{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROBERT   W DRUMHELLER","gend":0,"add":"77   COLUMBIA ROAD                                          ","city":"CARTERSVILLE                  ","state":"VA","zip":"23027-9709","dob":"1980-07-07","age":"","mstatus":"","insh":10260593,"cliId":"","pno":8043818058,"cno":8043818058,"email":"","ename":"","eno":"","pphy":"HYDER, HAROON S                                             ","ppno":"","pcpadd":"9600 Patterson Ave Ste B","pcpcity":"Henrico                       ","pcpstate":"VA","pcpzip":232296053,"pcpcounty":"","pcpid":"P0123810","pcpname":"BON SECOURS SENIOR CARE SERVICES","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"APARTMENT 1903                                              ","add3":"","madd1":"77   COLUMBIA ROAD                                          ","madd2":"APARTMENT 1903                                              ","madd3":"","mcity":"CARTERSVILLE                  ","mstate":"VA","mzip":"23027-9709","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I50.22","I21.3","I25.5","I10","E78.2","N18.9","Z79.02","Z68.31","Z68.33","E78.5","I21.02","Z68.32","N45.1","N50.812","I25.2","I25.10","Z79.82","S02.31XA","Y04.8XXA","S02.85XA","Y04.0XXA","S01.511A","Z04.89","Z04.1","K76.0","V89.2XXA","S22.31XA","S09.90XA","M79.89"],"date":["2021-03-02","2021-03-02","2020-11-03","2021-03-13","2021-03-02","2020-11-03","2021-03-05","2020-11-03","2021-03-02","2021-03-13","2020-11-03","2021-03-02","2021-03-05","2021-03-05","2021-03-13","2021-03-05","2021-03-13","2021-03-13","2021-03-13","2021-03-13","2021-03-13","2021-03-13","2021-03-13","2021-07-11","2021-07-11","2021-07-11","2021-07-11","2021-07-11","2021-07-11"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","68180098103","LISINOPRIL","20MG","30","Select","Select",""],["","00536123441","ASPIRIN","81MG EC","67","Select","Select",""],["","42799012001","BUMETANIDE","1MG","30","Select","Select",""],["","70377003012","ATORVASTATIN","80MG","30","Select","Select",""],["","00186077760","BRILINTA","90MG","60","Select","Select",""],["","55111046901","METOPROL","200MG ER","30","Select","Select",""],["","00406012301","HYDROCO\/APAP","5-325MG","10","Select","Select",""],["","49884072703","DOXYCYC","100MG","20","Select","Select",""],["","00781185220","AMOX\/K","875-125","14","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","69452017173","AZITHROMYCIN","250MG","6","Select","Select",""],["","31722095801","BENZONATATE","200MG","30","Select","Select",""],["","68180098103","LISINOPRIL ","TAB 20MG","30","Select","Select",""],["","00536123441","ASPIRIN ","TAB 81MG EC","67","Select","Select",""],["","42799012001","BUMETANIDE ","TAB 1MG","30","Select","Select",""],["","70377003012","ATORVASTATIN ","TAB 80MG","30","Select","Select",""],["","00186077760","BRILINTA ","TAB 90MG","60","Select","Select",""],["","55111046901","METOPROL ","TAB 200MG ER","30","Select","Select",""],["","00406012301","HYDROCO\/APAP ","TAB 5-325MG","10","Select","Select",""],["","49884072703","DOXYCYC ","CAP 100MG","20","Select","Select",""],["","00781185220","AMOX\/K ","TAB 875-125","14","Select","Select",""],["","00116200116","CHLORHEX ","SOL 0.0012","473","Select","Select",""],["","69452017173","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","31722095801","BENZONATATE ","CAP 200MG","30","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","",""],["Yes","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":""}]}]}