{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WILLIE ROYAL SR","gend":0,"add":"PO BOX 235","city":"AMELIA COURT HOUSE","state":"VA","zip":"23002-9998","dob":"1960-11-23","age":"","mstatus":"","insh":"20034362*01","cliId":"","pno":"804\/389-2650","cno":"804\/665-7778","email":"","ename":"","eno":"","pphy":"PAINE, MATTHEW MD","ppno":"804\/739-6142","pcpadd":"13540 HULL STREET ROAD","pcpcity":"MIDLOTHIAN","pcpstate":"VA","pcpzip":23112,"pcpcounty":"","pcpid":"","pcpname":"BON SECOURS ST. FRANCIS FAMILY MEDICINE CENTER","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/739-8923","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M79.604","M25.551","R51.9","M54.9","E78.5","F17.200","I10.","Z96.651","K92.1","I16.0","K21.9","M54.5","R00.2","F32.1","H69.81","G89.29","Z68.31","M51.36","F17.210","S93.402A"],"date":["2021-11-13","2021-11-13","2021-11-13","2021-11-13","2021-11-13","2021-11-13","2021-11-13","2021-11-13","2020-02-27","2020-02-27","2020-02-27","2020-02-27","2020-02-27","2020-02-27","2020-02-27","2020-02-27","2020-02-27","2019-11-14","2019-11-14","2019-10-29"],"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":[["","29300012810","HYDROCHLOROT","TAB 25MG","14","Select","Select",""],["","68382091634","METHYLPRED","TAB 4MG","21","Select","Select",""],["","80777027310","MODERNA","INJ COVID-19","0","Select","Select",""],["","68180051703","LISINOPRIL","TAB 40MG","14","Select","Select",""],["","27808003502","HYDROCO\/APAP","TAB 5-325MG","5","Select","Select",""],["","","PREDNISONE","TAB 50MG","","Select","Select",""],["","","OMEPRAZOLE","CAP 40MG","","Select","Select",""],["","","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","27241010950","RANITIDINE","CAP 150MG","30","Select","Select",""],["","31722052001","HYDRALAZINE","TAB 25MG","90","Select","Select",""],["","00378395277","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","00456140530","BYSTOLIC","TAB 5MG","30","Select","Select",""],["","68180051902","LISINOP\/HCTZ","TAB 20-12.5","60","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","12","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","20","Select","Select",""],["","00378001805","METOPROL","TAB 25MG","14","Select","Select",""],["","00363010412","PAIN","TAB 325MG","20","Select","Select",""],["","00904671960","ACETAMINOPHE","TAB 325MG","20","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":""}]}]}