{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHAWN SHIPP","gend":0,"add":"13100 COURTLAND LN","city":"RUTHER GLEN","state":"VA","zip":"22546-9998","dob":"1981-05-10","age":"","mstatus":"","insh":"2084292*01","cliId":"","pno":8044012791,"cno":8044012791,"email":"","ename":"","eno":"","pphy":"SCREENEY, GRACE I NP","ppno":8046286777,"pcpadd":"501 N 2ND ST,","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":"23219-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8046286768,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F19.10","F19.90","R68.82","F11.20","F11.90","R11.2","F11.23","D45.","G47.00","F39."],"date":["2022-06-13","2022-11-28","2023-09-13","2023-09-13","2022-06-28","2022-06-03","2022-06-03","2022-06-03","2022-06-03","2023-09-13"],"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","2","Select","Select",""],["","68382080510","TRAZODONE","TAB 50MG","15","Select","Select",""],["","43598058230","BUPREN\/NALOX","MIS 8-2MG","5","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","00406117003","NALTREXONE","TAB 50MG","30","Select","Select",""],["","65757030001","VIVITROL","INJ 380MG","1","Select","Select",""],["","00781717612","NALOXONE","SPR ","2","Select","Select",""],["","00093216568","NALOXONE HCL","SPR ","2","Select","Select",""],["","12496030001","SUBLOCADE","300 MG\/1.5","1.5","Select","Select",""],["","00069420030","VIAGRA","TAB 25MG","10","Select","Select",""],["","68645052354","SERTRALINE","TAB 100MG","30","Select","Select",""],["","00378165893","SILDENAFIL","TAB 25MG","10","Select","Select",""],["","68645052354","SERTRALINE HCL","100 MG","45","Select","Select",""],["","31722070930","SILDENAFIL CITRATE","25 MG","10","Select","Select",""],["","12496120803","SUBOXONE MIS","8-2MG","5","Select","Select",""],["","60505265301","TRAZODONE TAB","50MG","15","Select","Select",""],["","00406117003","NALTREXONE TAB","50MG","30","Select","Select",""],["","43598058230","BUPREN\/NALOX MIS","8-2MG","5","Select","Select",""],["","65862018730","ONDANSETRON TAB","4MG","20","Select","Select",""],["","65757030001","VIVITROL INJ","380MG","1","Select","Select",""],["","00781717612","NALOXONE SPR","","2","Select","Select",""],["","00093216568","NALOXONE HCL SPR","","2","Select","Select",""],["","12496030001","SUBLOCADE INJ","300\/1.5","2","Select","Select",""],["","68645052354","SERTRALINE TAB","100MG","30","Select","Select",""],["","00378165893","SILDENAFIL TAB","25MG","10","Select","Select",""],["","00069420030","VIAGRA TAB","25MG","10","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":""}]}]}