{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TAVONNA WRIGHT","gend":1,"add":"2068 CREIGHTON RD APT 1","city":"RICHMOND","state":"VA","zip":"23223-9998","dob":"1989-03-22","age":"","mstatus":"","insh":"2399820*01","cliId":"","pno":8048772017,"cno":8048772017,"email":"","ename":"","eno":"","pphy":"PERRON, CASSANDRA NP","ppno":8048284409,"pcpadd":"1001 E LEIGH ST,","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":"23298-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8048067588,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.9","F33.1","F43.10","M54.2","M62.838","N76.0","Z30.431","R35.0","B96.89","N89.8","Z11.3","N30.01","J45.909","F17.210","Z86.2","N23.","Z01.419","H66.92","M62.830","M54.9","B35.3","F17.200","M79.662","N20.1","R39.9","J06.9","R05.1","Z20.822","R00.0","R50.9"],"date":["2022-09-01","2022-10-30","2022-09-11","2023-08-10","2023-08-10","2023-07-20","2023-07-20","2023-07-20","2023-07-20","2023-07-20","2023-07-20","2022-10-30","2022-11-23","2022-11-23","2022-11-23","2022-10-30","2023-01-03","2021-07-11","2023-08-10","2023-08-10","2023-09-18","2023-09-18","2023-09-18","2021-08-05","2022-10-21","2022-11-23","2022-11-23","2022-11-23","2022-11-23","2022-11-23"],"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":[["","00781707787","METRONIDAZOL","GEL 0.75%VAG","70","Select","Select",""],["","57237002801","AMOXICILLIN","TAB 500MG","21","Select","Select",""],["","64380080807","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","00116200116","CHLORHEX GLU","SOL 0.0012","473","Select","Select",""],["","59267102501","PFIZER VACC","INJ ADLT RTU","0","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","8","Select","Select",""],["","51672200306","CLOTRIMAZOLE","CRE 1% VAG","45","Select","Select",""],["","45802012265","LORATADINE-D","TAB 5-120MG","20","Select","Select",""],["","75826011510","PHENAZOPYRID","TAB 200MG","6","Select","Select",""],["","13811071910","NITROFURANTN","CAP 100MG","6","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","30","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","50111033402","METRONIDAZOLE","500 MG","14","Select","Select",""],["","10702001801","OXYCODONE HCL","5 MG","15","Select","Select",""],["","76385012450","METHOCARBAMOL","750 MG","30","Select","Select",""],["","00378064110","PREDNISONE","10 MG","31","Select","Select",""],["","51672208002","TERBINAFINE","1 %","30","Select","Select",""],["","62037072001","POTASSIUM CHLORIDE","20 MEQ","28","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":""}]}]}