{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JUSTIN SHAW","gend":0,"add":"9702   GARDENIA DRIVE                                       ","city":"RICHMOND                      ","state":"VA","zip":"23228-1406","dob":"1990-08-27","age":"","mstatus":"","insh":10140349,"cliId":"","pno":8043040250,"cno":8042890313,"email":"","ename":"","eno":"","pphy":"HAITHCOCK, RODERICK E                                       ","ppno":"","pcpadd":"505 W Leigh St","pcpcity":"Richmond                      ","pcpstate":"VA","pcpzip":232203239,"pcpcounty":"","pcpid":"P0118438","pcpname":"PRIMARY HEALTH CARE ASSOCIATES","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"APT 6                                                       ","add3":"","madd1":"9702   GARDENIA DRIVE                                       ","madd2":"APT 6                                                       ","madd3":"","mcity":"RICHMOND                      ","mstate":"VA","mzip":"23228-1406","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R11.10","R61","R00.1","R11.2","F17.210","R10.9","K59.00","L02.224","F17.200","R10.32","K92.1","Z90.49","Z01.818","Z11.59","K62.5","R12","T18.128A","X58.XXXA","K22.2","K44.9","Z20.822","F41.1","F32.9"],"date":["2020-06-02","2019-05-25","2019-05-25","2020-06-02","2020-06-02","2020-06-02","2019-05-27","2019-08-08","2021-01-20","2020-06-02","2020-07-16","2020-06-02","2020-07-12","2020-07-12","2020-07-16","2021-01-20","2021-01-20","2021-01-20","2021-01-20","2021-01-20","2021-01-20","2021-11-08","2021-11-15"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","",null,null]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","55111015810","OMEPRAZOLE","20MG","30","Select","Select",""],["","00591079401","DICYCLOMINE","10MG","120","Select","Select",""],["","68462010630","ONDANSETRON","8MG","10","Select","Select",""],["","43386009019","GAVILYTE-G","","4,000.00","Select","Select",""],["","55111015810","OMEPRAZOLE ","CAP 20MG","30","Select","Select",""],["","00591079401","DICYCLOMINE ","CAP 10MG","120","Select","Select",""],["","63402030230","LATUDA ","TAB 20MG","30","Select","Select",""],["","42806016005","HYDROXYZ ","TAB 25MG","60","Select","Select",""],["","68462010630","ONDANSETRON ","TAB 8MG","10","Select","Select",""],["","43386009019","GAVILYTE-G ","SOL ","4,000.00","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}