{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MATTHEW A QUICK","gend":0,"add":"C\/O RICHARD QUICK 3212 WOOD DALE RD","city":"CHESTER","state":"VA","zip":"23831-9998","dob":"1996-10-16","age":"","mstatus":"","insh":"900046148*01","cliId":"","pno":"478\/397-5523","cno":"","email":"","ename":"","eno":"","pphy":"LOBB, KEEFE H DO","ppno":"804\/717-5300","pcpadd":"SUITE 117 11601 IRONBRIDGE ROAD","pcpcity":"CHESTER","pcpstate":"VA","pcpzip":23831,"pcpcounty":"","pcpid":"","pcpname":"IRONBRIDGE FAMILY PRACTICE","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/748-7269","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F25.0","Z01.818","F33.3","Z68.28","Z68.29","D50.9","E53.8","M54.5","R53.83","R79.0","Z79.899","E70.9","E78.2","R20.2","R45.87","Z51.81","R73.03","F33.9","R11.0","R16.1","R10.84","Z68.27","Z20.822","Z23.","K76.0","F41.9","Z00.00","Z11.1","F32.9","F42.2","F79.","R46.89","M77.51","M77.52","R10.33"],"date":["2021-12-07","2021-12-07","2021-11-19","2021-06-23","2021-05-14","2021-05-21","2021-05-21","2021-05-21","2021-05-21","2021-05-21","2021-10-14","2021-05-21","2021-05-21","2021-05-21","2021-05-21","2021-05-21","2021-05-21","2021-06-04","2021-10-21","2021-10-21","2021-10-21","2021-12-07","2021-08-30","2021-10-08","2021-10-14","2021-02-12","2021-05-14","2021-08-06","2021-01-15","2021-04-23","2021-04-23","2021-04-23","2021-11-11","2021-11-11","2021-11-11"],"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":[]}]},{"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":[["","64764072030","TRINTELLIX ","5MG","90","Select","Select",""],["","59762288806","ASENAPINE MALEATE SL ","10MG","-60","Select","Select",""],["","13811070910","METHYLPHENIDATE HYDROCHLORIDE ER ","54MG ER","30","Select","Select",""],["","69238106001","CHLORPROMAZINE HYDROCHLORIDE ","100MG","120","Select","Select",""],["","16729008110","NALTREXONE HCL ","50MG","60","Select","Select",""],["","65862057490","MONTELUKAST SODIUM ","10MG","90","Select","Select",""],["","10702010101","METHYLPHENIDATE HYDROCHLORIDE ","10MG","60","Select","Select",""],["","68462010530","ONDANSETRON HYDROCHLORIDE ","4MG","60","Select","Select",""],["","43547034406","RISPERIDONE ","4MG","90","Select","Select",""],["","00832030400","CHLORPROMAZINE HCL ","200MG","60","Select","Select",""],["","65162052110","PROMETHAZINE HYDROCHLORIDE ","25MG","90","Select","Select",""],["","65862070560","ZIPRASIDONE HCL ","80MG","60","Select","Select",""],["","00456241060","SAPHRIS ","10MG","60","Select","Select",""],["","10147095303","PALIPERIDONE ER ","ER 6MG","60","Select","Select",""],["","65862059501","DIVALPROEX SODIUM ER ","500MG ER","30","Select","Select",""],["","00228207310","OXAZEPAM ","30MG","-60","Select","Select",""],["","80777027399","MODERNA COVID-19 VACCINE ","COVID-19","0","Select","Select",""],["","66993068430","OLANZAPINE ","15MG","30","Select","Select",""],["","65862052305","GABAPENTIN ","600MG","120","Select","Select",""],["","50428041181","CVS VITAMIN C\/ROSE HIPS ","1000MG","90","Select","Select",""],["","50428029391","CVS VITAMIN C ","1000MG","90","Select","Select",""],["","50458058701","CONCERTA ","54MG","30","Select","Select",""],["","60505095303","AZELASTINE HYDROCHLORIDE\/FLUTICASONE PROPIONATE ","137-50","-69","Select","Select",""],["","70710122501","AMITRIPTYLINE HYDROCHLORIDE ","10MG","30","Select","Select",""],["","66993008169","SUMATRIPTAN ","5MG\/ACT","6","Select","Select",""],["","00006003330","BELSOMRA ","10MG","30","Select","Select",""],["","00115166202","PROPRANOLOL HYDROCHLORIDE ","80MG","60","Select","Select",""],["","49884040191","RISPERIDONE ODT ","2MG ODT","-60","Select","Select",""],["","55111015810","OMEPRAZOLE ","20MG","60","Select","Select",""],["","59651000305","OMEPRAZOLE DR ","40MG","90","Select","Select",""],["","11534018701","BUTALBITAL\/ACETAMINOPHEN\/CAFFEINE ","","90","Select","Select",""],["","59746011506","PROCHLORPERAZINE MALEATE ","10MG","120","Select","Select",""],["","00228212750","CLONIDINE HYDROCHLORIDE ","0.1MG","60","Select","Select",""],["","43598029690","PREGABALIN ","200MG","90","Select","Select",""],["","00093081101","NORTRIPTYLINE HCL ","25MG","30","Select","Select",""],["","37000096172","ALIGN JR FOR KIDS ","FOR KIDS","180","Select","Select",""],["","62175061743","PANTOPRAZOLE SODIUM ","40MG","90","Select","Select",""],["","00093081201","NORTRIPTYLINE HYDROCHLORIDE ","50MG","30","Select","Select",""],["","68308015260","NYSTATIN ","100000","60","Select","Select",""],["","45802000403","HYDROCORTISONE ","2.50%","28","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":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"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":""}]}]}