{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ARLEEN JACKSON","gend":1,"add":"1252 MOORE ST APT 417","city":"RICHMOND","state":"VA","zip":"23220-9998","dob":"1955-06-04","age":"","mstatus":"","insh":"20040713*01","cliId":"","pno":"804\/683-3027","cno":"804\/683-3027","email":"","ename":"","eno":"","pphy":"GREEN JR, HAROLD T MD","ppno":"804\/644-1665","pcpadd":"STE 308 1510 N 28TH ST","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23223,"pcpcounty":"","pcpid":208009,"pcpname":"PRIMARY HEALTHCARE ASSOCIATES","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"804\/309-0215","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/644-5285","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.11","F33.9","N39.490","I10.","H92.09","E78.00","E66.01","F41.8","J45.20","M62.838","R63.5","E55.9","Z68.39","M47.812","M50.30","R10.0","R11.2","R19.7","R10.84","F41.9","F32.9","N30.00","M47.817","K59.00"],"date":["2020-01-23","2021-09-14","2021-09-02","2021-02-16","2020-11-13","2021-02-16","2020-11-13","2020-11-13","2020-11-13","2020-11-13","2020-11-13","2020-11-13","2020-11-13","2020-01-22","2020-03-25","2020-09-30","2020-09-30","2020-09-30","2020-03-24","2020-03-24","2020-03-24","2021-02-16","2021-02-16","2020-02-26"],"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":[["","16714074703","OMEPRAZOLE ","20MG","30","Select","Select",""],["","00093221005","SUCRALFATE ","1GM","120","Select","Select",""],["","00904598426","AMMONIUM ","12%","226","Select","Select",""],["","31722070290","LOSARTAN ","100MG","30","Select","Select",""],["","69097012403","TOPIRAMATE ","100MG","60","Select","Select",""],["","53746010901","HYDROCO\/APAP ","5-325MG","5","Select","Select",""],["","00406051205","OXYCOD\/APAP ","5-325MG","45","Select","Select",""],["","43547040011","CYCLOBENZAPR ","10MG","90","Select","Select",""],["","27241009803","DULOXETINE ","30MG","30","Select","Select",""],["","00591034705","HYDROCHLOROT ","12.5MG","30","Select","Select",""],["","29300012401","MELOXICAM ","7.5MG","60","Select","Select",""],["","00093314705","CEPHALEXIN ","500MG","40","Select","Select",""],["","16729014701","QUETIAPINE ","100MG","60","Select","Select",""],["","67877032005","IBUPROFEN ","600MG","30","Select","Select",""],["","65862018730","ONDANSETRON ","4MG","10","Select","Select",""],["","33342002208","LEVOFLOXACIN ","500MG","7","Select","Select",""],["","00591352530","LIDOCAINE ","5%","30","Select","Select",""],["","43547028810","BUPROPION ","100MG SR","60","Select","Select",""],["","66993058597","FLUTIC\/SALME ","250\/50","60","Select","Select",""],["","00591079401","DICYCLOMINE ","10MG","20","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","80681004001","MELATONIN ","5MG","30","Select","Select",""],["","00093221005","SUCRALFATE","1GM","120","Select","Select",""],["","00904598426","AMMONIUM","12%","226","Select","Select",""],["","31722070290","LOSARTAN","100MG","30","Select","Select",""],["","16714074703","OMEPRAZOLE","20MG","30","Select","Select",""],["","69097012403","TOPIRAMATE","100MG","60","Select","Select",""],["","43547028810","BUPROPION","100MG SR","30","Select","Select",""],["","16729014701","QUETIAPINE","100MG","60","Select","Select",""],["","00591034705","HYDROCHLOROT","12.5MG","30","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","40","Select","Select",""],["","00406051205","OXYCOD\/APAP","5-325MG","45","Select","Select",""],["","53746010901","HYDROCO\/APAP","5-325MG","5","Select","Select",""],["","67877032005","IBUPROFEN","600MG","30","Select","Select",""],["","68462015713","ONDANSETRON","4MG ODT","10","Select","Select",""],["","29300012401","MELOXICAM","7.5MG","60","Select","Select",""],["","43547040011","CYCLOBENZAPR","10MG","90","Select","Select",""],["","27241009803","DULOXETINE","30MG","30","Select","Select",""],["","00591352530","LIDOCAINE","5%","30","Select","Select",""],["","33342002208","LEVOFLOXACIN","500MG","7","Select","Select",""],["","00591079401","DICYCLOMINE","10MG","20","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","80681004001","MELATONIN","5MG","30","Select","Select",""],["","66993058597","FLUTIC\/SALME","250\/50","60","Select","Select",""],["","62559099212","FLUCONAZOLE ","TAB 150MG","1","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":""}]}]}