{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WALTER CUMMINGS","gend":0,"add":"900 E MARSHALL ST","city":"RICHMOND","state":"VA","zip":"23219-9998","dob":"1977-08-16","age":"","mstatus":"","insh":"20050846*01","cliId":"","pno":8047880881,"cno":8047880881,"email":"","ename":"","eno":"","pphy":"BHAT, SHRIDHAR MD","ppno":8048194000,"pcpadd":"107 S 5TH STREET,","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":"23219-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8048195221,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","F39.","F14.10","F33.2","S51.011A","I10.","Z23.","Z65.1","Z87.891","Z79.899","I21.29","R94.39","F11.10","NO DATA","F33.9","F19.10","F41.1","V62.84","F90.2","R00.0","R94.31","R07.2","I63.9","F32.1","T50.7X1A","T50.901A"],"date":["2022-09-28","2021-11-27","2021-11-27","2022-01-05","2022-03-31","2022-03-31","2022-03-31","2022-03-31","2022-03-31","2022-03-31","2022-08-10","2022-08-10","2022-09-19","2021-12-31","2022-01-06","2022-08-19","2022-05-13","2022-01-03","2022-06-26","2022-08-19","2022-08-19","2022-08-19","2021-03-12","2021-12-05","2022-05-18","2022-05-18"],"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":[["","12496120403","SUBOXONE","MIS 4-1MG","7","Select","Select",""],["","43598058230","BUPREN\/NALOX","MIS 8-2MG","7","Select","Select",""],["","00228212710","CLONIDINE","TAB 0.1MG","8","Select","Select",""],["","00115180401","HYDROXYZ PAM","CAP 50MG","90","Select","Select",""],["","68180044601","QUETIAPINE","TAB 50MG","30","Select","Select",""],["","68180098003","LISINOPRIL","TAB 10MG","30","Select","Select",""],["","27241016701","DOXEPIN HCL","CAP 10MG","30","Select","Select",""],["","69097083512","SERTRALINE","TAB 100MG","45","Select","Select",""],["","42806016005","HYDROXYZ HCL","TAB 25MG","90","Select","Select",""],["","57664050658","METOPROL TAR","TAB 25MG","60","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","70377002811","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","00781717612","NALOXONE","SPR 4MG","2","Select","Select",""],["","47781035603","BUPREN\/NALOX MIS","4-1MG","7","Select","Select",""],["","42806016005","HYDROXYZ HCL TAB","25MG","90","Select","Select",""],["","49483060450","IBUPROFEN TAB","800MG","30","Select","Select",""],["","57664050658","METOPROL TAR TAB","25MG","60","Select","Select",""],["","68180098103","LISINOPRIL TAB","20MG","30","Select","Select",""],["","70377002811","ATORVASTATIN TAB","20MG","30","Select","Select",""],["","12496120403","SUBOXONE MIS","4-1MG","7","Select","Select",""],["","00781717612","NALOXONE SPR","4MG","2","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":""}]}]}