{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RICHARD  T LONG","gend":0,"add":"114 BRADFORD ST","city":"DANVILLE","state":"VA","zip":"24540-9998","dob":"2002-02-13","age":"","mstatus":"","insh":"7738803*01","cliId":"","pno":4347092197,"cno":4347092197,"email":"","ename":"","eno":"","pphy":"CHAPELL, PATTY J NP","ppno":4348354875,"pcpadd":"949 PINEY FOREST RD","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":"24540-9998","pcpcounty":"","pcpid":"","pcpname":"GoDocs - South Boston","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4348354875,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z72.51","R03.0","T14.8XXA","F12.90","F23.","F25.9","Z20.822","F33.2","Z23.","J34.89","S00.35XA","T17.1XXA","J32.1","F20.9","F25.1","F25.0","M25.472","E55.9","F29.","F41.9","J10.1","Z53.20","R42.","J30.2","F31.9","R07.0","J06.9","J45.901","I45.10","R06.02","R10.9","T19.4XXA","S39.94XA","J02.0","M25.571","R05.9","M25.572","Z04.9","R07.9","R94.31","S30.852A","W45.8XXA","R50.9","R19.7","R09.81","NO DATA","J45.909","F17.210","F32.9","F12.10","E66.9"],"date":["2022-07-30","2022-07-30","2022-08-08","2022-11-01","2021-04-21","2021-04-21","2022-10-30","2021-05-03","2021-08-21","2021-08-19","2021-08-19","2021-08-24","2021-08-24","2023-03-29","2021-12-23","2021-12-28","2021-10-13","2023-03-29","2021-12-26","2021-10-13","2022-10-30","2021-04-15","2021-04-16","2021-04-16","2021-12-26","2022-06-30","2022-10-16","2022-10-16","2022-10-16","2022-10-16","2022-03-30","2022-08-08","2022-08-08","2023-01-24","2023-01-24","2023-01-24","2023-01-24","2021-04-16","2021-08-10","2021-08-10","2022-08-08","2022-08-08","2022-10-30","2022-10-30","2022-10-30","2022-10-30","2022-10-30","2022-10-30","2021-03-25","2021-12-26","2023-03-29"],"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":[["","33342006807","OLANZAPINE","TAB 5MG","30","Select","Select",""],["","00185067405","HYDROXYZ PAM","CAP 25MG","45","Select","Select",""],["","00113006510","NASAL","SPR 0.0005","30","Select","Select",""],["","67877032005","IBUPROFEN","600 MG","30","Select","Select",""],["","41415009473","PX NASAL","SPR 0.0005","30","Select","Select",""],["","00904571135","NASAL DECONG","SPR 0.0005","30","Select","Select",""],["","45802041059","NASAL RELIEF","SPR 0.0005","30","Select","Select",""],["","50458056301","INVEGA SUST","INJ 156MG\/ML","1","Select","Select",""],["","68382011214","RISPERIDONE","TAB 0.25MG","30","Select","Select",""],["","54868608701","FEXOFEN\/PSE","TAB 60-120MG","20","Select","Select",""],["","43547028010","ESCITALOPRAM","TAB 5MG","30","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","65162090203","ARIPIPRAZOLE","TAB 30MG","30","Select","Select",""],["","62756079713","DIVALPROEX","TAB 250MG DR","60","Select","Select",""],["","65757040201","ARISTADA","INJ 662MG\/2","2","Select","Select",""],["","69315013710","BENZTROPINE","TAB 1MG","30","Select","Select",""],["","64380073706","VITAMIN D","2 1250 MCG","4","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","12","Select","Select",""],["","41163030026","TUSSIN COUGH","SYP 15MG\/5ML","120","Select","Select",""],["","00031875712","ROBIT CGH DM","LIQ 20-200","300","Select","Select",""],["","65862001401","AMOXICILLIN","500 MG","21","Select","Select",""],["","50458056301","INVEGA SUSTENNA","156 MG\/ML","1","Select","Select",""],["","00116200116","CHLORHEXIDINE GLUCONATE","0.12 %","473","Select","Select",""],["","71930001952","HYDROCODONE-ACETAMINOPHEN","5 MG-325MG","6","Select","Select",""],["","65862050320","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","20","Select","Select",""],["","29300014005","DIVALPROEX SODIUM","500 MG","90","Select","Select",""],["","69315013710","BENZTROPINE MESYLATE","1 MG","30","Select","Select",""],["","65862017760","CEFDINIR","300 MG","20","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":""}]}]}