{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHAUNY   D LEEPER","gend":1,"add":"6038   LAMAR DRIVE                                          ","city":"RICHMOND                      ","state":"VA","zip":"23225-5910","dob":"1975-09-24","age":"","mstatus":"","insh":5483834,"cliId":"","pno":8046291776,"cno":"","email":"","ename":"","eno":"","pphy":"FOSTER, BRIAN J                                             ","ppno":8047641253,"pcpadd":"8220 Meadowbridge Rd                                        ,Ste 203                                                     ","pcpcity":"Mechanicsville                ","pcpstate":"VA","pcpzip":231162339,"pcpcounty":"","pcpid":"","pcpname":"BON SECOURS MEMORIAL REGIONAL MEDICAL CENTER","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"6038   LAMAR DRIVE                                          ","add3":"","madd1":"6038   LAMAR DRIVE                                          ","madd2":"APARTMENT 203                                               ","madd3":"","mcity":"RICHMOND                      ","mstate":"VA","mzip":"23225-5910","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G47.00","J45.909","J41.0","R05","R09.81","Z20.828","Z20.822","J06.9","R06.2","K08.89","F33.2","F41.1","R45.851","N39.0","F12.90","F17.200","G25.81","F10.10","F32.9","Z09","F90.0","F31.9","F51.01","F41.9","R05.9","R50.9","R06.02","U07.1","R51.9","R43.9","J02.9","Z00.00","E66.9","Z68.37","R07.9","R03.0","E66.01","Z68.41","K76.89","R06.83","R06.81","G47.10","G47.33"],"date":["2020-01-06","2022-02-02","2021-01-03","2021-01-03","2021-01-03","2021-01-03","2022-01-17","2021-01-26","2021-01-26","2022-02-02","2021-03-22","2021-03-22","2021-03-23","2021-03-26","2021-03-22","2021-03-22","2021-03-22","2021-03-22","2021-03-23","2021-03-26","2021-03-26","2021-03-26","2021-03-26","2021-03-26","2022-01-17","2022-01-17","2022-01-17","2022-01-17","2022-01-17","2022-01-17","2022-01-17","2022-02-16","2022-02-16","2022-02-16","2022-08-05","2022-08-05","2022-11-16","2022-11-16","2022-09-01","2022-09-15","2022-09-15","2022-10-06","2022-12-01"],"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":[]},{"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":[["","67877025001","QUETIAPINE","TAB 100MG","60","Select","Select",""],["","64380080807","IBUPROFEN","TAB 600MG","21","Select","Select",""],["","57237002801","AMOXICILLIN","TAB 500MG","21","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","57237004105","PENICILLN","TAB 500MG","14","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","00185012201","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","60505015701","BUPROPION","TAB 100MG","60","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","16","Select","Select",""],["","45802086866","POLYETH","POW 3350 NF","30","Select","Select",""],["","10702001250","HYDROXYZ","TAB 50MG","7","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}