TAB","325MG","30","Select","Select",""],["","00168000615","TRIAMCINOLON OIN","0.1%","30","Select","Select",""],["","00472016630","NYSTATIN OIN","100000","30","Select","Select",""],["","70710113908","FLUCONAZOLE TAB","150MG","3","Select","Select",""],["","00574079001","METHAZOLAMID TAB","25MG","60","Select","Select",""],["","12843055565","BAYER ASA TAB","325MG","90","Select","Select",""],["","64980042712","TINIDAZOLE TAB","500MG","10","Select","Select",""],["","21922001704","CLOBETASOL OIN","0.05%","15","Select","Select",""],["","62559026530","TRANEX ACID TAB","650MG","30","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":""}]}]}