{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TEDDY QUARLES","gend":0,"add":"1423 NEWELL RD APT 1","city":"RICHMOND","state":"VA","zip":"23225-9998","dob":"1979-12-18","age":"","mstatus":"","insh":"20047629*01","cliId":"","pno":"804\/544-1314","cno":"","email":"","ename":"","eno":"","pphy":"BROWN JR, LEON J MD","ppno":"804\/232-7876","pcpadd":"101 COWARDIN AVE STE 105","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23224,"pcpcounty":"","pcpid":"","pcpname":"LEON J BROWN JR MD PC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/232-1708","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J06.9","I10.","F17.200","R05.","S86.012A","M79.89","R60.9","R22.42","M25.672","V58.89","R26.9","M25.572","R91.8","E66.9","R03.0","J45.909","J20.8","R09.81","R26.89","S51.011A","S01.411A","Y04.0XXA","G89.18","Y93.67","R07.89","R91.1","R51.9","J30.9","J40."],"date":["2019-09-09","2021-04-13","2020-07-15","2019-09-09","2020-07-15","2020-10-26","2020-07-06","2020-07-06","2020-09-16","2020-10-26","2020-09-16","2020-09-16","2021-09-14","2021-09-14","2020-06-29","2021-04-13","2019-04-16","2019-04-16","2020-09-02","2019-03-17","2019-03-17","2019-03-17","2020-07-15","2020-07-15","2021-08-09","2021-08-09","2021-04-13","2021-04-13","2019-04-16"],"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":[["","","TRAMADOL"," TRAMADOL ","15","Select","Select",""],["","","KETOROLAC"," KETOROLAC ","20","Select","Select",""],["","","PREDNISONE"," PREDNISONE ","15","Select","Select",""],["","","ALBUTEROL"," ALBUTEROL ","8","Select","Select",""],["","","MUCINEX"," MUCINEX ","20","Select","Select",""],["","","SYMBICORT"," SYMBICORT ","10","Select","Select",""],["","","PROAIR"," PROAIR ","8","Select","Select",""],["","","BENZONATATE"," BENZONATATE ","30","Select","Select",""],["","","CETIRIZINE"," CETIRIZINE ","30","Select","Select",""],["","","IBUPROFEN"," IBUPROFEN ","15","Select","Select",""],["","","BUDES\/FORMOT","AER 80-4.5","","Select","Select",""],["","","HYDROCO\/APAP","TAB 7.5-325","","Select","Select",""],["","","ONDANSETRON","TAB 4MG","","Select","Select",""],["","","ACETAMINOPHN","TAB 500MG","","Select","Select",""],["","","CVS","TAB 81MG EC","","Select","Select",""],["","","DOCUSATE","CAP 100MG","","Select","Select",""],["","","PENICILLN","TAB 500MG","","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":""}]}]}