{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PERRY   A WRIGHT","gend":0,"add":"1501 N 21ST ST APT 224","city":"RICHMOND","state":"VA","zip":"23223-9998","dob":"1969-02-20","age":"","mstatus":"","insh":"20037940*01","cliId":"","pno":"347\/928-9447","cno":"347\/928-9447","email":"","ename":"","eno":"","pphy":"COVINGTON, DAMIAN L MD","ppno":"804\/225-7177","pcpadd":"1510 N 28TH STREET STE 300","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23223,"pcpcounty":"","pcpid":127398,"pcpname":"Dominion Medical Associates, INC.","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/225-7176","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","R94.31","H46.9","F20.9","K59.00","I10.","F17.210","M54.5","G89.29","G35.","R05.","Z68.39","M19.90","J44.9","H46.8","S96.911A","H54.7","Z68.38","R79.9","Z92.29","R53.1","E78.5","K58.9","F33.0","Z01.818","Z11.59","H52.31","H52.13","H47.011","J45.909","R29.818","Z86.39","Z86.59","R07.9"],"date":["2021-11-07","2021-07-22","2020-04-01","2020-12-20","2020-01-03","2020-12-18","2020-12-18","2020-07-22","2020-01-03","2020-07-22","2020-03-16","2020-03-16","2020-03-16","2020-07-22","2020-04-24","2020-12-03","2020-04-01","2020-07-22","2020-07-22","2020-07-22","2020-07-22","2020-12-18","2020-08-21","2020-09-02","2021-01-08","2021-01-08","2020-01-16","2020-10-02","2020-10-02","2020-12-18","2020-10-13","2020-10-13","2020-10-13","2021-08-31"],"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":[["","00093317431","ALBUTEROL ","HFA","26","Select","Select",""],["","68682010810","NIFEDIPINE ","30MG ER","30","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","16","Select","Select",""],["","00536137206","NICOTINE ","4MG MINT","150","Select","Select",""],["","57896048930","POLYETH ","3350 NF","527","Select","Select",""],["","60505257908","ATORVASTATIN ","20MG","30","Select","Select",""],["","00173071820","FLOVENT ","44MCG","21","Select","Select",""],["","65862006299","METOPROL ","25MG","60","Select","Select",""],["","50111043303","TRAZODONE ","50MG","30","Select","Select",""],["","29300013510","CLONIDINE ","0.1MG","60","Select","Select",""],["","67877032105","IBUPROFEN ","800MG","90","Select","Select",""],["","16729000615","SIMVASTATIN ","40MG","30","Select","Select",""],["","59310057922","PROAIR ","","26","Select","Select",""],["","00456120330","LINZESS ","72MCG","30","Select","Select",""],["","00135058202","FLONASE ","50MCG","16","Select","Select",""],["","62332042631","BENZONATATE ","100MG","30","Select","Select",""],["","65162083366","DICLOFENAC ","1%","400","Select","Select",""],["","00054001825","PREDNISONE ","20MG","23","Select","Select",""],["","45802057178","FEXOFENADINE ","180MG","24","Select","Select",""],["","00904675180","ASPIRIN ","81MG EC","90","Select","Select",""],["","64380073706","VITAMIN ","50000UNT","3","Select","Select",""],["","37205065072","ALLER-EASE ","180MG","24","Select","Select",""],["","00093921841","DIMETHYL ","120MG DR","60","Select","Select",""],["","70000036104","24HR ","180MG","24","Select","Select",""],["","59627033304","AVONEX ","30MCG","4","Select","Select",""],["","67877024910","QUETIAPINE ","50MG","30","Select","Select",""],["","65162027250","SMZ\/TMP ","800-160","14","Select","Select",""],["","00536105224","PEG3350 ","","238","Select","Select",""],["","70000022102","GENTLE ","5MG EC","4","Select","Select",""],["","00591079401","DICYCLOMINE ","10MG","20","Select","Select",""],["","13668000801","ZOLPIDEM ","10MG","30","Select","Select",""],["","50111043303","TRAZODONE","50MG","30","Select","Select",""],["","29300013510","CLONIDINE","0.1MG","60","Select","Select",""],["","67877032105","IBUPROFEN","800MG","90","Select","Select",""],["","59310057922","PROAIR","","26","Select","Select",""],["","65162083366","DICLOFENAC","1%","400","Select","Select",""],["","52817036000","METOPROL","25MG","30","Select","Select",""],["","57896048930","POLYETH","3350 NF","527","Select","Select",""],["","68682010810","NIFEDIPINE","30MG ER","30","Select","Select",""],["","60505257908","ATORVASTATIN","20MG","30","Select","Select",""],["","00173071820","FLOVENT","44MCG","21","Select","Select",""],["","00536303006","NICOTINE","4MG ORIG","150","Select","Select",""],["","00456120330","LINZESS","72MCG","30","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","16","Select","Select",""],["","16729000615","SIMVASTATIN","40MG","30","Select","Select",""],["","00135058202","FLONASE","50MCG","16","Select","Select",""],["","00093317431","ALBUTEROL","HFA","26","Select","Select",""],["","00054001925","PREDNISONE","50MG","75","Select","Select",""],["","45802057178","FEXOFENADINE","180MG","24","Select","Select",""],["","70000036104","24HR","180MG","24","Select","Select",""],["","37205065072","ALLER-EASE","180MG","24","Select","Select",""],["","59627033304","AVONEX","30MCG","4","Select","Select",""],["","00093921841","DIMETHYL","120MG DR","60","Select","Select",""],["","67877024910","QUETIAPINE","50MG","30","Select","Select",""],["","65162027250","SMZ\/TMP","800-160","14","Select","Select",""],["","00536105224","PEG3350","","238","Select","Select",""],["","70000022102","GENTLE","5MG EC","4","Select","Select",""],["","00904675180","ASPIRIN","81MG EC","90","Select","Select",""],["","64380073706","VITAMIN","50000UNT","6","Select","Select",""],["","00591079401","DICYCLOMINE","10MG","20","Select","Select",""],["","13668000801","ZOLPIDEM","10MG","30","Select","Select",""],["","62332042631","BENZONATATE","100MG","30","Select","Select",""],["","80777027399","MODERNA ","INJ COVID-19","0","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":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}