{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   DLANODNOSBIG L","gend":0,"add":"OTAM 8063DAOR AKA","city":"HAMPTON","state":"VA","zip":"23661-9998","dob":"1977-08-29","age":"","mstatus":"","insh":"87200210*42","cliId":"","pno":"24\/4348883-0","cno":"","email":"","ename":"","eno":"","pphy":"MAMEDOVA, TAMARA DO","ppno":"804\/968-5700","pcpadd":"SUITE 100 5000 COX ROAD","pcpcity":"GLEN ALLEN","pcpstate":"VA","pcpzip":23060,"pcpcounty":"","pcpid":"","pcpname":"PATIENT FIRST RICHMOND MEDICAL GROUP PLLC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","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":["R07.1","Z20.828","G40.909","G80.9","Z91.19","R07.9","R07.89","M62.830","M54.12","F31.9","I20.0","F33.2","F41.9","E11.9","F12.10","F43.10","Z68.26","H61.20","M79.2","I49.3","V62.84","Z79.899","F39.","R56.9","R77.8","F14.10","I35.8","I34.8","R53.81","F20.89","F31.32","F12.20","F14.19","E78.5","G47.00","F12.90","M54.2","Z04.9","M50.123","M47.812","I45.10","F43.12","E78.1","T50.902A","F32.9","T50.904A","T14.91XA","V62.85","D72.829","R73.9"],"date":["2020-05-29","2020-05-29","2021-12-01","2021-12-01","2020-05-29","2021-09-07","2021-09-07","2020-09-13","2020-09-18","2021-12-08","2021-09-05","2021-05-11","2021-04-01","2021-09-05","2020-01-09","2021-09-05","2020-01-09","2020-01-09","2020-09-10","2021-09-07","2020-01-07","2021-12-01","2021-05-10","2021-05-11","2021-09-05","2021-09-07","2021-09-07","2021-09-07","2020-07-17","2021-04-01","2021-05-15","2021-05-15","2021-09-05","2021-09-05","2021-09-05","2021-09-05","2020-10-27","2021-09-05","2020-11-03","2020-11-03","2021-05-11","2021-08-20","2019-10-24","2019-10-22","2019-10-19","2019-10-19","2019-10-20","2019-10-20","2019-10-20","2019-10-20"],"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":[["","00185067401","HYDROXYZ","CAP 25MG","42","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","30","Select","Select",""],["","57237004705","DIVALPROEX","TAB 250MG DR","30","Select","Select",""],["","65862048901","QUETIAPINE","TAB 25MG","30","Select","Select",""],["","70436005801","BUPROPION","TAB 100MG SR","30","Select","Select",""],["","16729020301","BUSPIRONE","TAB 15MG","60","Select","Select",""],["","","GABAPENTIN","CAP 300MG","","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","12","Select","Select",""],["","","LIDOCAINE","PAD 0.05","","Select","Select",""],["","68645053959","METFORMIN","TAB 500MG","60","Select","Select",""],["","","IBUPROFEN","TAB 800MG","","Select","Select",""],["","","DICLOFENAC","TAB 50MG DR","","Select","Select",""],["","","METHYLPRED","TAB 4MG","","Select","Select",""],["","68645052354","SERTRALINE","TAB 100MG","30","Select","Select",""],["","65862024608","LEVETIRACETA","TAB 500MG","180","Select","Select",""],["","","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","","VITAMIN","CAP 50000UNT","","Select","Select",""],["","","NAPROXEN","TAB 500MG","","Select","Select",""],["","","METHOCARBAM","TAB 500MG","","Select","Select",""],["","","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","53885027025","ONETOUCH","TES VERIO","25","Select","Select",""],["","68645048154","ATORVASTATIN","TAB 20MG","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":""}]}]}