{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NICHOLAS   A SHARPE","gend":0,"add":"3836 OAKLEYS LN","city":"RICHMOND","state":"VA","zip":"23223-9998","dob":"1983-03-19","age":"","mstatus":"","insh":"20034792*01","cliId":"","pno":"804\/737-5568","cno":"804\/737-5568","email":"","ename":"","eno":"","pphy":"THOMAS, DENNIS L MD","ppno":"804\/932-4388","pcpadd":"1850 POCAHONTAS TRAIL","pcpcity":"QUINTON","pcpstate":"VA","pcpzip":23141,"pcpcounty":"","pcpid":671676,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/932-9860","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E10.65","F39.","T78.2XXA","R11.2","F31.81","F12.10","F32.9","F31.9","E10.43","K31.84","R06.02","F12.90","E10.21","N20.0","Z79.4","E86.0","F17.210","F90.9","I10.","K21.9","I48.91","E78.5","Z90.49","Z82.49","F12.188","E11.65","K59.00","M65.342","E10.618","M75.00","E10.9","M75.01","R29.898","E10.49","E10.8","E11.9","Z68.27","F12.20","R19.7","E87.6","F90.8","E66.3","F41.9","N17.9","E83.39","Z79.899","Z87.891","K59.09","F41.1","F90.1","E10.10","R80.9","D72.829","E78.00","F31.30","E87.3","Z79.82","I45.81","A41.9","E87.4","V58.69","NO DATA","R79.9","R00.0","E10.42","R11.15","H25.13","H52.13","E10.40","Z68.30","Z68.31","B37.81","R07.9","E66.9"],"date":["2021-09-24","2021-10-01","2020-09-12","2021-09-24","2021-08-13","2021-09-24","2021-09-24","2021-09-24","2021-09-24","2021-09-24","2021-05-25","2020-09-12","2020-10-22","2020-09-12","2021-08-13","2020-09-13","2020-09-12","2021-08-13","2021-08-13","2021-08-13","2021-08-13","2021-08-13","2021-08-13","2020-09-12","2020-10-27","2020-10-27","2020-10-27","2021-04-13","2021-04-13","2021-04-13","2021-08-18","2021-06-02","2021-06-02","2021-09-04","2021-02-24","2021-08-14","2021-01-08","2020-09-13","2020-10-29","2020-12-28","2020-10-05","2020-12-28","2020-12-28","2021-06-26","2020-10-26","2021-08-13","2021-08-13","2020-10-29","2020-10-25","2021-04-27","2021-09-17","2020-10-22","2020-12-28","2021-08-13","2020-12-28","2020-12-28","2021-08-13","2021-07-09","2020-09-12","2021-06-26","2021-06-26","2021-07-28","2021-07-29","2021-07-29","2021-05-27","2021-09-01","2021-08-18","2021-08-18","2021-09-01","2021-09-17","2021-09-24","2021-09-24","2021-08-15","2021-07-30"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null]}},{"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":[["","42806034501","AMPHET\/DEXTR ","30MG","60","Select","Select",""],["","64764075030","TRINTELLIX ","20MG","30","Select","Select",""],["","10702001250","HYDROXYZ ","50MG","30","Select","Select",""],["","70377002911","ATORVASTATIN ","40MG","30","Select","Select",""],["","62175061743","PANTOPRAZOLE ","40MG","60","Select","Select",""],["","65162052110","PROMETHAZINE ","25MG","60","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","30","Select","Select",""],["","50111064801","FLUOXETINE ","20MG","30","Select","Select",""],["","23155019201","BUPROPION ","100MG","30","Select","Select",""],["","08290328418","INSULIN ","1ML\/31G","500","Select","Select",""],["","00002751001","HUMALOG ","100\/ML","20","Select","Select",""],["","00088222033","LANTUS ","100\/ML","10","Select","Select",""],["","08627001601","DEXCOM ","TRANSMIT","1","Select","Select",""],["","54092038901","ADDERALL ","25MG","60","Select","Select",""],["","69097094312","GABAPENTIN ","300MG","90","Select","Select",""],["","53885024510","ONETOUCH ","ULTRA","300","Select","Select",""],["","68462015713","ONDANSETRON ","4MG ODT","60","Select","Select",""],["","00574722612","COMPRO ","25MG","12","Select","Select",""],["","00143312601","DICYCLOMINE ","10MG","20","Select","Select",""],["","59746011306","PROCHLORPER ","5MG","30","Select","Select",""],["","00093220301","METOCLOPRAM ","10MG","90","Select","Select",""],["","65162019050","NAPROXEN ","500MG","30","Select","Select",""],["","80777027398","MODERNA ","COVID-19","0","Select","Select",""],["","42806034501","AMPHET\/DEXTR","30MG","60","Select","Select",""],["","62175061743","PANTOPRAZOLE","40MG","60","Select","Select",""],["","10702001250","HYDROXYZ","50MG","30","Select","Select",""],["","50111064801","FLUOXETINE","20MG","30","Select","Select",""],["","00088222033","LANTUS","100\/ML","10","Select","Select",""],["","70377002911","ATORVASTATIN","40MG","30","Select","Select",""],["","64764075030","TRINTELLIX","20MG","30","Select","Select",""],["","65162052110","PROMETHAZINE","25MG","60","Select","Select",""],["","68180072003","AMLODIPINE","5MG","30","Select","Select",""],["","00002751001","HUMALOG","100\/ML","20","Select","Select",""],["","08290328418","INSULIN","1ML\/31G","500","Select","Select",""],["","69097094312","GABAPENTIN","300MG","90","Select","Select",""],["","23155019201","BUPROPION","100MG","30","Select","Select",""],["","08627001601","DEXCOM","TRANSMIT","1","Select","Select",""],["","00143312601","DICYCLOMINE","10MG","20","Select","Select",""],["","57844013001","ADDERALL","30MG","60","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","12","Select","Select",""],["","59746011506","PROCHLORPER","10MG","20","Select","Select",""],["","53885024510","ONETOUCH","ULTRA","300","Select","Select",""],["","65162019050","NAPROXEN","500MG","30","Select","Select",""],["","80777027398","MODERNA","COVID-19","0","Select","Select",""],["","00574722612","COMPRO","25MG","12","Select","Select",""],["","57664047758","METOPROL","50MG","60","Select","Select",""],["","70710114003","FLUCONAZOLE","200MG","10","Select","Select",""],["","00093220301","METOCLOPRAM","10MG","90","Select","Select",""],["","70710114003","FLUCONAZOLE ","TAB 200MG","10","Select","Select",""],["","57664047758","METOPROL ","TAB 50MG","60","Select","Select",""],["","00093031101","LOPERAMIDE ","CAP 2MG","30","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":""}]}]}