{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"OJ WERDNAIII NOSNH","gend":0,"add":" TEVILO 9427DAOR HCRUHC","city":"NEW KENT","state":"VA","zip":"23124-9998","dob":"1980-08-07","age":"","mstatus":"","insh":"6447110*96","cliId":"","pno":"16\/4088743-7","cno":"","email":"","ename":"","eno":"","pphy":"KRUSCHWITZ, ERIN NP","ppno":"540\/967-9401","pcpadd":"115 JEFFERSON HIGHWAY SUITE 9","pcpcity":"LOUISA","pcpstate":"VA","pcpzip":23093,"pcpcounty":"","pcpid":"","pcpname":"CENTRAL VIRGINIA HEALTH SERVICES INC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R52.","M25.531","M25.539","M25.422","M10.09","I10.","D86.9","R06.00","A54.9","A74.9","J01.90","Z20.828","E11.65","R09.02","R94.5","R55.","E86.0","R00.0","V58.89","M10.9","M79.642","Z11.59","R10.84","E16.1","E16.2","R07.89","R07.9","R51.","R06.2","R06.02","I26.99","Z86.711","Z86.718","Z95.828","E78.5","M1A.9XX0","Z79.899","R80.9","U07.1","M10.00","M25.541","D84.9","M25.542","M10.442","R59.0","R59.1","I88.9","M1A.40X0","W19.XXXA","M10.031","K21.9","B35.3","Z23.","N17.9","J45.909","R03.0","E87.2","F17.200","R31.29","R73.09","M79.89","Z20.5","Z13.220","H61.23","R53.81"],"date":["2020-06-07","2020-06-07","2020-06-07","2020-11-17","2020-11-17","2021-08-19","2021-07-12","2020-12-15","2021-03-21","2021-03-21","2021-03-21","2021-03-21","2021-07-12","2021-07-20","2020-01-15","2020-08-27","2020-08-27","2021-09-06","2020-09-09","2021-07-20","2021-07-20","2021-09-01","2021-09-06","2021-09-06","2021-09-06","2021-09-06","2021-09-06","2020-08-11","2020-12-15","2020-12-15","2020-12-15","2021-08-19","2021-08-19","2021-02-09","2021-02-09","2021-02-09","2021-07-12","2021-07-12","2021-09-06","2021-07-12","2021-07-12","2021-07-12","2021-07-12","2021-07-19","2021-08-19","2021-08-19","2021-08-19","2021-09-01","2020-05-19","2020-06-16","2021-06-03","2021-06-03","2019-02-28","2019-07-12","2019-07-12","2019-10-04","2019-07-11","2019-07-11","2019-07-11","2019-11-06","2019-10-24","2019-03-28","2019-03-28","2019-12-02","2019-10-24"],"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":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","","COLCHICINE"," COLCHICINE ","30","Select","Select",""],["","","PREDNISONE"," PREDNISONE ","8","Select","Select",""],["","00003089421","ELIQUIS","TAB 5MG","60","Select","Select",""],["","00378718505","METFORMIN","TAB 500MG","180","Select","Select",""],["","65862041901","SMZ-TMP","TAB 400-80MG","30","Select","Select",""],["","51672208002","TERBINAFINE","CRE 0.01","30","Select","Select",""],["","65862090901","CELECOXIB","CAP 200MG","90","Select","Select",""],["","59467031830","MITIGARE","CAP 0.6MG","104","Select","Select",""],["","","WIXELA","AER 500\/50","","Select","Select",""],["","00363237203","LANCETS","MIS THIN 28G","100","Select","Select",""],["","00173069700","ADVAIR","AER 500\/50","60","Select","Select",""],["","66993058697","FLUTIC\/SALME","AER 500\/50","60","Select","Select",""],["","","ALLOPURINOL"," ALLOPURINOL ","30","Select","Select",""],["","","AMLODIPINE","TAB 2.5MG","","Select","Select",""],["","00143211250","DOXYCYCL","TAB 100MG","14","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA","100","Select","Select",""],["","11917014455","ALCOHOL","PAD ","200","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","3","Select","Select",""],["","56151147002","TRUE","KIT METER","1","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","30","Select","Select",""],["","65862086001","FAMOTIDINE","TAB 40MG","30","Select","Select",""],["","50924097110","SOFTCLIX","MIS LANCETS","200","Select","Select",""],["","68462040601","INDOMETHACIN","CAP 25MG","50","Select","Select",""],["","","OXYCOD\/APAP"," OXYCOD\/APAP ","16","Select","Select",""],["","80777027315","MODERNA","INJ COVID-19","0","Select","Select",""],["","","PROBEN\/COLCH"," PROBEN\/COLCH ","30","Select","Select",""],["","","COLCRYS"," COLCRYS ","30","Select","Select",""],["","","ULORIC"," ULORIC ","30","Select","Select",""],["","","FEBUXOSTAT"," FEBUXOSTAT ","30","Select","Select",""],["","","HYDROCO\/APAP"," HYDROCO\/APAP ","20","Select","Select",""],["","","IBUPROFEN","TAB 600MG","","Select","Select",""],["","","LISINOPRIL","TAB 10MG","","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","","METHYLPRED","TAB 4MG","","Select","Select",""],["","","LIDOCAINE","PAD 0.05","","Select","Select",""],["","","PROAIR","AER ","","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":""}]}]}