{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GARY RITCHIE","gend":0,"add":"534 LONE PINE DR APT CC1","city":"TIMBERVILLE","state":"VA","zip":"22853-9998","dob":"1970-02-09","age":"","mstatus":"","insh":"20083101*01","cliId":"","pno":5408307259,"cno":5408307259,"email":"","ename":"","eno":"","pphy":"HALEY, JAMES A MD","ppno":5404333344,"pcpadd":"1751 ERICKSON AVE,","pcpcity":"HARRISONBURG","pcpstate":"VA","pcpzip":"22801-9998","pcpcounty":"","pcpid":"","pcpname":"Rockingham Family Physicians, PC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5404330031,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F34.9","F90.0","Z79.899","B02.29","G57.12","F39.","F41.9","F13.20","F90.9","F33.1","F17.200","F31.9","B20.","Z23.","R41.840","Z51.81","Z65.9"],"date":["2022-11-23","2023-02-23","2023-02-23","2022-06-23","2022-06-23","2023-09-18","2023-09-18","2023-09-18","2023-09-18","2022-08-22","2022-11-23","2023-02-23","2022-10-13","2022-10-13","2022-12-28","2023-09-18","2023-09-18"],"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":[["","16729044315","BUPROPN HCL","TAB 150MG XL","90","Select","Select",""],["","00228285111","GUANFACINE","TAB 2MG ER","30","Select","Select",""],["","70954007710","MELOXICAM","CAP 10MG","30","Select","Select",""],["","65862022801","LAMOTRIGINE","100 MG","180","Select","Select",""],["","68462012605","GABAPENTIN","600 MG","180","Select","Select",""],["","00093321205","CLONAZEPAM","1 MG","30","Select","Select",""],["","61958250101","BIKTARVY","50-200-25","30","Select","Select",""],["","47335079483","VENLAFAXINE","TAB 225MG ER","90","Select","Select",""],["","58160082311","SHINGRIX","50 MCG\/0.5","1","Select","Select",""],["","00555097302","AMPHET\/DEXTR","TAB 20MG","90","Select","Select",""],["","65862049301","QUETIAPINE","TAB 200MG","30","Select","Select",""],["","52817031910","BACLOFEN","5 MG","90","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","20","Select","Select",""],["","00228285111","GUANFACINE HCL ER","2 MG","90","Select","Select",""],["","13811071590","VENLAFAXINE HCL ER","225 MG","30","Select","Select",""],["","16729044315","BUPROPION XL","150 MG","90","Select","Select",""],["","00555077702","DEXTROAMPHETAMINE-AMPHETAMINE","15 MG","60","Select","Select",""],["","65862049301","QUETIAPINE FUMARATE","200 MG","90","Select","Select",""],["","00093342210","CYCLOBENZAPRINE HCL","10 MG","21","Select","Select",""],["","68462015713","ONDANSETRON ODT","4 MG","21","Select","Select",""],["","52817018000","CLONIDINE HCL","0.1 MG","21","Select","Select",""],["","00093321205","CLONAZEPAM TAB","1MG","60","Select","Select",""],["","70954007710","MELOXICAM CAP","10MG","30","Select","Select",""],["","69097094312","GABAPENTIN CAP","300MG","360","Select","Select",""],["","16729044315","BUPROPN HCL TAB","150MG XL","90","Select","Select",""],["","61958250101","BIKTARVY TAB","","30","Select","Select",""],["","00228285111","GUANFACINE TAB","2MG ER","90","Select","Select",""],["","65862049301","QUETIAPINE TAB","200MG","30","Select","Select",""],["","42858072601","AMPHET\/DEXTR TAB","20MG","90","Select","Select",""],["","65862022801","LAMOTRIGINE TAB","100MG","180","Select","Select",""],["","58160082311","SHINGRIX INJ","50\/0.5ML","1","Select","Select",""],["","47335079483","VENLAFAXINE TAB","225MG ER","90","Select","Select",""],["","68462012605","GABAPENTIN TAB","600MG","180","Select","Select",""],["","52817031910","BACLOFEN TAB","5MG","90","Select","Select",""],["","65862042005","SMZ\/TMP DS TAB","800-160","20","Select","Select",""],["","00185067401","HYDROXYZINE PAMOATE","25 MG","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":[]}},{"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":""}]}]}