{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  YELRIHSSENOJ L ","gend":1,"add":"HTUOS 1021H TPA TS ","city":"FRANKLIN","state":"VA","zip":"23851-9998","dob":"1956-05-05","age":"","mstatus":"","insh":"30300210*45","cliId":"","pno":"53\/7575897-3","cno":"757\/375-3470","email":"","ename":"","eno":"","pphy":"BROCKINGTON, RICKY NP","ppno":"757\/562-2158","pcpadd":"102 FAIRVIEW DR STE B","pcpcity":"FRANKLIN","pcpstate":"VA","pcpzip":23851,"pcpcounty":"","pcpid":"","pcpname":"BON SECOURS MEDICAL GROUP HAMPTON ROADS PRIMARY CARE LLC","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":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M75.52","M25.512","I10.","K52.9","R10.84","E11.9","M20.41","M20.42","Z80.0","M19.90","R19.00","E78.5","R19.7","E11.69","J30.9","Z68.31","R25.2","L60.0","B35.1","M79.674","M79.675","R10.9","R52.","Z96.1","H50.112","H52.7","Z01.419","Z90.710","Z13.89","R92.1","D24.2","M47.812","E04.9","M25.519","E66.9","J98.4","M79.661","D64.9","M17.10","R29.898","E78.2","K63.5","K57.30","R92.0","Z68.30","B37.9","M79.89","J40.","E10.9","D12.0","H20.011","M27.2","K13.79","E11.37X9","E11.21","H61.23","H66.93","Z01.818","M75.122","J45.909","J06.9","M75.100","G89.18","H00.12","J20.9","R09.81","R22.41","Z12.31","Z11.59","Z76.0","H53.149","M17.11","Z79.84","Z79.899","M79.604"],"date":["2020-03-31","2020-03-31","2021-11-17","2021-11-17","2021-04-06","2021-11-17","2021-03-26","2021-03-26","2021-07-29","2021-07-29","2021-07-29","2021-07-29","2021-09-29","2021-09-29","2021-09-29","2021-09-29","2020-11-12","2020-05-20","2020-05-20","2020-05-20","2020-05-20","2020-01-06","2020-01-06","2020-06-16","2020-06-16","2020-06-16","2020-06-24","2020-06-24","2020-06-24","2020-07-22","2020-08-06","2021-07-07","2021-07-07","2020-02-06","2021-06-07","2020-02-06","2020-10-13","2020-11-12","2021-02-05","2020-10-23","2021-06-07","2021-08-12","2021-08-12","2020-07-28","2021-06-07","2020-08-05","2020-10-13","2020-12-09","2021-05-17","2021-08-12","2019-03-25","2019-05-20","2019-05-20","2019-09-03","2019-08-27","2019-10-01","2019-10-01","2019-10-11","2019-10-31","2019-10-03","2019-05-28","2019-10-31","2019-10-31","2019-02-06","2019-10-22","2019-10-22","2019-01-03","2019-01-03","2019-05-21","2019-05-21","2019-07-02","2019-08-18","2019-08-18","2019-08-18","2019-08-18"],"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":[["","00378210001","LOPERAMIDE","CAP 2MG","60","Select","Select",""],["","00006057761","JANUMET","TAB 50-1000","60","Select","Select",""],["","68682010910","NIFEDIPINE","TAB 60MG ER","30","Select","Select",""],["","53885024450","ONETOUCH","TES ULTRA BL","50","Select","Select",""],["","68180051902","LISINOP\/HCTZ","TAB 20-12.5","30","Select","Select",""],["","50580029715","TYLENOL","TAB 650MG","150","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","52817033010","CYCLOBENZAPR","TAB 5MG","14","Select","Select",""],["","64380080807","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","","TRIAMCINOLON","CRE 0.005","","Select","Select",""],["","","NYSTATIN","CRE 100000","","Select","Select",""],["","","CETIRIZINE","TAB 10MG","","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","11917012353","ARTHRTS","TAB 650MG","60","Select","Select",""],["","00406051205","OXYCOD\/APAP","TAB 5-325MG","30","Select","Select",""],["","45802088014","NYSTAT\/TRIAM","CRE ","15","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00378027105","DIAZEPAM","TAB 2MG","2","Select","Select",""],["","66869040490","LIVALO","TAB 4MG","90","Select","Select",""],["","29300012510","MELOXICAM","TAB 15MG","30","Select","Select",""],["","60505014102","GLIPIZIDE","TAB 5MG","90","Select","Select",""],["","00536101601","DIPHENHIST","TAB 25MG","120","Select","Select",""],["","00904530760","BANOPHEN","CAP 50MG","120","Select","Select",""],["","42037010478","DEBROX","SOL 6.5% OT","15","Select","Select",""],["","65862018501","CLINDAMYCIN","CAP 150MG","40","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","20","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","14","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","24208079535","NEO\/POLY\/DEX","OIN 0.1% OP","4","Select","Select",""],["","24208072002","DEXAMETH","SOL 0.1% OP","5","Select","Select",""],["","42167000554","LANCET","MIS THIN 30G","200","Select","Select",""],["","65162010250","GABAPENTIN","CAP 300MG","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}