{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MAURICE   M FIFE","gend":1,"add":"900 E MARSHALL ST","city":"RICHMOND","state":"VA","zip":"23219-9998","dob":"1970-07-18","age":"","mstatus":"","insh":"2346665*01","cliId":"","pno":"804\/729-2870","cno":"804\/729-2870","email":"","ename":"","eno":"","pphy":"BRITZ, JACQUELINE B MD","ppno":"804\/230-7777","pcpadd":"4730 N SOUTHSIDE PLAZA ST","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23224,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/230-2071","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.32","F32.5","G93.41","R79.89","E86.0","A53.9","R40.20","R07.9","F11.129","F43.10","G44.319","S02.85XA","S02.92XA","Y92.89","F39.","F29.","F14.90","F12.90","B20.","E78.2","F31.9","F64.9","T40.5X1A","G92.","Z20.822","F14.10","F17.200","Z21.","F32.9","F41.9","I49.3","J45.909","R77.8","T40.1X1A","Z90.49","Z91.041","Z79.890","E78.5","I25.10","Z72.0","V62.84","Z03.818","T78.40XA","Z23.","H57.11","R42.","Z79.899","I49.1","R00.1","Z86.59","I25.2","B02.9","R21."],"date":["2021-06-08","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2022-06-27","2021-09-05","2021-09-05","2021-09-05","2021-12-02","2022-05-06","2022-05-06","2022-05-06","2022-05-06","2021-01-04","2021-01-04","2021-01-04","2021-01-04","2022-04-29","2022-04-29","2022-04-29","2022-04-29","2021-09-05","2021-09-05","2021-09-05","2021-09-05","2021-09-05","2021-09-05","2021-09-05","2021-09-05","2021-09-05","2021-09-05","2021-09-05","2021-09-05","2021-09-05","2021-09-05","2021-09-05","2022-01-18","2022-01-18","2022-01-18","2020-12-26","2020-12-26","2022-04-10","2022-04-29","2022-05-06","2022-05-06","2021-07-23","2021-09-05","2021-09-05","2021-03-23","2021-03-23","2022-04-10","2022-04-10"],"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":[["","67877024601","QUETIAPINE","TAB 200MG","30","Select","Select",""],["","61958250101","BIKTARVY","TAB ","30","Select","Select",""],["","65862050301","AMOX\/K","TAB 875-125","10","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","6","Select","Select",""],["","65862001205","SERTRALINE","TAB 50MG","7","Select","Select",""],["","23155050210","HYDROXYZ","TAB 50MG","30","Select","Select",""],["","50111056002","TRAZODONE","TAB 50MG","15","Select","Select",""],["","70000036601","LIDOCAINE","PAD 0.04","30","Select","Select",""],["","68180032002","BUPROPN","TAB 300MG XL","30","Select","Select",""],["","67877022310","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","68180063609","ATORVASTATIN","TAB 20MG","90","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}