{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   LEAHCIMRJ HCAEB O","gend":0,"add":"NOTDYOB 8185DAOR KNALP ","city":"PETERSBURG","state":"VA","zip":"23803-9998","dob":"1972-08-28","age":"","mstatus":"","insh":"63200210*79","cliId":"","pno":"38\/4089757-5","cno":"804\/490-2036","email":"","ename":"","eno":"","pphy":"RIVAS, JUAN MD","ppno":"434\/949-7211","pcpadd":"8380 BOYDTON PLANK RD","pcpcity":"ALBERTA","pcpstate":"VA","pcpzip":23821,"pcpcounty":"","pcpid":"","pcpname":"CENTRAL VIRGINIA HEALTH SERVICES INC","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":["F31.5","S83.512A","M25.462","S83.242A","M17.12","G40.319","G43.109","R41.82","G43.719","G44.209","R51.","G89.4","M54.9","M25.561","Z79.899","Z71.89","Z71.3","M25.511","M25.519","Z23.","F32.9","E78.5","R53.83","T15.01XA","H16.143","H43.393","H11.153","H04.123","H35.413","N52.1","J30.9","M17.11","M25.562","E66.3","R03.0","E66.9","M22.2X1","J30.1","Z13.1","G43.009","H17.821","R51.9","Z68.37","R63.5","K52.9","F41.0","E78.1","M25.50","R60.9","Z68.36","R07.89","J09.X2","R11.2","R19.7","F41.1","I49.9"],"date":["2021-11-10","2020-07-03","2020-07-27","2020-07-27","2020-07-27","2021-09-03","2020-10-21","2020-09-16","2021-09-03","2021-09-03","2020-09-16","2021-12-17","2021-12-17","2021-12-17","2021-12-17","2021-02-12","2021-01-14","2021-09-14","2021-12-17","2021-11-19","2021-10-22","2020-10-19","2020-10-19","2020-12-08","2020-12-15","2021-12-21","2021-12-21","2021-12-21","2021-12-21","2021-12-17","2020-05-22","2021-12-06","2021-12-17","2021-12-17","2021-12-17","2021-06-07","2020-01-10","2021-05-07","2021-06-07","2020-06-16","2020-12-15","2021-09-03","2021-09-03","2019-01-24","2019-07-26","2019-12-20","2019-02-25","2019-03-25","2019-03-25","2019-10-10","2019-11-05","2019-11-05","2019-11-05","2019-11-05","2019-04-26","2019-11-05"],"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":[["","47781019605","OXYCOD\/APAP","TAB 5-325MG","90","Select","Select",""],["","61442010310","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","60","Select","Select",""],["","43547035050","PAROXETINE","TAB 40MG","45","Select","Select",""],["","69315011610","FUROSEMIDE","TAB 20MG","10","Select","Select",""],["","47335030888","ZOLPIDEM","TAB 12.5MG","30","Select","Select",""],["","59762372104","ALPRAZOLAM","TAB 1MG","60","Select","Select",""],["","68382014114","TOPIRAMATE","TAB 200MG","120","Select","Select",""],["","","RIZATRIPTAN","TAB 10MG ODT","","Select","Select",""],["","45802091987","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","","GABAPENTIN","CAP 100MG","","Select","Select",""],["","16729017217","AMITRIPTYLIN","TAB 25MG","100","Select","Select",""],["","00093506105","HYDROXYZ","TAB 25MG","90","Select","Select",""],["","31722053960","LEVETIRACETA","TAB 1000MG","90","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","11917018705","FLUTICASONE","SPR 50MCG","20","Select","Select",""],["","00781652386","SUMATRIPTAN","SPR 20MG\/ACT","6","Select","Select",""],["","33342012110","SILDENAFIL","TAB 20MG","80","Select","Select",""],["","","TALIVA","CAP ","","Select","Select",""],["","","OFLOXACIN","DRO 0.3% OP","","Select","Select",""],["","","UBRELVY","TAB 50MG","","Select","Select",""],["","68462035705","POT  CHLORIDE","CAP 10MEQ ER","20","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","15","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":""}]}]}