{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KEYANA A MUNSON","gend":1,"add":"1373 FLEETON ROAD","city":"REEDVILLE","state":"VA","zip":"22539-9998","dob":"1987-09-30","age":"","mstatus":"","insh":"2358199*01","cliId":"","pno":5405347024,"cno":5405347024,"email":"","ename":"","eno":"","pphy":"WOLF-SMALL, BRIGITTE MD","ppno":8047769221,"pcpadd":",","pcpcity":"HARTFIELD","pcpstate":"VA","pcpzip":"23071-9998","pcpcounty":"","pcpid":"","pcpname":"Bon Secours Lively Medical Center","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8047767537,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R70.0","G62.9","Z71.2","NO DATA","B00.9","V58.89","H00.11","Z20.822","F14.90","N30.01","B34.9","F17.210","R10.9","G44.201","Z79.899","R51.9","O35.5XX0","O09.522","Z3A.20","F33.1","F43.10","O62.3","Z37.0","G60.0","O98.32","O76.","O99.344","Z3A.38","Z80.9","Z81.1","Z82.49","A60.09","O99.353","F12.90","Z87.891","O99.343","J02.9","N92.0","N94.6","Z30.09","Z32.02","Z11.3","A60.9","N39.0","G56.03","M25.572","M79.671","R19.7","F41.9","F51.04","M54.16","Z29.9","Z68.24","Z31.69","Q66.71","Q66.72","M19.071","M19.072","M21.542","M21.541","M25.571","O99.352","G44.209","O99.332","Z3A.16","R11.0","Z39.1","J06.9","B96.89","F43.20","M25.562","W10.8XXA","F41.8","H00.011","Z34.90","N89.8","R87.612","N76.0","M25.561","Z36.89","Z3A.24","Z01.818","Q68.5","Z68.23","S82.122A","B97.89","R59.9","G43.009","Z01.411","Z30.432","Z23.","M20.5X1","M20.5X2","O99.611","A08.4","Z3A.13","O35.0XX0","Z3A.17","O80.","Z3A.00","W18.40XA","Z68.22","O23.593","O36.8130","O22.43","Z3A.29","F41.1","O21.9","N30.00","R11.2","R53.83","O23.42"],"date":["2021-02-17","2022-10-06","2021-02-17","2023-05-23","2021-02-17","2021-03-04","2021-02-25","2021-12-21","2022-06-10","2021-11-04","2021-11-04","2022-04-25","2021-11-04","2022-04-25","2022-10-20","2022-04-25","2022-06-24","2022-05-27","2022-05-27","2023-08-01","2023-08-01","2022-09-30","2022-09-30","2023-01-04","2022-09-30","2022-09-30","2022-09-30","2022-09-30","2022-09-30","2022-09-30","2022-09-30","2022-09-30","2022-09-30","2022-09-30","2022-09-30","2022-09-30","2022-10-20","2023-03-01","2023-03-01","2023-03-01","2023-03-01","2021-11-22","2021-11-05","2021-11-05","2022-10-06","2023-01-04","2023-01-04","2021-06-03","2022-01-27","2022-02-28","2022-01-27","2022-01-27","2022-01-27","2022-02-08","2022-03-02","2022-03-02","2022-03-02","2022-03-02","2022-03-02","2022-03-02","2022-03-02","2022-04-23","2022-04-23","2022-04-23","2022-04-23","2022-04-23","2022-07-27","2023-03-15","2023-03-15","2023-05-03","2021-07-23","2021-03-30","2022-02-28","2023-05-23","2023-05-23","2021-03-29","2021-03-29","2021-11-22","2021-07-23","2022-04-06","2022-06-24","2021-03-04","2021-03-04","2022-05-09","2021-03-30","2021-12-21","2021-12-21","2022-05-09","2021-02-19","2021-02-19","2021-04-13","2021-07-15","2021-07-15","2022-04-06","2022-04-06","2022-04-06","2022-05-06","2022-05-06","2022-09-30","2023-09-13","2021-01-28","2021-01-28","2022-07-28","2022-07-28","2022-07-28","2022-07-28","2023-08-01","2023-09-13","2023-08-19","2023-08-19","2023-09-13","2023-08-19"],"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":[["","13107003134","MIRTAZAPINE","TAB 15MG","90","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","27241009803","DULOXETINE","CAP 