{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"YENALEDYRREP ","gend":1,"add":"OWGNIGNIS 0232B5 TPA NL SDO","city":"HENRICO","state":"VA","zip":"23233-9998","dob":"1981-09-01","age":"","mstatus":"","insh":"53600210*60","cliId":"","pno":"15\/4082254-0","cno":"","email":"","ename":"","eno":"","pphy":"JACKSON, JORDAN MD","ppno":"804\/741-6200","pcpadd":"9600 PATTERSON AVE","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23229,"pcpcounty":"","pcpid":"","pcpname":"PATTERSON AVENUE 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":["F20.9","R00.0","F25.1","F60.3","F99.","F41.9","F31.2","F32.9","V62.84","F10.10","K85.10","K80.10","Z20.822","K21.9","K59.00","K76.0","F25.9","F31.9","F79.","I10.","G47.00","G89.29","Z88.8","Z98.51","Z79.899","Z56.0","F10.20","F42.2","D72.829","R10.84","L73.2","Z68.38","K82.4","F25.0","N28.1","Z01.419","F17.210","N76.0","R07.9","R05.9","M25.522","E11.9","Z82.49","Z82.61","Z83.3","Z83.49","F42.9","F33.3","Z23.","K81.0","Z03.818","F39.","F42.8","K85.90","E80.6","R74.01","N28.9","F31.10","F70.","Z86.19","Z11.1","E66.01","F31.75","K80.40","Z51.81","F22.","R79.89","R94.31","F33.8","F17.200","F33.2","Z68.41","F32.3","F20.2","D58.2","K40.90","Z68.37","R19.8","R93.89","R20.2","R20.0","Z68.35","Z00.00","F90.2","F29.","F23.","G56.03"],"date":["2021-11-05","2020-06-27","2021-12-29","2021-06-28","2020-07-09","2021-10-30","2020-03-09","2020-06-27","2021-01-05","2021-12-31","2021-10-31","2021-10-30","2021-10-30","2021-12-27","2021-10-30","2021-10-30","2021-10-30","2021-10-30","2021-10-30","2021-12-27","2021-10-30","2021-10-30","2021-12-27","2021-10-30","2021-12-27","2021-10-30","2021-12-30","2021-03-05","2021-07-06","2021-08-03","2021-09-20","2021-07-06","2021-07-06","2021-11-30","2021-11-24","2021-11-08","2021-12-27","2021-11-08","2021-12-27","2021-12-27","2021-12-27","2021-12-27","2021-12-27","2021-12-27","2021-12-27","2021-12-27","2021-03-29","2021-03-29","2021-07-12","2021-10-31","2021-01-05","2021-02-16","2021-06-28","2021-11-01","2021-11-01","2021-11-01","2021-11-24","2020-01-06","2020-04-06","2021-05-11","2021-05-11","2021-05-11","2021-05-11","2021-10-30","2021-11-24","2020-02-28","2021-09-20","2020-06-27","2020-06-28","2020-06-28","2021-06-28","2020-12-08","2021-04-12","2021-05-24","2021-09-20","2021-09-20","2021-08-03","2021-09-20","2021-09-20","2021-09-20","2021-09-20","2021-09-20","2021-02-09","2021-02-09","2020-06-28","2020-04-03","2020-12-11"],"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":[["","","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","","FLUVOXAMINE","TAB 100MG","","Select","Select",""],["","","BUSPIRONE","TAB 10MG","","Select","Select",""],["","","BUPROPN","TAB 150MG XL","","Select","Select",""],["","","DIVALPROEX","TAB 250MG DR","","Select","Select",""],["","63402031230","LATUDA","TAB 120MG","30","Select","Select",""],["","","TRAZODONE","TAB 100MG","","Select","Select",""],["","","HYDROXYZ","CAP 50MG","","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","","AMPHET\/DEXTR","CAP 10MG ER","","Select","Select",""],["","65162027210","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","","ADDERALL","CAP 10MG","","Select","Select",""],["","","GNP","DIS 21MG\/24H","","Select","Select",""],["","","PRAZOSIN","CAP 5MG","","Select","Select",""],["","","TRIAMCINOLON","CRE 0.001","","Select","Select",""],["","","OLANZAPINE","TAB 10MG","","Select","Select",""],["","70461032103","FLUCLVX","INJ 2021-22","0","Select","Select",""],["","","DOXYCYC","CAP 100MG","","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","12","Select","Select",""],["","57237007530","ONDANSETRON","TAB 4MG","30","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","","NICOTINE","DIS 21MG\/24H","","Select","Select",""],["","","HALOPERIDOL","TAB 5MG","","Select","Select",""],["","","VENLAFAXINE","TAB 37.5MG","","Select","Select",""],["","","BUPROPION","TAB 100MG SR","","Select","Select",""],["","","FAMOTIDINE","TAB 20MG","","Select","Select",""],["","","CLINDAMY\/BEN","GEL 1-5%","","Select","Select",""],["","","ZIPRASIDONE","CAP 20MG","","Select","Select",""],["","","NAC","CAP 600MG","","Select","Select",""],["","","LORAZEPAM","TAB 1MG","","Select","Select",""],["","","BENZTROPINE","TAB 1MG","","Select","Select",""],["","","CLINDAMYCIN","GEL 0.01","","Select","Select",""],["","","TOPIRAMATE","TAB 50MG","","Select","Select",""],["","","LITHIUM","TAB 300MG ER","","Select","Select",""],["","","PHENTERMINE","TAB 37.5MG","","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":""}]}]}