{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   HALIEKYLLIER A","gend":1,"add":"EED 63321RD TSRUHR","city":"MIDLOTHIAN","state":"VA","zip":"23113-9998","dob":"1991-12-28","age":"","mstatus":"","insh":"2632210*40","cliId":"","pno":"16\/4087181-6","cno":"","email":"","ename":"","eno":"","pphy":"BHAT, SHRIDHAR MD","ppno":"804\/819-4000","pcpadd":"107 S 5TH STREET","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23219,"pcpcounty":"","pcpid":"","pcpname":"RICHMOND BEHAVIORAL HEALTH AUTHORITY","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","F43.10","F41.1","F11.10","F32.9","F43.12","F41.9","Z62.810","Z01.419","Z11.3","Z71.89","F11.20","L02.92","E05.00","Z76.89","F11.23","F17.200","F14.20","E05.90","F41.8","F17.210","F11.21","F10.21","H52.13","F11.90","Z23.","O34.211","O60.14X0","O99.324","O77.0","O99.284","O99.334","Z37.0","Z3A.36","O65.5","R56.9","Z39.2","Z39.0","Z30.017","O99.325","Z39.1","F14.10","F19.10"],"date":["2020-10-25","2020-10-25","2020-10-25","2020-12-16","2020-07-29","2020-02-20","2020-07-29","2020-02-20","2020-08-31","2020-08-31","2021-05-12","2021-12-08","2020-12-04","2021-08-19","2021-05-12","2021-05-14","2021-05-14","2021-05-14","2021-05-14","2020-08-19","2020-08-19","2020-10-14","2020-08-19","2021-08-19","2020-09-02","2021-08-24","2019-11-02","2019-11-02","2019-11-02","2019-11-02","2019-11-02","2019-11-02","2019-11-02","2019-11-02","2019-11-02","2019-12-03","2019-12-20","2019-11-05","2019-11-15","2019-11-22","2019-11-06","2020-10-21","2020-10-21"],"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":[["","12496120803","SUBOXONE","MIS 8-2MG","14","Select","Select",""],["","","METHIMAZOLE","TAB 5MG","","Select","Select",""],["","70074050461","ENSURE","LIQ VANILLA","5688","Select","Select",""],["","69097083412","SERTRALINE","TAB 50MG","30","Select","Select",""],["","00781723864","BUPREN\/NALOX","MIS 8-2MG","6","Select","Select",""],["","","SUBLOCADE","INJ 300\/1.5","","Select","Select",""],["","","HYDROXYZ","TAB 25MG","","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","00536406301","CL","TAB 28-0.8MG","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":[]}},{"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":""}]}]}