{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RENEE COLON","gend":1,"add":"5504 EUCLID AVE","city":"HENRICO","state":"VA","zip":"23231-9998","dob":"1965-05-23","age":"","mstatus":"","insh":"9305467*01","cliId":"","pno":4343721870,"cno":4343721870,"email":"","ename":"","eno":"","pphy":"DEBOER, SARAH E MD","ppno":8047800840,"pcpadd":"719 N 25th St","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":"23223-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8044201140,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R00.0","I95.9","M79.602","C54.1","I10.","T80.211A","A41.01","R65.20","J18.9","NO DATA","M00.812","E87.1","M86.9","E03.9","F12.10","E66.9","K27.9","Z20.822","T45.1X5A","Z79.899","M00.9","J15.8","M00.012","G56.22","M65.332","M72.0","R22.2","M25.552","Z71.89","F17.210","F17.200","S42.295A","N95.0","T78.40XA","N93.9","N84.0","K63.5","Z86.010","Z45.2","I05.9","R06.00","T80.212A","M25.512","E87.6","G60.9","M19.90","Z79.2","Z91.81","Z11.59","D12.2","D12.3","G89.29","I51.7","E83.42","R07.9","B19.20","A41.9","Z04.9","M65.352","E55.9","R73.03","Z12.4","K21.9","N17.9","L02.414","Z09.","D12.5","D12.7","D36.0","D27.0","D27.1","K66.0"],"date":["2022-11-30","2023-01-04","2022-10-26","2023-04-12","2023-04-11","2022-10-26","2023-01-04","2022-11-03","2023-01-04","2022-11-06","2022-11-03","2023-01-04","2022-10-26","2023-01-04","2022-10-26","2022-11-04","2022-10-26","2022-10-26","2022-11-06","2022-11-06","2023-02-27","2022-12-10","2023-04-11","2021-01-14","2021-01-14","2021-03-18","2022-01-06","2022-01-06","2022-11-09","2023-01-04","2022-10-05","2022-10-25","2022-05-09","2022-05-09","2022-08-05","2022-09-08","2022-07-19","2022-07-19","2022-10-28","2022-10-29","2022-11-03","2023-01-04","2023-02-27","2023-01-04","2023-01-04","2023-01-04","2023-01-04","2023-01-04","2022-03-22","2022-03-25","2022-07-19","2023-02-27","2022-11-30","2023-03-15","2023-02-01","2023-04-14","2022-11-04","2022-11-03","2021-02-25","2021-12-09","2021-12-09","2022-04-25","2023-04-11","2022-10-26","2022-11-02","2023-01-22","2022-07-19","2022-07-19","2022-09-08","2022-09-08","2022-09-08","2022-09-08"],"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":[["","27808003601","HYDROCO\/APAP","TAB 7.5-325","7","Select","Select",""],["","68382091634","METHYLPRED","TAB 4MG","21","Select","Select",""],["","29300012810","HYDROCHLOROT","TAB 25MG","90","Select","Select",""],["","68180097903","LISINOPRIL","40 MG","90","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","60","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","20","Select","Select",""],["","65862090801","CELECOXIB","CAP 100MG","60","Select","Select",""],["","80777027399","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","10572010001","PEG-3350","SOL ELECTROL","4000","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","52817033010","CYCLOBENZAPR","TAB 5MG","30","Select","Select",""],["","00904674860","BISACODYL","TAB 5MG EC","4","Select","Select",""],["","00363032706","GENTLE LAXAT","TAB 5MG EC","4","Select","Select",""],["","81421002001","DULCOLAX","TAB 5MG EC","4","Select","Select",""],["","00536589671","NICOTINE TD","DIS 21MG\/24H","28","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","00406851001","OXYCODONE","TAB 10MG","10","Select","Select",""],["","45802086866","POLYETH GLYC","POW 3350 NF","3","Select","Select",""],["","10135012310","ACETAMIN","TAB 325MG","30","Select","Select",""],["","59746011506","PROCHLORPER","TAB 10MG","30","Select","Select",""],["","70700015010","OMEPRAZOLE","20 MG","30","Select","Select",""],["","00093031101","LOPERAMIDE","CAP 2MG","30","Select","Select",""],["","00054418425","DEXAMETHASON","TAB 4MG","36","Select","Select",""],["","60505076900","CEFAZOLIN","INJ 10GM","5","Select","Select",""],["","00363042405","NICOTINE","LOZ 4MG CINN","72","Select","Select",""],["","68462019005","NAPROXEN","500 MG","60","Select","Select",""],["","10006073038","MAG OXIDE","TAB 400MG","30","Select","Select",""],["","60505614704","CEFEPIME","INJ 2GM","21","Select","Select",""],["","00409501701","VANCOMYCIN","INJ 10GM","2","Select","Select",""],["","43598044874","NICOTINE PATCH","21 MG\/24HR","28","Select","Select",""],["","10006073038","MAGNESIUM OXIDE","400 MG","60","Select","Select",""],["","00054418425","DEXAMETHASONE","4 MG","18","Select","Select",""],["","65862042005","SULFAMETHOXAZOLE-TRIMETHOPRIM","800-160 MG","20","Select","Select",""],["","33342006807","OLANZAPINE","5 MG","6","Select","Select",""],["","69097052444","DICLOFENAC SODIUM","1 %","100","Select","Select",""],["","59746011506","PROCHLORPERAZINE MALEATE","10 MG","30","Select","Select",""],["","80681017400","VITAMIN D","3 1250 MCG","4","Select","Select",""],["","53191036201","D3","50 1250 MCG","4","Select","Select",""],["","00406055201","OXYCODONE HCL","5 MG","28","Select","Select",""],["","57237000511","FLUCONAZOLE","150 MG","1","Select","Select",""],["","29300012810","HYDROCHLOROTHIAZIDE","25 MG","90","Select","Select",""],["","45802021696","BENZOYL PEROXIDE","5 %","60","Select","Select",""],["","68180072103","AMLODIPINE BESYLATE","10 MG","90","Select","Select",""],["","53191036201","D","3-50 1250 MCG","4","Select","Select",""],["","00074262528","MAVYRET","100MG-40MG","84","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":""}]}]}