{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BENJAMIN LUCAS","gend":0,"add":"4601 GREENES ROAD","city":"FORD","state":"VA","zip":"23850-9998","dob":"1961-01-08","age":"","mstatus":"","insh":"2150277*01","cliId":"","pno":4043795809,"cno":4043795809,"email":"","ename":"","eno":"","pphy":"SHAH, AMAR MD","ppno":8042568282,"pcpadd":"7300 ASHLAKE PKWY STE 200,","pcpcity":"CHESTERFIELD","pcpstate":"VA","pcpzip":"23832-9998","pcpcounty":"","pcpid":"","pcpname":"VitalCare Family, LLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8042568288,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J93.0","Z68.23","C91.10","J93.83","D72.828","I25.10","I10.","E78.5","R39.12","N50.3","J43.9","J93.9","R06.02","E66.3","R94.31","C83.01","M79.672","M21.6X2","M25.775","I25.2","Z95.5","Z79.02","Z79.82","Z87.891","R59.0","Z71.9","R07.9","J93.11","E03.8","J44.9","J93.82","N43.41","Z79.899","J98.11","R59.1"],"date":["2021-08-19","2021-08-17","2023-07-19","2021-08-18","2023-06-07","2023-07-06","2023-07-06","2023-07-06","2023-07-20","2023-07-20","2023-02-09","2021-10-14","2021-10-14","2023-02-09","2023-05-23","2023-07-06","2022-02-23","2022-02-23","2022-02-23","2023-07-06","2023-07-06","2023-07-06","2023-07-06","2023-07-06","2023-07-06","2022-01-05","2022-03-21","2022-03-21","2021-08-18","2021-08-18","2021-08-18","2021-08-18","2021-08-18","2021-08-18","2023-07-06"],"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":[["","67877019810","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","51991070405","ALPRAZOLAM","0.25 MG","60","Select","Select",""],["","68645059459","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","16729004517","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","57237003105","AMOXICILLIN","CAP 500MG","56","Select","Select",""],["","29033000305","SUCRALFATE","TAB 1GM","28","Select","Select",""],["","00781196260","CLARITHROMYC","TAB 500MG","28","Select","Select",""],["","68382056410","METOPROL SUC","TAB 25MG ER","90","Select","Select",""],["","00186077760","BRILINTA","90 MG","60","Select","Select",""],["","67877021905","CEPHALEXIN","500 MG","40","Select","Select",""],["","50742061510","METOPROLOL SUCCINATE","25 MG","30","Select","Select",""],["","67877024201","QUETIAPINE FUMARATE","25 MG","90","Select","Select",""],["","00378668910","PANTOPRAZOLE SODIUM","40 MG","90","Select","Select",""],["","21922000909","DICLOFENAC SODIUM","1 %","100","Select","Select",""],["","75834025601","ATORVASTATIN CALCIUM","20 MG","90","Select","Select",""],["","00113118901","ARTHRITIS PAIN","1 %","100","Select","Select",""],["","00378427677","VALACYCLOVIR","1000 MG","20","Select","Select",""],["","68382070718","DOXYCYCLINE MONOHYDRATE","100 MG","56","Select","Select",""],["","47781064010","LEVOTHYROXINE SODIUM","25 MCG","90","Select","Select",""],["","64380078407","PREDNISONE","10 MG","30","Select","Select",""],["","27808003501","HYDROCODONE-ACETAMINOPHEN","5 MG-325MG","12","Select","Select",""],["","13668056630","TADALAFIL","5 MG","30","Select","Select",""],["","29300039810","AMLODIPINE BESYLATE","10 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":""}]}]}