{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NORRIS  F BROOKS","gend":0,"add":"PO BOX 817","city":"MONTROSS","state":"VA","zip":22520,"dob":"1965-06-10","age":"","mstatus":"","insh":"20024459*01","cliId":"","pno":"804\/493-1319","cno":"","email":"","ename":"","eno":"","pphy":"Route,  barbara","ppno":"804\/493-9999","pcpadd":"5424 Discovery Park Blvd BLDB A STE 201","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":22520,"pcpcounty":"","pcpid":"","pcpname":"CENTRAL VIRGINIA HEALTH SERVICES INC","plan":"OHP","program":"Medicaid","lob":"OHCC","region":"CENTRAL","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":["M48.02","M54.2","M54.12","Z98.1","M19.011","M19.012","M25.511","M25.512","R63.3","C34.90","J30.2","Z71.89","F43.10","Z71.3","I10.","G56.01","E78.5","G56.23","G56.03","M77.01","R26.81","D64.9","M25.561","Z01.812","Z20.822","M51.36","F33.1","F41.1","F17.211","F12.90","Z72.89","NO DATA","F17.210","M47.812","F32.9","F10.99","F17.201","T21.02XA","Z23.","C34.11","C34.91","R42.","F10.21","Z08.","Z85.118","M79.601","G54.0","I25.10","Z92.3","Z72.0","N52.9","M79.2","R07.89","R93.1","M25.521","M25.531","M47.816","R07.9","G56.21","J30.9","J20.9","M22.8X1","M19.90","Z87.891","R20.0","N48.1","M54.31","M99.83","Z98.890","E78.2","G89.29","F41.9","K63.5","E11.9","F17.200","M25.562","Z68.20","M54.5","M47.817","R63.0","M50.30","M54.41","C79.51","Z80.42","R19.5","Z01.810","M23.91","M17.11","K62.1","Z12.11","S83.91XA","R29.3","M62.81","M51.37","R53.83","E53.8","E55.9","Z13.1","Z11.59","G62.9","R51.9","Z79.899","E78.00","L97.811","M25.461","M24.461","M25.569","S83.241A","S06.0X0A","S39.012A","S16.1XXA","V87.7XXA","Y92.410","M62.830","F12.21","R00.0","R63.4","R63.6","R63.8"],"date":["2022-03-16","2022-04-02","2022-05-13","2022-07-03","2020-02-26","2020-02-26","2020-02-26","2020-02-26","2021-09-02","2021-11-05","2021-11-05","2021-11-05","2022-09-21","2021-11-05","2022-11-16","2020-05-05","2022-08-31","2021-07-20","2021-02-01","2021-02-01","2021-11-05","2020-12-04","2022-02-27","2021-02-26","2021-02-26","2021-12-15","2022-09-21","2022-09-21","2021-08-24","2021-08-24","2021-08-24","2022-08-18","2022-07-03","2022-05-13","2021-03-02","2021-07-19","2022-09-21","2021-08-25","2021-11-05","2022-10-28","2021-11-05","2021-11-05","2022-09-21","2021-01-27","2022-07-03","2020-01-22","2021-01-27","2021-01-27","2021-01-27","2022-09-16","2020-01-23","2020-04-21","2022-04-02","2020-03-23","2020-05-14","2020-05-14","2022-07-05","2020-05-26","2020-02-27","2020-04-21","2020-02-27","2021-03-04","2020-03-02","2021-01-27","2021-07-20","2020-09-23","2019-05-03","2019-04-08","2019-04-08","2019-10-22","2022-08-18","2019-10-22","2019-03-29","2022-02-27","2022-09-16","2019-08-06","2019-06-12","2019-05-03","2022-08-30","2019-06-17","2019-11-13","2019-08-14","2019-01-15","2019-01-15","2019-03-27","2019-03-27","2019-08-16","2019-02-18","2019-03-29","2019-03-29","2019-04-16","2022-08-18","2022-08-18","2022-08-30","2022-08-31","2022-08-31","2022-08-31","2022-08-31","2022-08-31","2022-08-31","2022-07-03","2022-04-02","2022-04-02","2022-02-27","2022-02-27","2022-02-27","2022-02-27","2022-03-16","2022-06-19","2022-07-05","2022-06-19","2022-06-19","2022-06-19","2022-07-05","2022-09-21","2022-11-16","2022-10-28","2022-10-28","2022-10-28"],"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":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","57237000299","HYDROCHLOROT","CAP 12.5MG","30","Select","Select",""],["","65862049001","QUETIAPINE","TAB 50MG","90","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","68382091634","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00527169505","BUT\/APAP\/CAF","TAB ","5","Select","Select",""],["","43547040650","CLONAZEPAM","TAB 0.5MG","30","Select","Select",""],["","11822068181","ALLERGY","TAB 180MG","30","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","270","Select","Select",""],["","57237001030","MIRTAZAPINE","TAB 45MG","30","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","68180032002","BUPROPN","TAB 300MG XL","30","Select","Select",""],["","","NAPROXEN","TAB 500MG","","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","20","Select","Select",""],["","69315090505","LORAZEPAM","TAB 1MG","2","Select","Select",""],["","00378395205","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","00378034505","DIAZEPAM","TAB 5MG","15","Select","Select",""],["","59651036105","IBUPROFEN","TAB 600MG","20","Select","Select",""],["","72888001400","CYCLOBENZAPR","TAB 10MG","10","Select","Select",""],["","29300016915","TIZANIDINE","TAB 4MG","60","Select","Select",""],["","59746017210","PREDNISONE","TAB 5MG","21","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","2","Select","Select",""],["","74312058911","B-12","SUB 2500MCG","30","Select","Select",""],["","00087067444","BOOST","LIQ VANILLA","2844","Select","Select",""],["","70461032203","FLUCLVX","INJ 2022-23","0","Select","Select",""],["","00363042062","NICOTINE","GUM 2MG STRT","110","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","54","Select","Select",""],["","","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","","FEXOFENADINE","TAB 180MG","","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","30","Select","Select",""],["","","CITALOPRAM","TAB 20MG","","Select","Select",""],["","11917011354","BACITR","OIN 500\/GM","28","Select","Select",""],["","","SILDENAFIL","TAB 50MG","","Select","Select",""],["","","WAL-FEX","TAB 180MG","","Select","Select",""],["","","PAIN","TAB 500MG","","Select","Select",""],["","","OXYCODONE","TAB 5MG","","Select","Select",""],["","","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","","MELOXICAM","TAB 15MG","","Select","Select",""],["","","ACETAMIN","TAB 500MG","","Select","Select",""],["","","ALLEGRA","TAB 180MG","","Select","Select",""],["","","CLOTRIMAZOLE","CRE 0.01","","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","20","Select","Select",""],["","00185041501","BUPROPION","TAB 150MG SR","60","Select","Select",""],["","00054418425","DEXAMETHASON","TAB 4MG","7","Select","Select",""],["","11822505390","RA","TAB 10MG","30","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":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"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":""}]}]}