{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARTIN ACTON","gend":0,"add":"2823 GROVE AVE","city":"RICHMOND","state":"VA","zip":"23221-9998","dob":"1965-09-17","age":"","mstatus":"","insh":"20049945*01","cliId":"","pno":"804\/309-6446","cno":"804\/309-6446","email":"","ename":"","eno":"","pphy":"GREEN JR, HAROLD T MD","ppno":"804\/644-1665","pcpadd":"STE 308 1510 N 28TH ST","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23223,"pcpcounty":"","pcpid":208009,"pcpname":"PRIMARY HEALTHCARE ASSOCIATES","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/644-5285","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I44.0","R07.9","Z86.79","I48.91","R00.0","F10.929","F14.90","R07.89","R53.1","A41.9","J69.0","F10.239","I47.1","E83.42","F17.210","I25.10","I48.0","I49.5","K70.10","R79.1","Z95.0","Z95.2","Z11.59","Z79.01","R94.31","F10.10","F19.10","R06.02","R00.2","Z20.828","K29.20","F33.1","F10.20","F17.200","F10.129","I33.0","R31.9","R60.9","F32.9","I49.3","F14.20","I10.","R44.0","R74.01","Z72.0","R26.81","R06.00","F10.229","J34.89","D69.6","R74.8","I47.9","I51.7","I34.0","I36.1","I35.8","S30.810A","NO DATA","W26.8XXA","V62.84","F10.24","I49.9","S00.81XA","S80.211A","M54.2","W19.XXXA","I45.6","F39.","H25.13","H52.03","H52.203","H52.4","H53.041","F19.94","I50.9","I47.2","Z72.89","F41.9","F10.120","M79.621","I42.9","Z95.3","Z59.0","Z80.0","Z79.82","Z79.899","Z91.14","I35.1","Z95.810","Z88.1","I45.81","I48.92","M51.36","Z20.822","Z88.8","M79.89","Z53.20","Z56.0","R41.82","R60.0","R01.1","F10.99"],"date":["2020-11-09","2021-08-05","2020-07-25","2021-09-17","2020-08-16","2021-03-14","2020-07-11","2021-03-22","2020-07-11","2020-07-25","2020-07-27","2021-08-05","2021-08-05","2020-07-27","2021-08-05","2020-07-25","2021-09-18","2021-08-05","2020-07-25","2020-07-25","2021-08-05","2021-08-05","2020-07-25","2021-09-18","2021-02-09","2021-02-12","2020-08-05","2021-03-16","2020-08-12","2020-10-21","2020-08-18","2020-08-29","2021-04-30","2021-09-18","2021-08-05","2020-07-27","2021-09-18","2020-07-11","2021-03-16","2021-09-17","2021-03-24","2021-08-05","2020-08-26","2021-02-12","2021-03-14","2021-03-14","2021-03-22","2021-09-18","2020-07-27","2020-07-27","2020-07-27","2020-08-12","2021-03-19","2021-03-19","2021-03-19","2021-03-19","2020-09-16","2021-08-05","2020-09-16","2021-03-16","2020-08-03","2020-08-12","2020-08-25","2020-08-25","2020-08-25","2020-08-25","2020-08-26","2020-08-29","2021-04-15","2021-04-15","2021-04-15","2021-04-15","2021-04-15","2020-03-05","2021-09-18","2020-08-16","2020-07-11","2021-08-05","2020-03-05","2020-03-18","2021-08-05","2021-08-05","2021-09-18","2020-04-21","2020-04-21","2021-08-05","2021-08-05","2020-08-16","2020-08-16","2021-08-05","2020-08-25","2021-08-05","2021-03-25","2021-08-05","2021-08-05","2021-08-05","2021-08-06","2021-09-18","2021-08-05","2021-08-05","2021-08-05","2021-08-05"],"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":[["","68682099798","DILTIAZEM ","240MG ER","30","Select","Select",""],["","00527260043","METOPROL ","25MG ER","90","Select","Select",""],["","50458057930","XARELTO ","20MG","30","Select","Select",""],["","23155013525","DOXYCYC ","100MG","20","Select","Select",""],["","00172572880","FAMOTIDINE ","20MG","30","Select","Select",""],["","43598044874","NICOTINE ","21MG\/24H","14","Select","Select",""],["","62037060090","CARTIA ","300\/24HR","30","Select","Select",""],["","13107000105","MIRTAZAPINE ","7.5MG","30","Select","Select",""],["","00093005301","BUSPIRONE ","5MG","90","Select","Select",""],["","00378459510","METOPROLOL ","25MG ER","90","Select","Select",""],["","50458057930","XARELTO","20MG","30","Select","Select",""],["","68682099798","DILTIAZEM","240MG ER","30","Select","Select",""],["","50742061510","METOPROL","25MG ER","90","Select","Select",""],["","23155013525","DOXYCYC","100MG","20","Select","Select",""],["","00536589653","NICOTINE","21MG\/24H","14","Select","Select",""],["","00093005301","BUSPIRONE","5MG","90","Select","Select",""],["","00378459510","METOPROLOL","25MG ER","90","Select","Select",""],["","62037060090","CARTIA","300\/24HR","30","Select","Select",""],["","13107000105","MIRTAZAPINE","7.5MG","30","Select","Select",""],["","00172572880","FAMOTIDINE","20MG","30","Select","Select",""],["","00555015902","CHLORDIAZEP","25MG","18","Select","Select",""],["","00555015902","CHLORDIAZEP ","CAP 25MG","18","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":""}]}]}