{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOHN RIPLEY","gend":0,"add":"5500 PAT LN APT A","city":"RICHMOND","state":"VA","zip":"23234-9998","dob":"1960-12-28","age":"","mstatus":"","insh":"20034042*01","cliId":"","pno":"804\/269-1974","cno":"","email":"","ename":"","eno":"","pphy":"JOSEPH, LERLA G MD","ppno":"804\/230-4913","pcpadd":"1606 HULL ST RD","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23224,"pcpcounty":"","pcpid":"","pcpname":"CHARLES CITY MEDICAL GROUP INC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/233-1841","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z79.899","E78.5","I25.9","J44.9","M54.5","E55.9","Z13.31","F33.9","M54.2","M54.9","F17.200","R51.9","I10.","R97.20","R94.31","I49.9","I50.9","I25.10","Z95.828","Z12.5","F41.8","I45.0","I49.1","I51.7","Z13.83","J41.1","G89.4","Z12.11","Z12.12","K12.0","F51.09","K59.03","F31.9","G43.009","S61.012A","S13.9XXA","S33.5XXA","V89.0XXA","S83.8X1A","Z28.21","B35.6","M47.27","I95.1","Z20.828","Z76.89","R09.81","Z71.89","F41.9"],"date":["2021-10-13","2021-10-13","2021-10-13","2021-10-13","2021-09-17","2021-10-13","2020-09-30","2020-09-30","2021-06-21","2021-06-21","2021-06-21","2021-06-21","2021-07-13","2021-07-13","2019-04-20","2019-07-01","2019-07-01","2019-07-01","2019-07-01","2021-10-13","2021-10-13","2019-02-13","2019-07-01","2019-07-01","2020-06-15","2020-07-01","2020-07-01","2021-01-12","2021-01-12","2019-01-22","2019-03-13","2019-03-13","2020-04-02","2020-04-02","2021-01-26","2021-06-26","2021-06-26","2021-06-26","2021-10-13","2021-10-13","2021-10-13","2021-10-13","2020-06-15","2020-06-15","2020-01-30","2021-04-12","2021-04-12","2019-12-02"],"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":[]},{"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":[["","68180098003","LISINOPRIL","TAB 10MG","30","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","16729017317","AMITRIPTYLIN","TAB 50MG","60","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","59651000205","OMEPRAZOLE","CAP 20MG","90","Select","Select",""],["","68462063945","NITROGLYCERN","SUB 0.4MG","100","Select","Select",""],["","23155017801","ISOSORB","TAB 60MG ER","30","Select","Select",""],["","00228203150","ALPRAZOLAM","TAB 1MG","90","Select","Select",""],["","68462034690","LEVOCETIRIZI","TAB 5MG","30","Select","Select",""],["","27241009903","DULOXETINE","CAP 60MG","30","Select","Select",""],["","68462025401","ROPINIROLE","TAB 0.5MG","90","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","55111012305","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","70010077001","METHOCARBAM","TAB 750MG","15","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","00406052201","OXYCOD\/APAP","TAB 7.5-325","180","Select","Select",""],["","00254100752","ALBUTEROL","AER HFA","7","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","00093321930","KETOCONAZOLE","CRE 0.02","30","Select","Select",""],["","57237004805","DIVALPROEX","TAB 500MG DR","60","Select","Select",""],["","00054429731","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","20","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","15","Select","Select",""],["","27808003502","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","00173069600","ADVAIR","AER 250\/50","60","Select","Select",""],["","16729021816","CLOPIDOGREL","TAB 75MG","90","Select","Select",""],["","00378932132","WIXELA","AER 250\/50","60","Select","Select",""],["","62756052169","SUMATRIPTAN","TAB 50MG","9","Select","Select",""],["","66993058597","FLUTIC\/SALME","AER 250\/50","60","Select","Select",""],["","00904645760","DOK","CAP 100MG","30","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","15","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","65862049001","QUETIAPINE","TAB 50MG","30","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","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":""}]}]}