{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AICILEFYBBUC ","gend":1,"add":"SWAL 3153TEERTS NO","city":"RICHMOND","state":"VA","zip":"23224-1857","dob":"1968-04-13","age":"","mstatus":"","insh":"21016099","cliId":"","pno":"9940821487","cno":8049976658,"email":"","ename":"","eno":"","pphy":"CHERIAN, REENA","ppno":8048285883,"pcpadd":"1001 E LEIGH ST,","pcpcity":"Richmond","pcpstate":"VA","pcpzip":"23298-5004","pcpcounty":"","pcpid":"","pcpname":"VCU ADULT OUTPATIENT PAVILION","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"3513 LAWSON STREET","add3":"","madd1":"2309 Barton Ave Apt 2","madd2":"","madd3":"","mcity":"Richmond","mstate":"VA","mzip":"23222-4436","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","R68.89","F14.120","F31.61","I10","F33.0","F11.10","F43.11","F14.20","F31.9","B18.2","F11.11","Z71.89","Z68.32","F31.62","F43.10","L80","R82.5","F33.1","J45.909","J44.9","K76.0","F43.12","F12.20","F14.10","R32","F31.32","F43.23","K80.20","R77.2","F19.939"],"date":["2023-05-29","2021-02-28","2022-10-20","2022-05-31","2022-01-20","2022-02-24","2022-08-24","2022-02-18","2022-11-15","2022-05-06","2022-06-27","2022-01-20","2022-02-22","2022-01-20","2022-04-29","2022-03-22","2022-02-22","2022-02-22","2022-06-09","2022-11-14","2022-11-14","2022-06-27","2022-10-19","2022-10-20","2022-10-19","2022-10-04","2022-10-19","2022-05-24","2022-05-24","2022-06-27","2022-11-28"],"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":[["","29300046810","CLONIDINE","TAB 0.1MG","30","Select","Select",""],["","29300012810","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","59267100001","PFIZER VACC","INJ COVID-19","0.3","Select","Select",""],["","45802006435","TRIAMCINOLON","CRE 0.001","45","Select","Select",""],["","00074262528","MAVYRET","TAB 100-40MG","84","Select","Select",""],["","76204060030","IPRATROPIUM\/","SOL ALBUTER","90","Select","Select",""],["","65862018730","ONDANSETRON","TAB 4MG","14","Select","Select",""],["","00574010603","BROMOCRIPTIN","TAB 2.5MG","14","Select","Select",""],["","55111017915","TIZANIDINE","TAB 2MG","14","Select","Select",""],["","65162025009","CHLORTHALID","TAB 50MG","30","Select","Select",""],["","63402030230","LATUDA","TAB 20MG","30","Select","Select",""],["","69238117109","DOXEPIN HCL","CAP 50MG","30","Select","Select",""],["","00115180401","HYDROXYZ PAM","CAP 50MG","180","Select","Select",""],["","50111064801","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","13107003105","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","69238111801","BUSPIRONE","TAB 15MG","60","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":""}]}]}