{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROBERT E WILLIAMS","gend":0,"add":"645 WESTOVER HILLS BLVD APT G","city":"RICHMOND","state":"VA","zip":"23225-9998","dob":"1964-10-10","age":"","mstatus":"","insh":"20061265*01","cliId":"","pno":8047795197,"cno":8047795197,"email":"","ename":"","eno":"","pphy":"COOK, PATRICIA MD","ppno":8047832505,"pcpadd":"517 W GRACE ST,","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":"23220-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8046491635,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.5","F20.9","G95.9","M54.9","K85.90","I10.","F17.210","I45.10","I11.0","I50.30","E78.5","I77.810","F12.10","R93.1","R06.02","R10.9","I44.0","S62.001A","F33.2","R51.9","F17.200","J44.9","H53.9","Z87.898","S39.012A","S16.1XXA","M54.2","K40.20","Z20.2","D31.90","H52.13","Z79.899","F31.60","F33.3","F43.10","K57.32","K42.9","R19.7","R11.0","H11.223","K40.21","H57.13","R44.3","F19.90","K46.9","Z11.3","Z71.3","F15.90","F60.2","F31.9"],"date":["2022-04-03","2022-05-08","2022-09-16","2022-09-16","2023-01-11","2023-07-18","2023-06-03","2021-04-03","2021-04-07","2021-04-19","2021-04-07","2021-04-07","2023-07-31","2021-04-07","2021-04-07","2021-06-23","2021-07-14","2021-08-16","2022-07-05","2022-10-01","2021-07-14","2021-04-19","2021-04-19","2021-04-19","2022-02-12","2022-02-12","2022-02-12","2023-05-30","2023-03-05","2021-07-14","2021-07-14","2023-06-03","2022-04-21","2022-05-15","2023-07-31","2022-08-01","2022-08-01","2022-08-01","2023-05-10","2023-06-03","2023-06-03","2023-06-03","2023-07-18","2023-07-18","2023-05-23","2023-05-23","2023-05-23","2023-07-31","2023-07-31","2023-07-18"],"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":[["","00172208380","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","23155000301","HYDRALAZINE","TAB 50MG","60","Select","Select",""],["","76385011150","CARVEDILOL","TAB 6.25MG","60","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","70377002811","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","65162046510","IBUPROFEN","TAB 600MG","20","Select","Select",""],["","70010077001","METHOCARBAM","TAB 750MG","24","Select","Select",""],["","00093342210","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","29300039705","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","65162079108","LIDOCAINE","PAD 0.05","15","Select","Select",""],["","27241000306","RISPERIDONE","TAB 0.5MG","30","Select","Select",""],["","57664037708","TRAMADOL HCL","TAB 50MG","12","Select","Select",""],["","65862007701","CIPROFLOXACN","TAB 500MG","10","Select","Select",""],["","10702025301","BUT\/APAP\/CAF","TAB ","10","Select","Select",""],["","65862018730","ONDANSETRON","TAB 4MG","20","Select","Select",""],["","16571066401","METRONIDAZOL","TAB 500MG","10","Select","Select",""],["","00904699880","DOCUSATE SODIUM","100 MG","60","Select","Select",""],["","65862039010","ONDANSETRON ODT","4 MG","21","Select","Select",""],["","31722071390","PANTOPRAZOLE SODIUM","40 MG","20","Select","Select",""],["","00172208380","HYDROCHLOROTHIAZIDE","25 MG","30","Select","Select",""],["","00406012301","HYDROCODONE-ACETAMINOPHEN","5 MG-325MG","7","Select","Select",""],["","29300039805","AMLODIPINE BESYLATE","10 MG","30","Select","Select",""],["","53746010901","HYDROCO\/APAP TAB","5-325MG","12","Select","Select",""],["","00093342210","CYCLOBENZAPR TAB","10MG","15","Select","Select",""],["","00172208380","HYDROCHLOROT TAB","25MG","30","Select","Select",""],["","70010077001","METHOCARBAM TAB","750MG","24","Select","Select",""],["","65162079108","LIDOCAINE PAD","5%","15","Select","Select",""],["","29300039705","AMLODIPINE TAB","5MG","30","Select","Select",""],["","57664037708","TRAMADOL HCL TAB","50MG","12","Select","Select",""],["","27241000306","RISPERIDONE TAB","0.5MG","30","Select","Select",""],["","65862018730","ONDANSETRON TAB","4MG","20","Select","Select",""],["","16571066401","METRONIDAZOL TAB","500MG","10","Select","Select",""],["","65862007701","CIPROFLOXACN TAB","500MG","10","Select","Select",""],["","10702025301","BUT\/APAP\/CAF TAB","","10","Select","Select",""],["","65162046510","IBUPROFEN TAB","600MG","20","Select","Select",""],["","55111053401","DIVALPROEX SODIUM ER","500 MG","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":""}]}]}