{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AIMEE CHEELY","gend":1,"add":"14010 BOYDTON PLANK ROAD","city":"DINWIDDIE","state":"VA","zip":"23841-9998","dob":"1977-05-26","age":"","mstatus":"","insh":"1012231*01","cliId":"","pno":"434\/637-2591","cno":"","email":"","ename":"","eno":"","pphy":"JOHNSON, RUSSELL MD","ppno":"804\/747-5555","pcpadd":"4101 DOMINION BLVD SUITE 300","pcpcity":"GLEN ALLEN","pcpstate":"VA","pcpzip":23060,"pcpcounty":"","pcpid":"","pcpname":"DOMINION FAMILY CARE LLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/747-5550","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G40.89","J44.9","M54.9","D64.9","G40.109","G43.909","R20.8","U07.1","S61.215A","G40.909","R56.9","R41.0","R55.","R47.9","J44.1","Z87.891","S22.082A","R51.9","Z79.899","J45.909","Z98.1","Z86.16","Z98.51","Z22.322","Z90.49","Z83.3","R40.4","V54.17","G82.20","K21.9","M19.90","F07.81","Z87.820","Z91.81","K13.29","R42.","R53.83","L03.012","K37.","E87.6","K35.80","Z20.828","F41.9","K14.8","G40.209","R25.9","R44.8","S20.212A","R07.81","G40.009","Z04.9","X50.9XXA","S69.92XA","F17.200","Z23.","M79.644","Z20.822","R94.31","V89.2XXA","Z47.89","R20.0","J98.4","M25.562","S22.081A","N31.9","K59.2","R07.9","R91.8","F17.210","R07.89","S22.069A","V49.40XA","V58.89","G82.22","M25.561","M79.652","M79.651","R26.9","R20.2","R41.841","J02.9","R05.","R09.81","R52.","R68.83","Z68.20","S22.080A","V48.5XXA","Z91.14","R26.2","K59.00","E83.42","S09.90XA","V49.9XXA","S22.089A"],"date":["2020-01-08","2021-09-16","2020-01-08","2020-01-08","2021-09-22","2021-09-22","2021-04-20","2021-08-25","2021-09-09","2021-09-29","2021-09-29","2021-09-29","2021-09-29","2021-09-29","2021-10-18","2021-10-18","2020-01-10","2021-09-27","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-09-25","2020-06-09","2020-02-05","2020-02-05","2020-02-05","2020-02-05","2020-02-05","2020-02-05","2021-04-26","2021-05-05","2021-09-27","2021-09-16","2020-11-19","2020-11-20","2020-11-20","2020-11-20","2020-11-20","2021-04-26","2021-04-26","2021-05-05","2021-05-05","2021-08-03","2021-08-03","2020-09-02","2021-04-26","2021-08-03","2021-09-09","2021-09-16","2021-09-16","2021-09-16","2021-09-20","2020-11-19","2020-01-01","2020-11-03","2021-04-26","2019-03-26","2019-12-30","2019-12-24","2019-12-30","2019-12-30","2019-03-06","2019-04-03","2019-12-23","2019-03-06","2019-12-23","2019-12-23","2019-12-30","2019-12-30","2019-12-30","2019-12-30","2019-12-30","2019-12-30","2019-12-30","2019-12-30","2019-10-01","2019-10-01","2019-10-01","2019-10-01","2019-10-01","2019-10-01","2019-12-23","2019-12-23","2019-12-23","2019-12-23","2019-12-23","2019-12-23","2019-12-23","2019-12-23","2019-12-24"],"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":[["","00527169505","BUT\/APAP\/CAF","TAB ","20","Select","Select",""],["","55111053301","DIVALPROEX","TAB 250MG ER","90","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","10","Select","Select",""],["","68462013801","OXCARBAZEPIN","TAB 300MG","180","Select","Select",""],["","00591544305","PREDNISONE","TAB 20MG","15","Select","Select",""],["","69097068205","PREGABALIN","CAP 150MG","180","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","14","Select","Select",""],["","65862053750","LEVOFLOXACIN","TAB 500MG","5","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","12","Select","Select",""],["","70010077001","METHOCARBAM","TAB 750MG","20","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":""}]}]}