30MG","30","Select","Select",""],["","62175011843","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","68180035202","SERTRALINE","TAB 50MG","30","Select","Select",""],["","00536408501","PRENATAL","TAB 28-0.8MG","30","Select","Select",""],["","00378461501","DOXYL\/PYRID","TAB 10-10MG","60","Select","Select",""],["","65862044890","VALACYCLOVIR","500 MG","90","Select","Select",""],["","68382004101","PROMETHAZINE","TAB 25MG","12","Select","Select",""],["","00093312301","DICLOXACILL","CAP 250MG","28","Select","Select",""],["","68180012202","CEPHALEXIN","500 MG","21","Select","Select",""],["","10702025350","BUT\/APAP\/CAF","TAB ","15","Select","Select",""],["","00093220401","METOCLOPRAM","TAB 5MG","9","Select","Select",""],["","57237007810","ONDANSETRON","TAB 8MG ODT","25","Select","Select",""],["","54766079904","ANALPRAM HC","CRE 2.5-1%","30","Select","Select",""],["","00168034720","TERCONAZOLE","CRE 0.008","20","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","14","Select","Select",""],["","00363853020",""," ","30","Select","Select",""],["","59651036205","IBUPROFEN","800 MG","30","Select","Select",""],["","00378727253","NORETHINDRON","TAB 0.35MG","84","Select","Select",""],["","00904531346","PRENATAL VITAMIN","27MG-0.8MG","30","Select","Select",""],["","00574402435","ERYTHROMYCIN","5 MG\/GRAM","3.5","Select","Select",""],["","68180035302","SERTRALINE HCL","100 MG","90","Select","Select",""],["","29300041510","CYCLOBENZAPRINE HCL","10 MG","30","Select","Select",""],["","00378727253","NORETHINDRONE","0.35 MG","84","Select","Select",""],["","65862001501","AMOXICILLIN","875 MG","20","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","13107003134","MIRTAZAPINE TAB","15MG","90","Select","Select",""],["","16571020150","DICLOFENAC TAB","75MG DR","60","Select","Select",""],["","27241009803","DULOXETINE CAP","30MG","30","Select","Select",""],["","62175011843","OMEPRAZOLE CAP","20MG","30","Select","Select",""],["","68180035302","SERTRALINE TAB","100MG","90","Select","Select",""],["","00536408501","PRENATAL TAB","28-0.8MG","30","Select","Select",""],["","00378461501","DOXYL\/PYRID TAB","10-10MG","60","Select","Select",""],["","00093312301","DICLOXACILL CAP","250MG","28","Select","Select",""],["","68382004101","PROMETHAZINE TAB","25MG","12","Select","Select",""],["","57237007810","ONDANSETRON TAB","8MG ODT","25","Select","Select",""],["","10702025350","BUT\/APAP\/CAF TAB","","15","Select","Select",""],["","00378427577","VALACYCLOVIR TAB","500MG","90","Select","Select",""],["","00093220401","METOCLOPRAM TAB","5MG","9","Select","Select",""],["","00093314705","CEPHALEXIN CAP","500MG","21","Select","Select",""],["","00168034720","TERCONAZOLE CRE","0.8%","20","Select","Select",""],["","65862018601","CLINDAMYCIN CAP","300MG","14","Select","Select",""],["","54766079904","ANALPRAM HC CRE","2.5-1%","30","Select","Select",""],["","64380080707","IBUPROFEN TAB","800MG","30","Select","Select",""],["","00378727253","NORETHINDRON TAB","0.35MG","84","Select","Select",""],["","65862018601","CLINDAMYCIN HCL","300 MG","14","Select","Select",""],["","00185012201","NITROFURANTOIN MONO-MACRO","100 MG","14","Select","Select",""],["","57237007710","ONDANSETRON ODT","4 MG","21","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":""}]}]}