{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TIFFONE   F SHELTON","gend":1,"add":"916 WYNFIELD TERRACE                                        ","city":"HENRICO                       ","state":"VA","zip":"23223-5960","dob":"1989-07-21","age":"","mstatus":"","insh":6289236,"cliId":"","pno":8047291406,"cno":8042776595,"email":"","ename":"","eno":"","pphy":"DOMAH, NAU                                                  ","ppno":8042262444,"pcpadd":"5855 Bremo Rd                                               ,Ste 55                                                      ","pcpcity":"Richmond                      ","pcpstate":"VA","pcpzip":232261930,"pcpcounty":"","pcpid":"","pcpname":"LABURNUM MEDICAL CENTER","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"916 WYNFIELD TERRACE                                        ","add3":"","madd1":"916 WYNFIELD TERRACE                                        ","madd2":"                                                            ","madd3":"","mcity":"HENRICO                       ","mstate":"VA","mzip":"23223-5960","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J02.9","F11.20","I10","R79.89","E05.90","R53.82","Z79.899","Z68.20","F31.30","M54.5","N39.0","F60.3","F31.81","F33.0","M25.552","M54.16","M62.830","F43.23","Z20.828","R35.0","Z01.419","R35.1","N89.8","Z13.228","H20.9","H57.10","J45.909","K21.9","Z85.51","Z86.73","F17.210","F10.129","R20.0","R20.2","Y90.8","R07.9","R13.10","R07.89","K58.9","M19.90","E03.9","Z79.1","Z91.19","R53.83","R35.89","R00.2","Z86.2","I20.0","R10.13","R10.9","G89.4","I49.8","Z80.3","Z82.49","Z88.5","Z88.6","Z88.8"],"date":["2020-01-15","2020-01-20","2022-10-24","2020-03-03","2020-03-03","2020-03-03","2022-02-27","2020-03-03","2020-04-20","2020-06-26","2020-09-22","2021-12-28","2021-12-28","2021-12-28","2020-12-30","2020-12-30","2020-12-30","2021-02-26","2021-03-23","2021-08-18","2021-08-18","2021-08-18","2021-08-18","2021-08-18","2021-08-21","2021-08-21","2022-10-24","2022-10-24","2022-10-24","2022-02-27","2022-02-27","2021-09-02","2021-09-02","2021-09-02","2021-09-02","2022-02-27","2021-11-04","2021-11-04","2022-10-24","2022-10-24","2022-02-27","2022-10-24","2021-12-28","2022-02-27","2022-02-27","2022-02-27","2022-02-27","2022-10-24","2022-10-24","2022-10-24","2022-10-24","2022-10-24","2022-10-24","2022-10-24","2022-10-24","2022-10-24","2022-10-24"],"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":[["","65862085901","FAMOTIDINE","TAB 20MG","20","Select","Select",""],["","50428063305","CVS","SUS ANTI-GAS","355","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","20","Select","Select",""],["","59779050301","OMEPRAZOLE","TAB 20MG","14","Select","Select",""],["","50742061510","METOPROL","TAB 25MG ER","90","Select","Select",""],["","00093083205","CLONAZEPAM","TAB 0.5MG","15","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","60758011905","PREDNISOLONE","SUS 1% OP","15","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","00054350547","LIDOCAINE","SOL 0.04","50","Select","Select",""],["","00093226301","AMOXICILLIN","TAB 500MG","28","Select","Select",""],["","00603233832","APAP\/CODEINE","TAB 300-30MG","16","Select","Select",""],["","00172392670","DIAZEPAM","TAB 5MG","10","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00456120230","LINZESS","CAP 290MCG","30","Select","Select",""],["","16729020201","BUSPIRONE","TAB 10MG","60","Select","Select",""],["","14539067401","HYDROXYZ","CAP 25MG","90","Select","Select",""],["","68382003516","VENLAFAXINE","CAP 75MG ER","30","Select","Select",""],["","57237004705","DIVALPROEX","TAB 250MG DR","90","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","4","Select","Select",""],["","71093014105","METHOCARBAM","TAB 750MG","9","Select","Select",""],["","00378064010","PREDNISONE","TAB 5MG","21","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","63402030430","LATUDA","TAB 40MG","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":[]}},{"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":""}]}]}