{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LUCIAN   P TUPPINCE JR","gend":0,"add":"3108 GARLAND AVE","city":"RICHMOND","state":"VA","zip":"23222-9998","dob":"1965-01-26","age":"","mstatus":"","insh":"20068355*01","cliId":"","pno":"804\/806-1633","cno":"804\/806-1633","email":"","ename":"","eno":"","pphy":"DOMAH, NAU MD","ppno":"804\/226-2444","pcpadd":"4620 S LABURNUM AVE","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23231,"pcpcounty":"","pcpid":"","pcpname":"LABURNUM MEDICAL CENTER ","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/222-0458","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01.812","Z20.822","I70.211","I70.402","F17.210","I70.203","F17.200","I10.","E55.9","E78.00","Z13.6","Z12.11","Z87.891","H53.8","D12.4","D12.3","K64.0","K63.5","K64.9","I70.499","R05.","N40.0","R35.0","I73.9","I70.399","E78.5","R73.03","Z13.29","Z76.89","Z12.5","Z11.59","Z68.21","I70.209","E03.9","Z79.899","Z23."],"date":["2021-06-07","2021-06-07","2021-09-21","2021-09-21","2021-09-21","2021-09-21","2021-04-23","2022-05-24","2022-05-24","2022-05-24","2021-04-23","2021-07-07","2021-04-23","2021-05-28","2021-07-07","2021-07-07","2021-07-07","2021-07-07","2021-07-07","2021-03-16","2021-07-26","2022-05-24","2022-05-24","2021-03-16","2020-09-15","2020-12-14","2022-05-24","2020-12-14","2020-12-14","2020-12-14","2020-12-14","2020-12-14","2021-09-21","2022-05-24","2022-05-24","2022-05-25"],"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":[["","68645051554","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","68645059090","CLOPIDOGREL","TAB 75MG","30","Select","Select",""],["","68382013201","TAMSULOSIN","CAP 0.4MG","30","Select","Select",""],["","60505016809","PRAVASTATIN","TAB 10MG","30","Select","Select",""],["","50268086615","VITAMIN","TAB 5000UNIT","60","Select","Select",""],["","52268001201","SUPREP","SOL PREP KIT","354","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","05388000927","D3","CAP 5000UNIT","60","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":""}]}]}