{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"B SUNEVSELTTA","gend":1,"add":"BRAH GAS 2271102 TPA NL RO","city":"FREDERICKSBURG","state":"VA","zip":"22401-9998","dob":"1976-12-17","age":"","mstatus":"","insh":"4471210*49","cliId":"","pno":"27\/7042290-9","cno":"","email":"","ename":"","eno":"","pphy":"MORALES, DELBERT U MD","ppno":"804\/822-4351","pcpadd":"5000 COX ROAD","pcpcity":"GLEN ALLEN","pcpstate":"VA","pcpzip":23060,"pcpcounty":"","pcpid":"","pcpname":"PATIENT FIRST RICHMOND MEDICAL GROUP PLLC","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":["R07.9","R52.","J01.90","I10.","R40.0","F32.9","F41.9","N30.01","G43.101","H40.9","M16.12","J45.41","K21.9","R09.82","R53.83","J45.901","J01.80","R00.2","Z87.891","R07.89","E66.9","R03.0","R53.81","M16.11","I21.4","J06.9","J45.40","R06.83","Q15.0","H53.002","R00.0","R06.2","R91.8","G47.19","J45.909","Z87.19","Z53.8","M62.838","M25.552","G47.10","R09.81","M16.0","S76.011A","N39.0","M54.16","M47.816","R73.03","M19.011","M75.21","J45.21","G44.209","R51.","D25.9","G47.8","F51.5","D64.9","Z79.82","Z79.51","J45.20","T68.XXXA","R06.9","R45.7","M25.561","J02.9","R50.9","J30.9"],"date":["2020-03-22","2020-09-28","2020-07-12","2021-04-02","2020-07-22","2021-04-02","2021-11-16","2021-02-26","2021-02-26","2021-02-26","2021-12-23","2021-06-14","2021-09-10","2021-09-10","2021-09-10","2020-04-20","2020-01-03","2020-08-10","2020-04-27","2020-08-10","2020-08-10","2020-03-25","2020-03-25","2021-12-02","2020-03-21","2020-08-24","2021-09-10","2021-09-10","2021-10-08","2021-10-08","2020-04-03","2020-04-20","2020-04-29","2021-04-02","2021-04-02","2020-08-31","2020-08-31","2021-05-17","2021-05-17","2021-06-03","2020-09-11","2021-11-30","2020-09-15","2021-01-05","2021-04-28","2021-04-28","2021-05-06","2021-12-13","2021-12-13","2020-03-21","2020-09-28","2020-09-28","2021-03-25","2021-04-02","2021-04-02","2021-04-02","2021-04-02","2021-04-02","2020-03-20","2020-03-28","2020-03-28","2020-03-28","2019-05-31","2019-04-30","2019-04-30","2019-04-30"],"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":[["","","ALBUTEROL","AER HFA","","Select","Select",""],["","","BUT\/APAP\/CAF","TAB ","","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","","HYDROCHLOROT","TAB 25MG","","Select","Select",""],["","","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","","METOPROL","TAB 25MG ER","","Select","Select",""],["","","LOSARTAN","TAB 25MG","","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","120","Select","Select",""],["","","IPRATROPIUM","SPR 0.0006","","Select","Select",""],["","47781030801","NITROFUR","CAP 100MG","14","Select","Select",""],["","24208048610","DORZOL\/TIMOL","SOL 22.3-6.8","10","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","","TRAVOPROST","DRO 0.00004","","Select","Select",""],["","13668000705","ZOLPIDEM","TAB 5MG","5","Select","Select",""],["","78206012702","DULERA","AER 100-5MCG","1","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","65862053820","LEVOFLOXACIN","TAB 750MG","7","Select","Select",""],["","","LORAZEPAM","TAB 1MG","","Select","Select",""],["","24208046325","LATANOPROST","SOL 0.00005","8","Select","Select",""],["","","PREDNISONE","TAB 20MG","","Select","Select",""],["","","ASPIRIN","TAB 81MG EC","","Select","Select",""],["","","AMLODIPINE","TAB 2.5MG","","Select","Select",""],["","","IPRATROPIUM\/","SOL ALBUTER","","Select","Select",""],["","","CARVEDILOL","TAB 6.25MG","","Select","Select",""],["","","FLOVENT","AER 110MCG","","Select","Select",""],["","","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","","ATORVASTATIN","TAB 20MG","","Select","Select",""],["","","CVS","TAB 81MG EC","","Select","Select",""],["","","BENZONATATE","CAP 200MG","","Select","Select",""],["","","LEVOCETIRIZI","TAB 5MG","","Select","Select",""],["","","MONTELUKAST","TAB 10MG","","Select","Select",""],["","00065026025","TRAVATAN","DRO 0.00004","5","Select","Select",""],["","00093005805","TRAMADOL","TAB 50MG","15","Select","Select",""],["","68180098003","LISINOPRIL","TAB 10MG","20","Select","Select",""],["","24658031205","DOXYCYCL","TAB 100MG","20","Select","Select",""],["","63481068447","VOLTAREN","GEL 0.01","100","Select","Select",""],["","49884093547","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","24208048510","DORZOLAMIDE","SOL 2% OP","10","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":""}]}]}