{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DONNELL LEWIS","gend":0,"add":"611 LUTHER ROAD","city":"HENRICO","state":"VA","zip":"23075-9998","dob":"1983-08-31","age":"","mstatus":"","insh":"2486751*01","cliId":"","pno":7035680766,"cno":7035680766,"email":"","ename":"","eno":"","pphy":"MARZOUK, CAROLIN NP","ppno":8046284327,"pcpadd":"417 N 11TH STREET","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":8048284670,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I50.22","R07.9","Q87.89","I71.2","Z95.2","I51.7","I11.0","I50.23","Z20.822","E51.9","I42.8","F10.10","F17.210","G40.909","R09.02","Z59.01","Z63.8","Z79.82","Z90.2","Z95.3","Z13.6","R06.00","R05.9","R53.83","R57.0","I51.3","NO DATA","J93.83","N17.8","E43.","I50.9","E16.2","R06.02","I42.9","I50.20","F10.20","Z04.9","Z45.2","I23.6","G40.89","Z95.811","Z79.899","Z79.01","R56.9","Z00.00","L13.8","Z95.4","R78.81","G43.909","I67.1","A41.02","T80.211A","J43.9","Z51.81","Z79.2","I42.0","I25.2","B95.7","Z16.29","Z71.89","Z09.","R00.1","N17.9","I35.1","I71.9","R68.89","F17.200","T80.212A","I38.","J18.9","T82.897A","Z68.1","Z16.11","I08.8","I50.21","D69.6","R64.","R69.","Z74.3","Z72.0","E46.","I45.81","R00.0","R51.9","I33.0","Z16.39","D64.9","R94.31","I51.89"],"date":["2023-04-13","2023-01-22","2023-04-13","2022-07-19","2023-04-04","2023-02-05","2022-11-03","2023-01-18","2023-01-18","2022-10-09","2023-01-18","2023-01-16","2023-01-18","2023-01-04","2022-10-09","2022-10-09","2022-10-09","2023-01-16","2022-11-05","2022-10-09","2022-10-24","2022-11-02","2023-01-13","2022-11-02","2023-01-22","2023-03-02","2023-04-13","2022-11-04","2022-11-04","2022-11-05","2023-04-03","2022-12-19","2022-10-08","2022-11-15","2022-11-05","2022-11-05","2022-11-16","2023-04-04","2023-01-16","2023-04-04","2023-01-16","2023-04-04","2023-04-04","2023-01-13","2022-12-19","2022-11-03","2022-11-03","2023-01-18","2023-01-04","2023-01-18","2023-04-04","2023-04-04","2023-04-13","2023-04-04","2023-04-04","2023-01-15","2023-01-15","2022-12-29","2022-12-27","2023-01-21","2023-01-27","2023-03-02","2022-11-01","2023-01-18","2022-11-01","2022-11-01","2022-11-01","2022-12-29","2022-12-29","2023-01-18","2023-01-18","2023-01-18","2023-01-18","2022-11-03","2022-11-15","2022-11-15","2022-11-15","2022-10-08","2022-10-08","2022-10-09","2022-12-26","2022-11-03","2023-02-05","2022-12-26","2023-02-08","2022-12-26","2022-12-26","2023-02-05","2022-08-17"],"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":[["","53746051105","SPIRONOLACT","TAB 25MG","90","Select","Select",""],["","67877022301","GABAPENTIN","CAP 300MG","30","Select","Select",""],["","31722053705","LEVETIRACETA","TAB 500MG","60","Select","Select",""],["","00597015230","JARDIANCE","10 MG","90","Select","Select",""],["","33342006207","VALSARTAN","TAB 40MG","30","Select","Select",""],["","69097094605","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","42806071401","BENZONATATE","100 MG","10","Select","Select",""],["","70000017802","ASPIRIN","TAB 81MG EC","30","Select","Select",""],["","50111091701","TORSEMIDE","20 MG","30","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","30","Select","Select",""],["","51672403201","WARFARIN","TAB 5MG","30","Select","Select",""],["","80681009800","VITAMIN B-1","TAB 100MG","30","Select","Select",""],["","68462035701","POT CHLORIDE","CAP 10MEQ ER","30","Select","Select",""],["","65862020199","LOSARTAN POT","TAB 25MG","15","Select","Select",""],["","72611076510","VANCOMYCIN","INJ 1 GM","11","Select","Select",""],["","65219025624","PIPER\/TAZOBA","INJ 36-4.5GM","4","Select","Select",""],["","00378668910","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","16729043505","DAPTOMYCIN","INJ 500MG","7","Select","Select",""],["","80681004001","MELATONIN","TAB 5MG","30","Select","Select",""],["","69097084607","CYCLOBENZAPR","TAB 10MG","10","Select","Select",""],["","00003089421","ELIQUIS","5 MG","180","Select","Select",""],["","00527169501","BUTALBITAL-ACETAMINOPHEN-CAFFE","50-325-40","20","Select","Select",""],["","68180079901","POTASSIUM CHLORIDE","10 MEQ","90","Select","Select",""],["","31722053705","LEVETIRACETAM","500 MG","60","Select","Select",""],["","53746051105","SPIRONOLACTONE","25 MG","90","Select","Select",""],["","65862020199","LOSARTAN POTASSIUM","25 MG","15","Select","Select",""],["","43598083205","ATORVASTATIN CALCIUM","40 MG","90","Select","Select",""],["","50242004164","CATHFLO ACTIVASE","2 MG","1","Select","Select",""],["","51672403201","WARFARIN SODIUM","5 MG","30","Select","Select",""],["","00591352530","LIDOCAINE","5 %","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":""}]}]}