{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TONYA M HARRIS","gend":1,"add":"2209 CHATEAU DR APT H","city":"RICHMOND","state":"VA","zip":"23220-9998","dob":"1974-03-23","age":"","mstatus":"","insh":"8218269*01","cliId":"","pno":8045915718,"cno":8045915718,"email":"","ename":"","eno":"","pphy":"CZAJKOWSKI, STANLEY B DO","ppno":8047641253,"pcpadd":"8200 MEADOWBRIDGE ROAD SUITE 306,","pcpcity":"MECHANICSVILLE","pcpstate":"VA","pcpzip":"23116-9998","pcpcounty":"","pcpid":"","pcpname":"Memorial Medical Center","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8047641259,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N83.292","S83.8X1A","S83.8X2A","E11.65","R10.31","N83.202","Z79.4","E11.8","N04.9","I10.","E78.2","G47.00","F41.9","E55.9","Z91.19","F32.9","R10.2","D50.0","Z79.899","Z11.3","Z68.28","NO DATA","J44.9","R73.9","Z79.84","E11.21","Z79.82","Z87.891","N23.","L08.89","R11.0","J03.90","H10.9","Z76.0","R68.2","Z86.2","R53.1","Z12.31","E11.69","E78.5","Z12.11","F41.1","N83.209","Z80.0","L08.9","H10.33"],"date":["2023-01-11","2022-04-11","2022-04-11","2023-06-22","2022-09-25","2022-10-03","2023-06-22","2021-09-24","2021-09-24","2023-06-22","2023-06-05","2023-06-22","2022-03-17","2022-03-17","2022-03-17","2021-09-24","2022-10-10","2022-03-17","2023-06-05","2021-09-03","2021-04-26","2023-02-10","2023-06-05","2022-09-25","2022-09-25","2022-09-25","2023-06-05","2023-06-05","2022-09-25","2023-06-04","2023-06-04","2023-06-05","2023-06-05","2023-06-05","2023-06-05","2023-06-05","2023-06-05","2023-06-22","2023-06-22","2023-06-22","2023-06-22","2023-06-22","2023-06-22","2023-06-22","2023-06-04","2023-06-05"],"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":[["","00169369619","NOVOLOG MIX","INJ FLEXPEN","18","Select","Select",""],["","65862020399","LOSARTAN POT","TAB 100MG","90","Select","Select",""],["","08290320119","BD PEN NEEDL","MIS 31GX5MM","100","Select","Select",""],["","68180035302","SERTRALINE","TAB 100MG","90","Select","Select",""],["","55111012205","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","45963070911","METOPROL SUC","TAB 25MG ER","90","Select","Select",""],["","69452015120","VITAMIN D","CAP 50000UNT","4","Select","Select",""],["","73070020315","INS ASP PROT","INJ FLEXPEN","18","Select","Select",""],["","60505265401","TRAZODONE","TAB 100MG","30","Select","Select",""],["","00378718705","METFORMIN","TAB 1000MG","180","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","30","Select","Select",""],["","11917009215","FERROUS SULF","TAB 325MG","30","Select","Select",""],["","00904404073","ASPIRIN","CHW 81MG","30","Select","Select",""],["","65862015901","ZOLPIDEM","TAB 5MG","30","Select","Select",""],["","00169300715","NOVOLIN","INJ 70\/30 FP","15","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","98302000199","COMFORT EZ","MIS 31GX5MM","100","Select","Select",""],["","61442010210","DICLOFENAC","TAB 50MG DR","14","Select","Select",""],["","64380080807","IBUPROFEN","TAB 600MG","20","Select","Select",""],["","70954006020","PREDNISONE","20 MG","12","Select","Select",""],["","00574402435","ERYTHROMYCIN","5 MG\/GRAM","3.5","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","53885000810","ONETOUCH DELICA PLUS LANCET","33 GAUGE","100","Select","Select",""],["","00781261305","AMOXICILLIN","500 MG","20","Select","Select",""],["","68180035302","SERTRALINE TAB","100MG","90","Select","Select",""],["","69452015120","VITAMIN D CAP","50000UNT","4","Select","Select",""],["","00904759080","FEROSUL TAB","325MG","30","Select","Select",""],["","73070020315","INS ASP PROT INJ FLEXPEN","","18","Select","Select",""],["","65862015901","ZOLPIDEM TAB","5MG","30","Select","Select",""],["","00378718705","METFORMIN TAB","1000MG","60","Select","Select",""],["","65862020399","LOSARTAN POT TAB","100MG","30","Select","Select",""],["","45963070911","METOPROL SUC TAB","25MG ER","90","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","55111012205","ATORVASTATIN TAB","20MG","30","Select","Select",""],["","00536100836","ASPIRIN CHW","81MG","30","Select","Select",""],["","08290320119","BD PEN NEEDL MIS","31GX5MM","100","Select","Select",""],["","98302000199","COMFORT EZ MIS","31GX5MM","100","Select","Select",""],["","11917009215","FERROUS SULF TAB","325MG","30","Select","Select",""],["","00169369619","NOVOLOG MIX INJ FLEXPEN","","6","Select","Select",""],["","61442010210","DICLOFENAC TAB","50MG DR","14","Select","Select",""],["","64380080807","IBUPROFEN TAB","600MG","20","Select","Select",""],["","65862020399","LOSARTAN POTASSIUM","100 MG","90","Select","Select",""],["","43386009019","GAVILYTE-G","236-22.74G","4000","Select","Select",""],["","00378718705","METFORMIN HCL","1000 MG","60","Select","Select",""],["","73070020011","INSULIN ASPART PROT MIX","70-30 70-30\/ML","20","Select","Select",""],["","45963070911","METOPROLOL SUCCINATE","25 MG","90","Select","Select",""],["","31722088390","ROSUVASTATIN CALCIUM","10 MG","90","Select","Select",""],["","72205002305","ATORVASTATIN CALCIUM","20 MG","30","Select","Select",""],["","60505265401","TRAZODONE HCL","100 MG","90","Select","Select",""],["","68180035302","SERTRALINE HCL","100 MG","90","Select","Select",""],["","53885013610","ONETOUCH DELICA","33 GAUGE","100","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","100\/ML (3)","15","Select","Select",""],["","00310621030","FARXIGA","10 MG","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":""}]}]}