{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RICKESHA   D REEVES","gend":1,"add":"115 CRESTWOOD DR APT C","city":"DANVILLE","state":"VA","zip":"24541-9998","dob":"1977-07-01","age":"","mstatus":"","insh":"20033863*01","cliId":"","pno":"347\/856-2115","cno":"347\/856-2115","email":"","ename":"","eno":"","pphy":"FALGUI, VICENTE T MD","ppno":"434\/791-4648","pcpadd":"SUITE 204 990 MAIN ST","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"pcpcounty":"","pcpid":105858,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.2","F41.1","R11.2","G89.18","E11.9","I10.","Z90.711","Z88.1","Z72.0","Z53.20","E11.65","R40.4","R40.2431","R40.20","R06.89","R10.84","R52.","R11.0","D64.9","F43.12","R00.0","O20.8","F32.89","R10.13","K59.00","N39.0","D25.0","N93.9","R10.11","K31.84","Z20.828","Z11.59","D25.9","Z87.442","Z88.0","R10.9","Z79.4","N94.6"],"date":["2021-09-05","2021-09-05","2021-07-01","2021-07-01","2021-09-24","2021-09-09","2021-07-01","2021-07-01","2021-07-01","2021-07-01","2021-06-29","2020-05-14","2020-05-14","2020-05-14","2020-05-14","2021-09-09","2020-06-14","2020-06-14","2021-09-09","2021-01-19","2021-01-19","2021-05-09","2021-06-27","2021-08-07","2020-06-14","2020-06-14","2021-06-29","2021-09-24","2020-03-26","2021-08-07","2020-09-08","2020-09-08","2021-06-29","2021-09-09","2021-09-09","2021-09-09","2021-09-24","2021-09-24"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","00093206301","QUETIAPINE ","25MG","30","Select","Select",""],["","13668013601","ESCITALOPRAM ","10MG","30","Select","Select",""],["","43547030203","ARIPIPRAZOLE ","2MG","30","Select","Select",""],["","16729020201","BUSPIRONE ","10MG","60","Select","Select",""],["","00591079501","DICYCLOMINE ","20MG","40","Select","Select",""],["","00904759080","FEROSUL ","325MG","90","Select","Select",""],["","57237007710","ONDANSETRON ","4MG ODT","12","Select","Select",""],["","16729018201","HYDROCHLOROT ","12.5MG","30","Select","Select",""],["","00904645760","DOK ","100MG","14","Select","Select",""],["","00904604377","MAG ","LEMON","296","Select","Select",""],["","55111012701","CIPROFLOXACN ","500MG","14","Select","Select",""],["","65862020299","LOSARTAN ","50MG","30","Select","Select",""],["","11917009215","FERROUS ","325MG","90","Select","Select",""],["","00378623201","CITALOPRAM ","20MG","30","Select","Select",""],["","60505265301","TRAZODONE ","50MG","30","Select","Select",""],["","64380080807","IBUPROFEN ","600MG","40","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","20","Select","Select",""],["","49884068905","METOCLOPRAM ","10MG","60","Select","Select",""],["","43547030203","ARIPIPRAZOLE","2MG","30","Select","Select",""],["","13668013601","ESCITALOPRAM","10MG","30","Select","Select",""],["","00093206301","QUETIAPINE","25MG","30","Select","Select",""],["","16729020201","BUSPIRONE","10MG","60","Select","Select",""],["","00904759080","FEROSUL","325MG","90","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","12","Select","Select",""],["","55111012701","CIPROFLOXACN","500MG","14","Select","Select",""],["","65862020299","LOSARTAN","50MG","30","Select","Select",""],["","00591079501","DICYCLOMINE","20MG","20","Select","Select",""],["","00904678744","MAG","LEMON","296","Select","Select",""],["","16729018201","HYDROCHLOROT","12.5MG","30","Select","Select",""],["","00904645760","DOK","100MG","14","Select","Select",""],["","60505265301","TRAZODONE","50MG","30","Select","Select",""],["","64380080807","IBUPROFEN","600MG","40","Select","Select",""],["","11917009215","FERROUS","325MG","90","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","20","Select","Select",""],["","00093220305","METOCLOPRAM","10MG","60","Select","Select",""],["","00555077902","MEDROXYPR","10MG","30","Select","Select",""],["","00378623201","CITALOPRAM","20MG","30","Select","Select",""],["","00555077902","MEDROXYPR ","TAB 10MG","30","Select","Select",""],["","67877056110","METFORMIN ","TAB 500MG","20","Select","Select",""],["","68180072003","AMLODIPINE ","TAB 5MG","20","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}