{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ODELL PACE","gend":0,"add":"3540 PACETOWN RD","city":"SANDY HOOK","state":"VA","zip":"23153-9998","dob":"1964-05-22","age":"","mstatus":"","insh":"20033011*01","cliId":"","pno":"804\/510-4877","cno":"804\/510-4877","email":"","ename":"","eno":"","pphy":"DESHMUKH, PRAVIN M MD","ppno":"804\/612-2980","pcpadd":"STE 204 12320 W BROAD ST","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23233,"pcpcounty":"","pcpid":208002,"pcpname":"BON SECOURS SHORT PUMP PRIMARY CARE","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"804\/510-4877","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/360-2437","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D50.0","E87.1","E87.6","F10.10","F17.210","K29.00","K26.9","K70.31","E44.0","R64.","K44.9","K29.80","R19.7","D64.9","D53.9","R18.8","I10.","J96.01","J81.1","I35.1","I34.0","I47.1","D62.","K29.70","K25.9","I49.9","J44.9","J81.0","R06.02","Z98.61","J96.22","R55.","N17.9","R60.0","I50.9","Z04.9","C92.00","D69.6","K70.30","Z68.23","R65.10","J44.1","R40.2212","J96.02","G93.41","J18.9","E87.2","E83.42","N39.0","D63.8","V72.85","Z87.891","D61.818","A41.9","D50.9","D72.820","D47.3","I51.7","F10.99","R53.83","Z68.22","R79.89","R00.0","J96.92","D72.829","H00.013","R50.9","K74.60","Z79.899","K92.2","C94.6","Z23.","D46.9"],"date":["2021-07-08","2020-01-15","2020-02-06","2021-02-12","2020-02-06","2020-01-21","2020-01-29","2021-11-01","2020-01-15","2020-01-15","2020-01-20","2020-01-20","2020-01-16","2021-11-01","2020-01-21","2020-02-10","2021-11-01","2020-02-08","2020-02-08","2020-02-07","2020-02-07","2020-02-08","2021-07-07","2021-07-08","2021-07-08","2021-07-08","2021-07-08","2020-02-06","2020-02-07","2020-02-07","2020-02-11","2021-07-08","2020-01-19","2020-02-07","2020-02-07","2021-07-16","2021-07-23","2021-08-19","2021-11-01","2021-07-10","2020-01-21","2020-02-10","2020-02-06","2020-02-06","2020-02-06","2020-02-06","2020-02-06","2020-02-06","2020-02-06","2020-02-06","2020-02-06","2020-02-06","2021-07-09","2020-01-16","2020-02-10","2020-01-16","2020-02-10","2020-01-18","2020-01-19","2021-07-06","2021-07-07","2021-07-11","2021-08-19","2020-02-08","2020-02-10","2020-03-05","2021-08-19","2021-07-11","2021-10-29","2021-07-07","2021-10-29","2021-11-01","2021-11-01"],"priorHcc":["","","","","","","",null,"","","","","",null,"","",null,"","","","","","","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,"",null,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":[["","00832532511","POT  CL MICRO","20MEQ ER","30","Select","Select",""],["","00182451910","THERAPEUTIC ","","30","Select","Select",""],["","11534016503","FOLIC ","1MG","20","Select","Select",""],["","65862056090","PANTOPRAZOLE ","40MG","30","Select","Select",""],["","00093221001","SUCRALFATE ","1GM","120","Select","Select",""],["","00115166001","PROPRANOLOL ","20MG","60","Select","Select",""],["","55111028130","LEVOFLOXACIN ","750MG","3","Select","Select",""],["","69315011710","FUROSEMIDE ","40MG","30","Select","Select",""],["","67877021905","CEPHALEXIN ","500MG","30","Select","Select",""],["","70461042010","FLUCLVX ","2020-21","0","Select","Select",""],["","59746011506","PROCHLORPER ","10MG","60","Select","Select",""],["","64842072709","INQOVI ","35-100MG","5","Select","Select",""],["","31722077701","ACYCLOVIR ","400MG","60","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","55111073005","ALLOPURINOL ","300MG","30","Select","Select",""],["","77333093410","VITAMIN ","100MG","15","Select","Select",""],["","00115166001","PROPRANOLOL","20MG","60","Select","Select",""],["","77333093410","VITAMIN","100MG","15","Select","Select",""],["","11534016503","FOLIC","1MG","20","Select","Select",""],["","65862056090","PANTOPRAZOLE","40MG","30","Select","Select",""],["","96295012782","THERAPEUTIC","","30","Select","Select",""],["","00832532511","POT CL MICRO","20MEQ ER","30","Select","Select",""],["","69315011710","FUROSEMIDE","40MG","30","Select","Select",""],["","55111028130","LEVOFLOXACIN","750MG","3","Select","Select",""],["","67877021905","CEPHALEXIN","500MG","30","Select","Select",""],["","00093221001","SUCRALFATE","1GM","120","Select","Select",""],["","70461042010","FLUCLVX","2020-21","0","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","59746011506","PROCHLORPER","10MG","60","Select","Select",""],["","64842072709","INQOVI","35-100MG","5","Select","Select",""],["","31722077701","ACYCLOVIR","400MG","60","Select","Select",""],["","55111073005","ALLOPURINOL","300MG","30","Select","Select",""],["","68180021509","LOSARTAN\/HCT ","TAB 50-12.5","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","",""],["Yes","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":""}]}]}