{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"D YELRIHSLLEWRUB ","gend":1,"add":"HTUOS   2271EUNEVA NWAL","city":"RICHMOND","state":"VA","zip":23224,"dob":"1966-04-07","age":"","mstatus":"","insh":"70018750","cliId":"","pno":"3440812277","cno":8044377221,"email":"","ename":"","eno":"","pphy":"PEEBLES, RICHARD C","ppno":8044377221,"pcpadd":"110 N ROBINSON ST ,STE 400","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23220,"pcpcounty":"","pcpid":"","pcpname":"RETREAT INTERNAL MEDICINE","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"1722   SOUTHLAWN AVENUE","add3":"","madd1":"1722 SOUTHLAWN AVENUE","madd2":"APT 306","madd3":"","mcity":"RICHMOND","mstate":"VA","mzip":"23224-7832","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.32","M25.559","M47.816","I10","E11.9","Z21","Z79.899","Z79.1","Z90.710","Z82.49","M54.42","V89.2XXA","M54.5","Z04.3","J06.9","J02.9","Z88.8","B20","E66.01","N89.8","L30.9","N39.0","E78.5","Z23","Z20.828","E11.65","R07.9","E11.69","Z79.84","K64.9","H60.501","J01.00","N64.4","H60.503","Z12.11","G60.9","R00.2","M54.9","D47.3","M43.17","M51.36","M25.561","M25.551","W01.0XXA","M25.552","M25.571","Y99.0","M19.90","M25.579","E78.00","R35.0","R21","T78.40XA","X58.XXXA","Z12.31","L29.2","J32.9","S70.01XA","V09.9XXA","M79.10","R74.8","M62.838","V43.62XA","R30.0","M54.2","M70.61","M54.41","R10.2","R30.9","G62.9","R20.8","M62.541","E87.6","B00.9","B37.2","L25.3","E66.09","Z68.41","R29.898","M50.30","M51.37","Q05.6","Z68.39","N76.0","M79.645","R07.81","S16.1XXA","V43.02XA","Y92.481","S63.602A","S39.012A","V49.50XA","M79.642","S46.912D","S16.1XXD","V89.2XXD","M79.605","M76.32","S70.12XA","M25.532","G56.03","H66.93","M47.812","Y92.410","J45.909","M95.3","Z04.1","G44.319","S70.02XA","S63.501A","H60.92"],"date":["2020-01-01","2020-01-01","2020-01-01","2021-09-15","2021-09-05","2021-12-06","2021-12-06","2021-07-03","2020-01-01","2020-01-01","2020-01-01","2020-01-01","2021-06-22","2020-01-01","2020-01-29","2021-12-17","2020-01-07","2021-12-06","2020-01-29","2020-12-29","2020-03-19","2022-04-06","2021-12-06","2020-07-10","2020-07-10","2020-08-27","2020-09-22","2021-02-24","2020-10-09","2020-12-29","2021-01-06","2021-01-28","2021-02-19","2021-02-24","2021-02-24","2021-04-27","2021-04-27","2021-06-22","2021-04-27","2021-04-27","2021-04-27","2021-06-22","2021-06-22","2021-06-22","2021-06-22","2021-06-22","2021-06-22","2021-07-03","2021-06-23","2021-08-12","2021-08-12","2021-09-05","2021-09-05","2021-09-05","2021-09-15","2021-12-06","2021-12-17","2019-01-25","2019-01-25","2019-12-19","2019-12-19","2019-02-02","2019-02-02","2019-05-21","2019-12-06","2019-04-18","2019-02-12","2019-02-14","2019-02-14","2019-05-06","2019-05-06","2019-05-06","2019-05-21","2019-06-13","2019-06-22","2019-06-22","2019-06-22","2019-06-22","2019-11-14","2019-06-25","2019-06-25","2019-06-25","2019-06-25","2019-06-27","2019-07-18","2019-07-18","2019-11-26","2019-07-18","2019-07-18","2019-07-18","2019-11-26","2019-07-18","2019-08-15","2019-08-12","2019-08-12","2019-08-12","2019-08-15","2019-08-15","2019-08-15","2019-08-21","2019-11-14","2019-11-14","2019-11-25","2019-11-25","2019-11-25","2019-11-25","2019-11-25","2019-11-26","2019-11-26","2019-11-26","2019-11-26"],"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":{"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":[["","49702020613","EPZICOM","49702020613 EPZICOM ","30","Select","Select",""],["","67877056105","METFORMIN","67877056105 METFORMIN ","30","Select","Select",""],["","55111064501","OMEPRAZOLE","55111064501 OMEPRAZOLE ","90","Select","Select",""],["","67877019905","AMLODIPINE","67877019905 AMLODIPINE ","90","Select","Select",""],["","29300012810","HYDROCHLOROT","29300012810 HYDROCHLOROT ","90","Select","Select",""],["","00904585652","CALCIUM","TAB 600MG","60","Select","Select",""],["","00056051030","SUSTIVA","00056051030 SUSTIVA ","30","Select","Select",""],["","00093317431","ALBUTEROL","00093317431 ALBUTEROL ","8.5","Select","Select",""],["","00832532511","POT  CL MICRO","TAB 20MEQ ER","30","Select","Select",""],["","50111032701","HYDRALAZINE","50111032701 HYDRALAZINE ","270","Select","Select",""],["","68180063709","ATORVASTATIN","68180063709 ATORVASTATIN ","90","Select","Select",""],["","50742061701","METOPROL","50742061701 METOPROL ","90","Select","Select",""],["","00603533715","PREDNISONE","00603533715 PREDNISONE ","21","Select","Select",""],["","00904530660","BANOPHEN","00904530660 BANOPHEN ","20","Select","Select",""],["","65862085901","FAMOTIDINE","65862085901 FAMOTIDINE ","20","Select","Select",""],["","50383002505","OFLOXACIN","50383002505 OFLOXACIN ","5","Select","Select",""],["","00143924920","AMOX\/K","00143924920 AMOX\/K ","20","Select","Select",""],["","62332025118","AZITHROMYCIN","62332025118 AZITHROMYCIN ","6","Select","Select",""],["","80681013800","CALCIUM\/D3","80681013800 CALCIUM\/D3 ","60","Select","Select",""],["","51672203506","MICONAZOLE","51672203506 MICONAZOLE ","45","Select","Select",""],["","68462011944","FLUCONAZOLE","68462011944 FLUCONAZOLE ","1","Select","Select",""],["","69238106901","POT  CHLORIDE","69238106901 POT  CHLORIDE","90","Select","Select",""],["","16714043901","NITROFURANTN","16714043901 NITROFURANTN ","14","Select","Select",""],["","69315031228","PROCTO-MED","69315031228 PROCTO-MED ","56","Select","Select",""],["","49483048112","ASPIRIN","TAB 81MG EC","30","Select","Select",""],["","58657050916","GUAIFENESIN","58657050916 GUAIFENESIN ","300","Select","Select",""],["","68462029817","CLOTRIM\/BETA","68462029817 CLOTRIM\/BETA ","15","Select","Select",""],["","00168008031","HYDROCORT","00168008031 HYDROCORT ","30","Select","Select",""],["","68462019001","NAPROXEN","TAB 500MG","20","Select","Select",""],["","69097084507","CYCLOBENZAPR","69097084507 CYCLOBENZAPR ","20","Select","Select",""],["","00472040030","CLOBETASOL","CRE 0.0005","30","Select","Select",""],["","00904546052","OYST","TAB 500MG","60","Select","Select",""],["","11822771100","RA","LIQ 100\/5ML","600","Select","Select",""],["","65162046510","IBUPROFEN","65162046510 IBUPROFEN ","20","Select","Select",""],["","64380071206","BENZONATATE","CAP 100MG","15","Select","Select",""],["","69097036202","ABACA\/LAMIVU","69097036202 ABACA\/LAMIVU ","30","Select","Select",""],["","00185067401","HYDROXYZ","CAP 25MG","42","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","20","Select","Select",""],["","59310057922","PROAIR","AER ","8.5","Select","Select",""],["","69097030102","EFAVIRENZ","TAB 600MG","30","Select","Select",""],["","00378427693","VALACYCLOVIR","TAB 1GM","20","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","59762444002","METHYLPRED","TAB 4MG","21","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","20","Select","Select",""],["","68382005101","MELOXICAM","TAB 15MG","30","Select","Select",""],["","51672129801","KETOCONAZOLE","CRE 0.02","45","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","",""],[""],[""],[""],[""]],"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":""}]}]}