{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROBERT   D GIBBS","gend":0,"add":"9502 BOYDTON PLANK ROAD","city":"PETERSBURG","state":"VA","zip":"23803-9998","dob":"1965-05-22","age":"","mstatus":"","insh":"20043110*01","cliId":"","pno":"804\/469-7660","cno":"","email":"","ename":"","eno":"","pphy":"VILLANUEVA, JOHN G MD","ppno":"804\/452-5800","pcpadd":"SUITE 2 4260 CROSSINGS BLVD","pcpcity":"PRINCE GEORGE","pcpstate":"VA","pcpzip":23875,"pcpcounty":"","pcpid":"","pcpname":"CENTRAL VIRGINIA HEALTH SERVICES INC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/452-5801","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","J44.9","F32.9","E78.2","J30.89","Z12.5","Z13.220","Z23.","J44.1","Z71.89","Z71.3","H25.13","H52.13","H52.223","Z20.822","V62.84"],"date":["2022-06-03","2022-06-03","2022-06-03","2022-01-17","2022-06-03","2020-11-06","2020-11-06","2021-09-17","2020-03-05","2020-03-05","2020-03-05","2020-09-08","2020-09-08","2020-09-08","2022-01-20","2022-11-07"],"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":[]},{"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":[["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","68180098103","LISINOPRIL","TAB 20MG","90","Select","Select",""],["","00173069604","ADVAIR","AER 250\/50","14","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","00378623201","CITALOPRAM","TAB 20MG","30","Select","Select",""],["","76204020060","ALBUTEROL","NEB 0.00083","2700","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","00378932132","WIXELA","AER 250\/50","60","Select","Select",""],["","00054032756","FLUTIC\/SALME","AER 250\/50","60","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00904671741","CETIRIZINE","TAB 10MG","14","Select","Select",""],["","00143980305","DOXYCYCL","CAP 100MG","14","Select","Select",""],["","00781227701","AMLOD\/BENAZP","CAP 5-40MG","30","Select","Select",""],["","00591544210","PREDNISONE","TAB 10MG","42","Select","Select",""],["","00363032908","WAL-DRYL","TAB 25MG","30","Select","Select",""],["","64380071206","BENZONATATE","CAP 100MG","30","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":""}]}]}