{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LANEE SPELL","gend":1,"add":"2318 CARMINE ST","city":"RICHMOND","state":"VA","zip":"23223-9998","dob":"1993-06-26","age":"","mstatus":"","insh":"20041622*01","cliId":"","pno":"804\/878-5472","cno":"","email":"","ename":"","eno":"","pphy":"JACKSON, RICHARD A MD","ppno":"804\/225-7148","pcpadd":"304 E LEIGH ST","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23219,"pcpcounty":"","pcpid":"","pcpname":"Dominion Medical Associates, INC.","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/225-7159","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","F20.9","F25.0","F10.10","Z68.22","F25.9","R00.0","R45.1","F23.","Z91.14","J45.909","I25.10","F31.2","R44.0","R44.1","E87.6","F17.210","R46.2","F20.81","Z68.20","Z68.23","J45.20","F31.9","R51.9","I95.0","F90.2","R41.82","R41.0","Z30.42","Z32.02","E55.9","F90.9","F17.200","Z13.31","I10.","R79.9","Z92.29","R06.02","E11.9","F20.1","F29.","Z79.82","Z20.822","F31.64","R07.9","I95.9","Z91.19","F60.9","Z71.6","R40.0","F33.3","F10.20","Z00.00","F31.30","Z09.","H93.299","H53.8","I11.9","R94.31","F43.12","F33.2","F41.1","G47.00","Z72.0","R44.3","F99.","V62.84","Z79.899","Z04.6","V62.85","F41.0","F51.05","K08.89","K59.00","M43.6","R32.","Z81.8","Z83.3"],"date":["2020-09-21","2022-05-29","2022-08-23","2022-03-24","2022-06-06","2022-05-13","2020-10-02","2020-10-02","2022-05-13","2022-03-24","2022-05-13","2021-07-21","2022-02-03","2020-09-23","2020-09-23","2021-02-01","2022-05-13","2022-05-11","2020-09-29","2020-12-16","2022-03-24","2021-12-08","2021-12-08","2021-01-13","2021-02-09","2021-10-31","2022-04-30","2021-12-31","2020-01-07","2020-01-07","2020-07-23","2022-03-24","2021-11-07","2020-07-23","2020-07-23","2020-07-23","2020-07-23","2020-07-23","2021-02-09","2020-12-29","2022-05-13","2021-11-07","2022-05-13","2021-12-13","2020-12-30","2021-02-01","2022-03-24","2020-09-24","2021-12-08","2021-12-14","2019-12-16","2019-02-04","2019-01-24","2019-01-24","2019-01-24","2019-01-24","2019-01-24","2019-01-24","2019-01-24","2019-04-19","2019-04-19","2019-07-14","2019-12-16","2019-03-06","2022-05-12","2022-05-12","2022-05-13","2022-05-13","2022-05-13","2022-03-24","2022-03-24","2022-03-24","2022-03-24","2022-03-24","2022-03-24","2022-03-24","2022-03-24","2022-03-24"],"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":[["","57896055501","SENNA-PLUS","TAB 8.6-50MG","30","Select","Select",""],["","70710146305","HALOPER","INJ 100MG\/ML","4","Select","Select",""],["","57664078686","CLONAZEP","TAB 1MG","60","Select","Select",""],["","69238207707","PROPRANOLOL","TAB 10MG","60","Select","Select",""],["","","TRAZODONE","TAB 100MG","","Select","Select",""],["","","ZOLPIDEM","TAB 10MG","","Select","Select",""],["","","LITHIUM","CAP 300MG","","Select","Select",""],["","33342007207","OLANZAPINE","TAB 20MG","60","Select","Select",""],["","65162075750","DIVALPROEX","TAB 500MG ER","14","Select","Select",""],["","68382025701","OXYBUTYNIN","TAB 15MG ER","30","Select","Select",""],["","16729013600","CLONAZEPAM","TAB 0.5MG","14","Select","Select",""],["","","HYDROXYZ","TAB 50MG","","Select","Select",""],["","","CLOZAPINE","TAB 100MG","","Select","Select",""],["","00591246401","DESMOPRESSIN","TAB 0.1MG","31","Select","Select",""],["","00536106210","STOOL","CAP 100MG","62","Select","Select",""],["","00121067516","VALPROIC","SOL 250\/5ML","946","Select","Select",""],["","43547034406","RISPERIDONE","TAB 4MG","30","Select","Select",""],["","23155010210","METFORMIN","TAB 500MG","31","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","16729009612","QUETIAPINE","TAB 300MG ER","62","Select","Select",""],["","","METOPROL","TAB 50MG ER","","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","50383077932","LACTULOSE","SOL 10GM\/15","946","Select","Select",""],["","42806064810","DIPHENHYDRAM","CAP 25MG","30","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","00904693181","PEG","POW ","30","Select","Select",""],["","57896040110","DOCUSATE","CAP 100MG","62","Select","Select",""],["","68382007901","HALOPERIDOL","TAB 5MG","140","Select","Select",""],["","10370010250","BUPROPN","TAB 300MG XL","30","Select","Select",""],["","59651017401","DOXEPIN","CAP 25MG","30","Select","Select",""],["","","IBUPROFEN","TAB 800MG","","Select","Select",""],["","","AMOXICILLIN","CAP 500MG","","Select","Select",""],["","","MEDROXYPR","INJ 150MG\/ML","","Select","Select",""],["","","PROVENTIL","AER HFA","","Select","Select",""],["","","DICLOFENAC","TAB 50MG DR","","Select","Select",""],["","","DOXYCYCL","TAB 100MG","","Select","Select",""],["","","NICOTINE","DIS 14MG\/24H","","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","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":{"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":""}]}]}