{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"REBLIWLLIH T","gend":0,"add":"SCINAHCEM 8071EKIPNRUT ELLIV","city":"RICHMOND                      ","state":"VA","zip":"23223-3957","dob":"1940-10-27","age":"","mstatus":"","insh":"40018839","cliId":"","pno":"8840839637","cno":"","email":"","ename":"","eno":"","pphy":"COVINGTON, DAMIAN L","ppno":8047446310,"pcpadd":"11020 HULL STREET RD,","pcpcity":"MIDLOTHIAN                    ","pcpstate":"VA","pcpzip":231123200,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"1708 MECHANICSVILLE TURNPIKE","add3":"","madd1":"1708 MECHANICSVILLE TURNPIKE","madd2":"3405 CHAMBERLAYNE AVE","madd3":"","mcity":"RICHMOND                      ","mstate":"VA","mzip":"23223-3957","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z00.00","R97.20","I11.9","E78.5","Z23","C61","N40.1","R30.0","N32.0","N13.30","R30.9","N40.0","Z85.46","Z79.899","I10","R33.9","R10.2","Z68.24","R79.9","Z92.29","R79.89","E53.8","R53.1","N30.01","R10.30","Z46.6","R00.0","R39.89","R10.9","R68.89","N39.0","R07.89","M54.9","R07.9","S09.90XA","W07.XXXA","J98.11","Y92.018","S29.011D","W19.XXXD","R10.13","W01.0XXD","R35.1","R35.0","R06.02","R63.4","E55.9","M25.559","Z01.818","Z11.59","Z53.09","R33.8","I73.9","N28.9","Z79.82","Z79.02","Z90.79","R10.12","R31.9","N99.89","R10.32","K56.7","N18.9","I12.9","K59.00","E86.0","N32.89","N36.8","T81.42XA","Z46.82","T83.84XA","R10.84","T83.091A","T83.031A","T83.098A","N28.82","W19.XXXA","T83.511A","Z48.816","G62.9","R89.9","Z13.89","M47.816","S92.002A","W01.0XXA","W18.30XA","S99.922A","M19.072","S99.912A"],"date":["2019-09-11","2020-02-10","2020-09-23","2019-09-11","2020-09-24","2021-07-30","2021-01-15","2020-12-11","2020-02-01","2020-11-16","2020-12-12","2020-02-01","2021-11-03","2020-09-18","2021-08-26","2021-01-15","2020-02-02","2021-08-26","2021-08-26","2021-08-26","2021-08-26","2021-08-26","2020-09-23","2020-02-14","2020-02-17","2020-12-12","2020-02-17","2020-02-17","2020-11-16","2021-08-26","2020-12-12","2020-08-17","2021-08-30","2020-08-17","2020-08-10","2020-08-13","2020-08-13","2020-08-13","2020-08-13","2020-08-13","2020-08-17","2020-08-17","2021-08-26","2020-09-18","2020-09-23","2020-09-23","2021-08-26","2020-10-15","2020-10-15","2020-11-09","2020-10-20","2020-11-11","2020-11-11","2020-11-11","2020-11-11","2020-11-11","2021-01-15","2020-11-15","2020-12-12","2020-11-16","2020-11-16","2020-11-18","2020-11-16","2020-11-16","2020-11-16","2020-11-16","2020-11-27","2020-11-20","2020-11-19","2020-11-20","2020-11-27","2020-12-10","2020-12-10","2020-12-11","2020-12-11","2020-12-11","2020-12-12","2020-12-12","2021-01-15","2021-08-26","2021-08-26","2021-08-26","2021-08-30","2021-10-06","2021-10-06","2021-10-06","2021-10-06","2021-10-06","2021-10-06"],"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":[["","68180072003","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","16729018201","HYDROCHLOROT","TAB 12.5MG","30","Select","Select",""],["","00093206406","CILOSTAZOL","TAB 100MG","60","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","70436000203","POT  CHLORIDE","TAB 10MEQ ER","30","Select","Select",""],["","59779060014","ASPIRIN","TA B EC","90","Select","Select",""],["","57237001401","TAMSULOSIN","CAP 0.4MG","30","Select","Select",""],["","69097081312","GABAPENTIN","CAP 100MG","60","Select","Select",""],["","00603233832","APAP\/CODEINE","TAB 300-30MG","30","Select","Select",""],["","00603497532","OXYBUTYNIN","TAB 5MG","42","Select","Select",""],["","65862007701","CIPROFLOXACN","TAB 500MG","10","Select","Select",""],["","71093014105","METHOCARBAM","TAB 750MG","20","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","75826011510","PHENAZOPYRID","TAB 200MG","6","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","10","Select","Select",""],["","50428057834","CVS","PAD 0.04","5","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","12","Select","Select",""],["","00536106210","STOOL","CAP 100MG","28","Select","Select",""],["","70000044701","SENNA","TAB 8.6MG","28","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","6","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":""}]}]}