{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BARBARA   A DICKENS","gend":1,"add":"2100 N IDLEWOOD AVE E WINTHROP MANOR ALF","city":"RICHMOND","state":"VA","zip":"23220-9998","dob":"1965-06-09","age":"","mstatus":"","insh":"20026503*01","cliId":"","pno":"804\/328-1606","cno":"","email":"","ename":"","eno":"","pphy":"WAX, WILLIAM NP","ppno":"804\/402-6514","pcpadd":"2105 E PARHAM RD STE 109","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23228,"pcpcounty":"","pcpid":"","pcpname":"IN HOME SOLUTIONS LLC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/562-8481","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F20.0","F33.9","E78.00","J45.998","E11.9","I10.","F41.1","J20.9","E55.9","F20.9","E78.5","F25.0","V58.89","M79.672","B07.0","M19.271","M19.272","M62.81","R26.81","M24.571","J45.909","G47.33","F33.2","J44.9","B35.1","E11.41","E11.21","Z68.36","S90.922A","R29.818","R26.89","M25.671","M25.672","R27.9","H40.013","H04.123","R07.9","F25.1","H25.13","M24.572","M20.42","V62.84","Z11.59","B37.3","M76.822","L03.312","K02.9","E66.01","Z68.37","Z79.84","K08.89","K04.7","H52.11","H52.223","H52.4","S60.222A","E66.9","Z68.38","Z68.32","Z68.35"],"date":["2021-12-29","2020-05-03","2020-02-19","2020-01-16","2021-11-23","2021-08-20","2020-06-24","2020-03-02","2021-11-23","2020-10-26","2021-11-23","2021-11-11","2021-01-14","2021-01-14","2021-12-06","2021-12-06","2021-12-06","2021-12-06","2021-12-06","2021-12-06","2021-11-23","2021-12-15","2020-09-12","2021-08-20","2021-12-06","2021-12-06","2021-03-11","2020-04-20","2020-10-30","2021-06-01","2021-06-01","2021-06-01","2021-06-01","2021-06-01","2021-10-20","2021-10-20","2020-02-13","2020-09-14","2021-07-16","2021-12-06","2020-08-27","2020-09-09","2020-09-09","2020-10-01","2021-01-14","2021-01-28","2019-03-24","2019-03-24","2019-04-03","2019-03-24","2019-03-24","2019-04-04","2019-01-25","2019-01-25","2019-01-25","2019-10-02","2019-04-03","2019-01-02","2019-11-06","2019-11-06"],"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":[["","","FLUTICASONE"," FLUTICASONE ","16","Select","Select",""],["","","FERROUS"," FERROUS ","28","Select","Select",""],["","","ESCITALOPRAM","TAB 10MG","","Select","Select",""],["","","OMEPRAZOLE"," OMEPRAZOLE ","28","Select","Select",""],["","","TOPIRAMATE"," TOPIRAMATE ","28","Select","Select",""],["","","TRAZODONE"," TRAZODONE ","16","Select","Select",""],["","","ARIPIPRAZOLE"," ARIPIPRAZOLE ","28","Select","Select",""],["","","APAP\/CODEINE"," APAP\/CODEINE ","10","Select","Select",""],["","","POT  CHLORIDE"," POT  CHLORIDE","28","Select","Select",""],["","","LISINOPRIL"," LISINOPRIL ","28","Select","Select",""],["","","METFORMIN"," METFORMIN ","56","Select","Select",""],["","","VITAMIN"," VITAMIN ","4","Select","Select",""],["","","PRAVASTATIN"," PRAVASTATIN ","28","Select","Select",""],["","","CARVEDILOL"," CARVEDILOL ","56","Select","Select",""],["","","ACETAMIN","TAB 325MG","","Select","Select",""],["","69420100101","CYCLOBENZAPR","TAB 7.5MG","90","Select","Select",""],["","71800015631","TRIAMCINOLON","AER SPRAY","100","Select","Select",""],["","42806031205","DOXYCYCL","TAB 100MG","14","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","65162091174","DICLOFENAC","SOL 0.015","300","Select","Select",""],["","00574709012","HYDROCORT","SUP 25MG","3","Select","Select",""],["","51672125903","CLOBETASOL","OIN 0.0005","120","Select","Select",""],["","00804768822",""," ","34","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","31","Select","Select",""],["","64980047201","METAXALONE","TAB 800MG","100","Select","Select",""],["","70512003460","FLUOCINONIDE","GEL 0.0005","120","Select","Select",""],["","71800063115","LIDOCAINE","CRE TETRACAI","30","Select","Select",""],["","00904131309","BISMATROL","SUS 262\/15ML","236","Select","Select",""],["","","FLUPHENAZINE"," FLUPHENAZINE ","224","Select","Select",""],["","","MAPAP"," MAPAP ","62","Select","Select",""],["","","BREO"," BREO ","60","Select","Select",""],["","","BACLOFEN"," BACLOFEN ","30","Select","Select",""],["","","FLUCONAZOLE"," FLUCONAZOLE ","2","Select","Select",""],["","","IBUPROFEN"," IBUPROFEN ","30","Select","Select",""],["","","IBU"," IBU ","15","Select","Select",""],["","","HYDROCO\/APAP"," HYDROCO\/APAP ","12","Select","Select",""],["","","AMOXICILLIN"," AMOXICILLIN ","21","Select","Select",""],["","","AMOX\/K"," AMOX\/K ","14","Select","Select",""],["","","PROAIR"," PROAIR ","8","Select","Select",""],["","","ALBUTEROL"," ALBUTEROL ","18","Select","Select",""],["","","TRAMADOL"," TRAMADOL ","15","Select","Select",""],["","","VENTOLIN"," VENTOLIN ","18","Select","Select",""],["","","PROVENTIL"," PROVENTIL ","7","Select","Select",""],["","","ETODOLAC"," ETODOLAC ","60","Select","Select",""],["","","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","","BENZONATATE","CAP 100MG","","Select","Select",""],["","","FLUAD","INJ 0.5ML","","Select","Select",""],["","","REFRESH","DRO 0.5% OP","","Select","Select",""],["","","COUGH","SYP 100\/5ML","","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}