{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"W APPILIHPELGALSELO","gend":1,"add":"KLOFFUS 112A3 TPA EVA ","city":"COLONIAL HEIGHTS","state":"VA","zip":"23834-9998","dob":"1977-05-21","age":"","mstatus":"","insh":"15600210*72","cliId":"","pno":"84\/4083670-4","cno":"804\/484-0763","email":"","ename":"","eno":"","pphy":"ROSE, ANDREW MD","ppno":"804\/560-8838","pcpadd":"SUITE 1-A 9220 FOREST HILL AVE","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23235,"pcpcounty":"","pcpid":"","pcpname":"IRONBRIDGE FAMILY PRACTICE","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F39.","F33.2","F41.9","G47.00","F60.3","F33.1","F31.32","F41.1","F32.1","R06.02","R05.","R50.9","Z20.828","Z03.818","F33.40","I45.19","Z20.822","L08.9","F32.9","Z11.1"],"date":["2022-03-16","2022-03-16","2022-03-16","2022-03-16","2021-03-11","2020-12-18","2020-12-18","2020-12-18","2021-02-04","2021-01-08","2021-01-08","2021-01-08","2021-03-22","2021-09-02","2021-06-24","2021-08-04","2021-09-02","2020-07-18","2020-07-18","2020-11-03"],"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":[["","63402030830","LATUDA","TAB 80MG","30","Select","Select",""],["","00054002125","LITHIUM","TAB 300MG ER","60","Select","Select",""],["","00591354360","BUPROPION","TAB 150MG SR","60","Select","Select",""],["","00228212750","CLONIDINE","TAB 0.1MG","30","Select","Select",""],["","69097012303","TOPIRAMATE","TAB 50MG","60","Select","Select",""],["","69097083512","SERTRALINE","TAB 100MG","60","Select","Select",""],["","59417010410","VYVANSE","CAP 40MG","30","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","00093342210","CYCLOBENZAPR","TAB 10MG","3","Select","Select",""],["","69097096507","NABUMETONE","TAB 500MG","60","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","30","Select","Select",""],["","10702010101","METHYLPHENID","TAB 10MG","30","Select","Select",""],["","00228306011","AMPHET\/DEXTR","CAP 20MG ER","26","Select","Select",""],["","54092038701","ADDERALL","CAP 20MG","26","Select","Select",""],["","51991029301","OXCARBAZEPIN","TAB 300MG","60","Select","Select",""],["","60505283303","ATOMOXETINE","CAP 40MG","180","Select","Select",""],["","60505393001","GUANFACINE","TAB 4MG ER","30","Select","Select",""],["","57237004705","DIVALPROEX","TAB 250MG DR","60","Select","Select",""],["","10702001150","HYDROXYZ","TAB 25MG","90","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":""}]}]}