{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RALPH RHYNE","gend":0,"add":"273 MILL CREEK LN","city":"CHATHAM","state":"VA","zip":"24531-9998","dob":"1955-05-06","age":"","mstatus":"","insh":"1057429*01","cliId":"","pno":2403532018,"cno":2403532018,"email":"","ename":"","eno":"","pphy":"RICHARDSON, JENNIFER NP","ppno":4347914122,"pcpadd":"705 MAIN ST","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":"24541-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4347914126,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S32.302A","R00.2","Z13.6","I10.","R06.00","R97.20","C61.","F52.21","Z20.828","M79.672","M25.552","S32.392A","B20.","B18.2","Z21.","Z23.","S32.592A","R20.0","V54.13","M25.561","M25.562","S32.402A","S50.312A","R07.9","R06.02","S32.425A","S32.502A","J44.9","R79.89","M17.9","R39.12","S32.315A","S32.415A","S32.512A","W17.89XA","Z13.1"],"date":["2021-11-10","2023-02-27","2023-02-27","2023-02-27","2023-02-27","2023-04-06","2023-04-06","2023-02-27","2021-04-14","2021-05-13","2021-11-03","2021-11-03","2023-03-07","2023-03-07","2022-02-22","2023-03-07","2021-11-03","2021-08-26","2021-12-01","2021-02-16","2021-02-16","2021-11-03","2021-11-03","2022-02-18","2022-02-18","2021-11-03","2021-11-03","2021-11-05","2022-03-07","2021-02-02","2021-03-22","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2022-01-24"],"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":[]},{"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":[["","00093534356","SILDENAFIL","TAB 100MG","30","Select","Select",""],["","61958250101","BIKTARVY","50-200-25","30","Select","Select",""],["","65162018910","NAPROXEN","TAB 375MG","28","Select","Select",""],["","49483060350","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","43547040011","CYCLOBENZAPR","TAB 10MG","14","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","20","Select","Select",""],["","80777027398","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","00093005805","TRAMADOL HCL","TAB 50MG","30","Select","Select",""],["","00116200116","CHLORHEX GLU","SOL 0.0012","473","Select","Select",""],["","42858000110","OXYCODONE","TAB 5MG","21","Select","Select",""],["","69097012715","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","00074709804","VUITY","SOL 1.25% OP","2","Select","Select",""],["","55111011910","FAMOTIDINE","20 MG","30","Select","Select",""],["","68382089906","TADALAFIL","TAB 20MG","8","Select","Select",""],["","49281012265","FLUZONE HD","INJ 2022-23","1","Select","Select",""],["","69097012715","AMLODIPINE BESYLATE","5 MG","90","Select","Select",""],["","00069422066","VIAGRA","100 MG","30","Select","Select",""],["","82607066026","FLOWFLEX COVID-","19 AG HOME TEST","8","Select","Select",""],["","60008040780","INDICAID COVID-","19 AG HOME TEST","8","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":""}]}]}