{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RUSSELL   T SEAMSTER","gend":0,"add":"2055 MOUNT ZION CHURCH ROAD","city":"SOUTH BOSTON","state":"VA","zip":"24592-9998","dob":"1963-09-02","age":"","mstatus":"","insh":"20034697*01","cliId":"","pno":"434\/476-1204","cno":"","email":"","ename":"","eno":"","pphy":"KING, BRODERICK MD","ppno":"434\/575-1336","pcpadd":"1627 SEYMOUR DR SUITE B","pcpcity":"SOUTH BOSTON","pcpstate":"VA","pcpzip":24592,"pcpcounty":"","pcpid":"","pcpname":"PIEDMONT ACCESS TO HEALTH SERVICES INC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/575-1349","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R33.9","K59.00","R31.9","M25.511","N41.0","N30.00","R35.1","R39.14","R35.0","M79.2","G40.109","F32.89","F41.8","F41.0","G47.09","G40.909","F32.9","F41.9","M54.2","F51.5","M75.112","M25.512","G40.301","M75.41","H25.13","H40.013","H35.413","H33.322","R39.15","G47.00","L81.4","D48.5","Z08.","Z85.828","G47.9","G47.51","J01.90","J02.9","J06.9"],"date":["2019-02-19","2019-02-19","2019-02-19","2021-06-09","2021-04-06","2021-04-06","2021-04-06","2021-04-06","2021-04-06","2021-08-18","2019-09-05","2019-09-05","2019-09-05","2021-09-16","2019-09-05","2021-09-16","2021-09-16","2021-09-16","2021-01-13","2021-09-16","2019-03-08","2019-01-02","2019-01-10","2019-03-08","2020-02-14","2020-02-14","2020-02-14","2020-02-14","2021-03-01","2021-09-16","2020-10-01","2020-10-01","2020-12-01","2020-12-01","2021-01-13","2021-01-13","2019-12-01","2020-11-12","2020-11-12"],"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":[["","","LEVETIRACETA"," LEVETIRACETA ","60","Select","Select",""],["","","DIVALPROEX"," DIVALPROEX ","30","Select","Select",""],["","","MELATONIN"," MELATONIN ","30","Select","Select",""],["","","CLONAZEPAM"," CLONAZEPAM ","30","Select","Select",""],["","","SMZ-TMP"," SMZ-TMP ","20","Select","Select",""],["","","TRAZODONE"," TRAZODONE ","30","Select","Select",""],["","","DOXYCYCL"," DOXYCYCL ","20","Select","Select",""],["","","FLUCLVX"," FLUCLVX ","0","Select","Select",""],["","","PROMETHAZINE"," PROMETHAZINE ","118","Select","Select",""],["","","SIMVASTATIN","TAB 10MG","","Select","Select",""],["","","MELOXICAM","TAB 15MG","","Select","Select",""],["","","PREDNISONE","PAK 10MG","","Select","Select",""],["","","TRAMADOL","TAB 50MG","","Select","Select",""],["","","FLUZONE","INJ 2020-21","","Select","Select",""],["","","BENZONATATE","CAP 200MG","","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":""}]}]}