{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   DNOMYAREITTAEB C","gend":0,"add":"YTIC W 2121DAOR TNIOP ","city":"HOPEWELL","state":"VA","zip":"23860-3757","dob":"1952-11-10","age":"","mstatus":"","insh":"40011438","cliId":"","pno":"2740884831","cno":"","email":"","ename":"","eno":"","pphy":"BUSH, JAMES A","ppno":8045201110,"pcpadd":"815 W POYTHRESS ST, ","pcpcity":"HOPEWELL","pcpstate":"VA","pcpzip":238602532,"pcpcounty":"","pcpid":"","pcpname":"HOPEWELL MEDICAL CENTER","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"APT 6","add3":"","madd1":"1212 W CITY POINT ROAD","madd2":"APT 6","madd3":"","mcity":"HOPEWELL","mstate":"VA","mzip":"23860-3757","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I49.1","R94.31","S82.142A","Y93.55","V19.9XXA","S89.92XA","M25.562","S82.302A","S82.142D","S80.822D","V19.3XXD","G56.01","Z79.82","S81.802A","S82.832A","S82.192A","M25.462","T84.89XA","S82.102A","E66.9","Z68.27","S82.142K","Z98.890","D64.9","R52","F31.9","G47.00","V19.9XXD","R26.2","I49.9","D62","Z87.891","R42","R25.2","G81.94","L29.9","H55.00","T14.8XXA","R68.89","T84.623A","S82.222D","L03.115","M79.605","L03.116","M79.89","S82.145D","S82.452D","T81.40XA","Z47.89","R60.0","I87.2","L02.426","L08.9","S90.821A","M79.673","X58.XXXA","Y92.9","S90.822A","B35.3","M79.671","M79.672","L30.8","S82.102D","S82.491D","M17.12","M85.862","M11.262","Z09","M25.662","S82.402D","M81.0","L25.9","I89.0","F41.9","G89.4","B35.1","L30.9","L29.8","S20.309A","S20.402A","L21.8","S82.892D","M77.41","L85.1","R23.4","V18.0XXD","Z91.81","R26.81","R26.89","R53.1","Z74.09","Z72.89","Z88.0","Z88.1","Z88.2","F32.9","F43.10","F20.0","R31.9","K57.30","R35.0","R39.15","N40.0","F03.90","Z85.46","R31.0","Z01.810","Z01.818","Z20.828","F43.23","C61","R97.20","I10","R53.82","R10.31","R60.9","E78.5","Z12.5","E55.9","K59.00"],"date":["2020-04-27","2020-04-27","2020-08-01","2020-04-27","2020-04-27","2020-04-27","2021-05-06","2020-04-28","2021-05-06","2020-05-01","2020-05-01","2020-05-01","2020-08-07","2020-07-06","2020-05-08","2020-05-08","2020-09-29","2020-05-08","2020-05-18","2020-05-18","2020-05-18","2020-05-18","2020-05-18","2020-08-07","2020-08-01","2022-03-16","2020-05-23","2020-05-22","2020-05-22","2020-05-22","2020-05-22","2020-08-07","2020-05-22","2020-05-22","2020-05-22","2020-05-22","2020-05-22","2020-05-22","2021-05-06","2020-08-07","2020-08-07","2020-06-22","2020-08-18","2020-06-22","2020-06-22","2020-06-26","2020-06-26","2020-07-14","2020-07-14","2022-03-16","2022-03-02","2020-08-03","2020-08-03","2020-08-14","2020-08-14","2020-08-14","2020-08-14","2020-08-14","2021-03-30","2020-08-14","2020-08-14","2020-08-17","2020-08-18","2020-08-18","2020-08-18","2020-08-18","2020-08-18","2020-08-18","2021-05-06","2020-09-29","2020-09-29","2021-08-20","2020-10-02","2021-09-27","2020-10-02","2021-03-29","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2021-04-06","2021-04-09","2021-04-09","2021-04-09","2021-04-30","2021-05-06","2021-05-06","2021-05-06","2021-04-30","2021-05-06","2021-04-30","2021-05-06","2021-05-06","2021-05-06","2021-08-20","2021-12-13","2021-08-20","2021-11-19","2021-09-15","2021-09-15","2021-09-15","2021-09-27","2021-09-27","2021-12-01","2022-03-16","2021-10-13","2021-10-13","2021-10-13","2021-10-28","2022-03-16","2021-11-19","2021-11-19","2021-12-13","2021-12-15","2022-03-02","2019-01-28","2019-01-28","2019-02-25","2019-02-25"],"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":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","42799080601","IVERMECTIN","42799080601 IVERMECTIN ","6","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","21","Select","Select",""],["","65162004710","OXYCODONE","TAB 5MG","20","Select","Select",""],["","31722094101","HYDROCO\/APAP","TAB 5-325MG","14","Select","Select",""],["","45802006405","TRIAMCINOLON","45802006405 TRIAMCINOLON ","908","Select","Select",""],["","51672128902","NYSTATIN","51672128902 NYSTATIN ","60","Select","Select",""],["","65862092205","TRAMADL\/APAP","TAB 37.5-325","40","Select","Select",""],["","23155050105","HYDROXYZ","23155050105 HYDROXYZ ","90","Select","Select",""],["","45802046564","KETOCONAZOLE","45802046564 KETOCONAZOLE ","120","Select","Select",""],["","45802026937","PERMETHRIN","45802026937 PERMETHRIN ","60","Select","Select",""],["","51672130308","ECONAZOLE","51672130308 ECONAZOLE ","85","Select","Select",""],["","11822317510","RA","TAB 325MG","60","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","67877021901","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","65162027210","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","65862059801","TAMSULOSIN","65862059801 TAMSULOSIN ","3","Select","Select",""],["","65862007930","TERBINAFINE","TAB 250MG","14","Select","Select",""],["","11822985210","NAPROXEN","TAB 220MG","60","Select","Select",""],["","00904598348","AMMONIUM","00904598348 AMMONIUM ","140","Select","Select",""],["","51672129003","HC","CRE 0.002","60","Select","Select",""],["","65162062710","TRAMADOL","TAB 50MG","21","Select","Select",""],["","59267100002","PFIZER","59267100002 PFIZER ","0.3","Select","Select",""],["","00172392660","DIAZEPAM","00172392660 DIAZEPAM ","30","Select","Select",""],["","50111056001","TRAZODONE","50111056001 TRAZODONE ","30","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","60","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","50228018005","GABAPENTIN","CAP 300MG","30","Select","Select",""],["","68180071160","CEFDINIR","68180071160 CEFDINIR ","6","Select","Select",""],["","62135030901","CIPROFLOXACN","62135030901 CIPROFLOXACN ","6","Select","Select",""],["","11822549870","VITAMIN","CAP 5000UNIT","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}