{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BOBBY   L WILLIAMS","gend":0,"add":"110 TERRY ST APT 18","city":"PETERSBURG","state":"VA","zip":"23803-9998","dob":"1968-08-03","age":"","mstatus":"","insh":"20069999*01","cliId":"","pno":"804\/366-3509","cno":"804\/366-3509","email":"","ename":"","eno":"","pphy":"MOULDEN, KRISTEN PA","ppno":"804\/254-3500","pcpadd":"1250 E MARSHALL ST","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23298,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/254-1616","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S06.9X0A","S02.19XB","S02.40FA","S02.40DA","J96.01","Y00.XXXA","G93.89","J81.1","R45.1","S06.9X9A","S02.19XA","S02.601A","S01.312A","S01.81XA","Z93.0","S06.309A","S02.81XA","G89.11","Y99.9","M79.89","NO DATA","Z78.1","I10.","Z20.822","Z93.1","R13.13","V54.19","S02.85XD","V58.89","Y00.XXXD","Z23.","R13.12","Z47.89","F19.10","F10.10","Z11.52","R00.0","R60.9","G82.50","S06.2X0A","R13.10","N17.9","D72.829","Z46.82","D64.9","G81.11","R13.19","R47.1","S06.9X9S","U07.1","I16.0","Z43.1","Z87.820","D64.89","F31.81","T68.XXXA","G93.40","E87.2","F10.20","Y90.6","I95.0","R94.01","R41.82","S02.609A","H11.32","R94.31","K40.90","S02.91XS","S06.9X0S","F29.","Z73.1","Z87.81","Z98.890","S06.9X1S","F33.3","S09.90XA","S09.93XA","R40.2433","Z99.11","S02.0XXB","S12.8XXA","J69.0","E87.1","F10.239","R40.2312","R40.2212","R40.2112","I25.10","Z46.59","R05.9","Z86.16","L30.9","I73.89","B35.1","R13.14","R63.30","A41.9","E86.0","R56.9","F14.90","F10.229","G92.","S02.91XA","T14.90XA","S02.652A","S02.66XA","W22.8XXA","S02.82XA","J96.02","S06.2X9A"],"date":["2021-09-01","2021-09-01","2021-09-20","2021-09-20","2021-09-01","2021-09-20","2021-09-09","2021-09-08","2021-09-27","2021-09-20","2021-10-13","2021-09-20","2021-10-13","2021-09-20","2021-09-20","2021-09-27","2021-09-27","2021-09-27","2021-09-27","2021-11-04","2021-11-04","2021-10-13","2022-03-29","2021-10-13","2022-03-01","2022-02-17","2022-02-28","2022-02-28","2022-03-01","2021-10-21","2021-12-01","2022-03-29","2022-01-01","2022-03-01","2022-03-01","2022-02-14","2021-09-04","2021-09-09","2021-09-21","2021-09-21","2021-10-06","2021-12-09","2021-12-09","2021-10-06","2021-10-06","2021-12-01","2021-12-01","2021-12-01","2022-03-29","2022-01-06","2022-03-10","2022-03-10","2022-03-16","2022-03-29","2020-12-09","2021-01-29","2021-01-29","2021-01-29","2021-01-29","2021-01-29","2021-08-30","2021-09-01","2021-09-01","2021-09-04","2021-09-04","2021-09-11","2021-10-25","2022-02-28","2022-02-28","2022-06-16","2021-12-09","2021-12-09","2022-02-28","2022-02-28","2020-12-09","2021-08-30","2021-08-30","2021-08-30","2021-08-30","2021-08-30","2021-08-30","2021-08-30","2021-08-30","2021-08-30","2021-08-30","2021-08-30","2021-08-30","2021-09-08","2021-09-09","2021-10-04","2022-03-01","2021-11-17","2021-11-17","2021-11-17","2022-03-01","2022-03-01","2021-01-29","2021-01-29","2021-01-29","2021-01-29","2021-01-29","2021-01-29","2021-08-30","2021-08-30","2021-08-31","2021-08-31","2021-08-31","2021-08-31","2021-09-05","2021-09-04"],"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":[["","16729014501","QUETIAPINE","TAB 25MG","4","Select","Select",""],["","71093011105","GABAPENTIN","TAB 600MG","30","Select","Select",""],["","00378967130","IPRATROPIUM\/","SOL ALBUTER","90","Select","Select",""],["","71093014806","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","00115165903","PROPRANOLOL","TAB 10MG","30","Select","Select",""],["","45802086802","POLYETH","POW 3350 NF","476","Select","Select",""],["","51991074790","DULOXETINE","CAP 30MG","30","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","49348001737","SM","SYP 100-10\/5","237","Select","Select",""],["","00409272330","HEPARIN","INJ 5000\/ML","1","Select","Select",""],["","00904515460","GUAIFENESIN","TAB 200MG","100","Select","Select",""],["","10006073027","ZINC","TAB 220MG","100","Select","Select",""],["","00065050935","SYSTANE","OIN ","4","Select","Select",""],["","57237004705","DIVALPROEX","TAB 250MG DR","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":""}]}]}