{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CLAUDIA D JACKSON","gend":1,"add":"306 NEWBRIDGE RD APT 108","city":"RICHMOND","state":"VA","zip":"23223-9998","dob":"1977-09-12","age":"","mstatus":"","insh":"8275068*01","cliId":"","pno":8046686581,"cno":8046686581,"email":"","ename":"","eno":"","pphy":"NGTAM, NGUYEN MD","ppno":8042262444,"pcpadd":"4620 S LABURNUM AVE","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":"23231-9998","pcpcounty":"","pcpid":"","pcpname":"Laburnum Medical Center","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8042220458,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.9","N73.9","N30.90","R10.84","R11.2","F12.90","Z20.2","N76.0","I10.","F51.01","J45.30","B96.89","N39.0","A41.9","E87.1","J45.909","Z79.899","Z11.59","Z13.1","R00.0","A59.9","E87.6","F17.210","F10.10","G43.909","F41.9","J45.20","Z90.49","Z91.048","Z91.199","R10.9","N73.0","N30.00","E86.0","R10.32","K21.9","Z13.220","Z91.19","R87.1","J30.89","N89.8","A64.","L20.84","K59.01","Z12.11","Z11.4","Z68.26"],"date":["2023-05-01","2022-10-08","2022-10-05","2023-01-19","2023-01-19","2023-01-19","2023-01-19","2022-10-05","2023-04-26","2023-04-26","2023-04-26","2022-10-07","2022-10-08","2022-10-08","2022-10-07","2022-10-08","2023-04-07","2023-04-26","2022-07-07","2022-06-19","2022-10-05","2022-10-05","2023-04-07","2022-10-05","2022-10-05","2022-10-05","2022-10-05","2022-10-05","2022-10-05","2023-04-07","2022-10-05","2022-10-07","2022-10-07","2022-08-15","2022-10-09","2022-07-07","2022-07-07","2022-07-07","2022-10-08","2023-04-07","2023-04-26","2023-04-26","2023-04-26","2023-04-26","2023-04-26","2023-04-26","2023-04-26"],"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":[["","42806016005","HYDROXYZ HCL","TAB 25MG","90","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","59779030602","CVS PURELAX","POW ","238","Select","Select",""],["","16571040250","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","67877043403","ARIPIPRAZOLE","20 MG","30","Select","Select",""],["","31722054501","LITHIUM CARB","CAP 300MG","180","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","59651000305","OMEPRAZOLE","40 MG","30","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","65162019050","NAPROXEN","500 MG","30","Select","Select",""],["","00115165903","PROPRANOLOL","TAB 10MG","180","Select","Select",""],["","45802086801","POLYETH GLYC","POW 3350 NF","238","Select","Select",""],["","00115180401","HYDROXYZ PAM","CAP 50MG","60","Select","Select",""],["","13668000805","ZOLPIDEM","TAB 10MG","30","Select","Select",""],["","00228212750","CLONIDINE","TAB 0.1MG","180","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","43386031208","GAVILAX","POW ","238","Select","Select",""],["","59267100001","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","20","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","45802075930","PROMETHAZINE","SUP 25MG","12","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","20","Select","Select",""],["","00093310705","AMOXICILLIN","CAP 250MG","21","Select","Select",""],["","65862098799","POT CHLORIDE","TAB 10MEQ ER","20","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","46122009979","THERAPEUTIC-","TAB M","30","Select","Select",""],["","10135013201","THIAMINE HCL","TAB 100MG","30","Select","Select",""],["","00904549261","THERA M PLUS","TAB ","30","Select","Select",""],["","71930005552","APAP\/CODEINE","TAB 300-30MG","16","Select","Select",""],["","24658031205","DOXYCYCL HYC","TAB 100MG","20","Select","Select",""],["","68180072003","AMLODIPINE BESYLATE","5 MG","90","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","24658031205","DOXYCYCLINE HYCLATE","100 MG","14","Select","Select",""],["","65862057490","MONTELUKAST SODIUM","10 MG","30","Select","Select",""],["","00228212750","CLONIDINE HCL","0.1 MG","180","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","47335070354","ALBUTEROL SULFATE","2.5 MG\/3ML","225","Select","Select",""],["","00168000615","TRIAMCINOLONE ACETONIDE","0.1 %","30","Select","Select",""],["","31722054501","LITHIUM CARBONATE","300 MG","90","Select","Select",""],["","13668000805","ZOLPIDEM TARTRATE","10 MG","15","Select","Select",""],["","59779030602","PURELAX","17 G\/DOSE","238","Select","Select",""],["","00115180401","HYDROXYZINE PAMOATE","50 MG","60","Select","Select",""],["","00274340060",""," ","30","Select","Select",""],["","50111033401","METRONIDAZOLE","500 MG","14","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":""}]}]}