{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ELELLA  V BRAUN","gend":1,"add":"3514 FLOYD AVE APT 1","city":"RICHMOND","state":"VA","zip":"23221-9998","dob":"1948-08-30","age":"","mstatus":"","insh":"20040483*01","cliId":"","pno":8043583935,"cno":8043583935,"email":"","ename":"","eno":"","pphy":"JACKSON, RICHARD A MD","ppno":8042257148,"pcpadd":"304 E LEIGH ST,","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":"23219-9998","pcpcounty":"","pcpid":"","pcpname":"Dominion Medical Associates, INC.","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8042257159,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M20.40","L60.0","L85.1","E10.40","B35.1","L60.9","E11.3293","H04.123","NO DATA","H43.813","Z96.1","E11.42","L85.9","I63.30","E78.2","E11.22","I63.9","E11.41","R94.31","I11.9"],"date":["2022-07-25","2022-07-25","2022-07-25","2022-07-25","2022-07-25","2022-07-25","2022-03-25","2022-03-25","2022-03-25","2022-03-25","2022-03-25","2021-07-09","2021-07-09","2021-04-01","2021-04-01","2021-04-01","2021-04-01","2022-05-26","2021-08-25","2021-08-25"],"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":[["","68180072003","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","70377002911","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","65862056099","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","23155000810","HYDROCHLOROT","TAB 25MG","90","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","15","Select","Select",""],["","00093031101","LOPERAMIDE","CAP 2MG","120","Select","Select",""],["","08290320109","BD PEN NEEDL","MIS 31GX8MM","100","Select","Select",""],["","62332002991","LOSARTAN POT","TAB 100MG","85","Select","Select",""],["","68462040560","ASA\/DIPYRIDA","CAP 25-200MG","60","Select","Select",""],["","00193709021","CONTOUR","TES BLD GLUC","100","Select","Select",""],["","70461012103","FLUAD QUADRI","INJ 2021-22","0","Select","Select",""],["","70954006020","PREDNISONE","20 MG","8","Select","Select",""],["","70377002911","ATORVASTATIN CALCIUM","40 MG","90","Select","Select",""],["","08290320109","ULTRA-FINE SHORT PEN NEEDLE","31 GX5\/16\"","100","Select","Select",""],["","68180072003","AMLODIPINE BESYLATE","5 MG","90","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","100\/ML (3)","15","Select","Select",""],["","62332002991","LOSARTAN POTASSIUM","100 MG","90","Select","Select",""],["","00378668910","PANTOPRAZOLE SODIUM","40 MG","90","Select","Select",""],["","23155000810","HYDROCHLOROTHIAZIDE","25 MG","90","Select","Select",""],["","00378668910","PANTOPRAZOLE TAB","40MG","90","Select","Select",""],["","68180072003","AMLODIPINE TAB","5MG","90","Select","Select",""],["","62332002991","LOSARTAN POT TAB","100MG","85","Select","Select",""],["","70377002911","ATORVASTATIN TAB","40MG","90","Select","Select",""],["","23155000810","HYDROCHLOROT TAB","25MG","90","Select","Select",""],["","08290320109","BD PEN NEEDL MIS","31GX8MM","100","Select","Select",""],["","68462040560","ASA\/DIPYRIDA CAP","25-200MG","60","Select","Select",""],["","00088221905","LANTUS SOLOS INJ","100\/ML","15","Select","Select",""],["","00310621030","FARXIGA","10 MG","30","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":""}]}]}