{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DERRICK  L ROBERTS","gend":0,"add":"105B DANIEL STREET ST","city":"BROOKNEAL","state":"VA","zip":24528,"dob":"1990-11-02","age":"","mstatus":"","insh":"20049379*01","cliId":"","pno":"434\/907-4518","cno":"","email":"","ename":"","eno":"","pphy":"Route,  barbara","ppno":"434\/542-5560","pcpadd":"5424 Discovery Park Blvd BLDB A STE 201","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":24528,"pcpcounty":"","pcpid":"","pcpname":"CENTRAL VIRGINIA HEALTH SERVICES INC","plan":"OHP","program":"Medicaid","lob":"OHCC","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/542-4670","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R50.9","R11.0","R06.2","I11.0","I50.22","A40.9","I42.9","E11.9","Q21.3","I49.01","I48.0","NO DATA","F12.90","Z95.810","Z87.891","Z45.2","B99.9","I50.9","Z45.02","I48.91","E87.6","R42.","Q22.1","I51.9","I49.9","E66.01","I10.","I47.2","N17.9","E87.1","E86.0","Q21.0","B95.5","R78.81","Z86.79","T82.6XXA","I38.","Q24.9","Z91.89","N39.0","A41.9","J45.909","R06.9","I47.1","R07.89","A40.8","I33.0","Z11.59","K02.9","I37.0","I95.9","J45.41","Z71.89","I51.7","Z71.3","Z87.898","R06.02","Z74.3","Z79.899","Z79.01","F14.90","Z79.84","Z95.0","Z23.","I42.7","E78.5","R06.00","R55.","I27.81","R07.9","J98.01","E87.70","J30.89","Z09.","E11.65","I50.32","I48.92","I25.10","Z79.51","Z83.3","Q22.4","R09.89","I37.1","G89.18","R94.31","Z79.4","Z95.4","U07.1","Z20.822","Z95.2","I49.3","I37.2","D62.","J98.4","Z87.74","I35.1","Z86.718","R06.89","R57.0","R73.9","B88.2","R91.8","J95.821","R09.02","E86.1","J44.9","Z01.30"],"date":["2020-07-02","2020-07-02","2020-07-07","2022-10-03","2021-04-11","2020-08-17","2022-11-23","2022-11-23","2022-11-23","2021-04-12","2021-09-06","2022-02-27","2021-09-06","2022-11-23","2022-02-24","2020-08-17","2022-05-12","2022-10-03","2022-09-04","2022-10-03","2021-04-12","2022-09-04","2022-10-02","2022-08-17","2021-09-07","2021-09-07","2022-11-23","2021-11-08","2022-10-03","2021-04-12","2021-04-24","2022-02-24","2020-07-02","2020-07-08","2021-10-23","2020-07-10","2021-04-12","2020-07-10","2020-07-10","2020-07-03","2020-07-10","2022-11-23","2021-10-23","2021-11-01","2021-11-01","2020-07-04","2021-09-06","2020-07-04","2020-07-10","2020-07-04","2022-02-24","2021-01-22","2022-11-23","2022-02-23","2022-11-23","2021-01-22","2021-01-22","2022-09-04","2022-02-24","2022-02-24","2021-04-12","2022-02-24","2022-02-23","2022-11-23","2021-04-11","2021-04-11","2021-04-26","2021-04-26","2021-04-26","2022-10-03","2021-10-23","2021-10-23","2021-05-28","2021-05-28","2022-03-02","2021-09-06","2022-09-04","2021-09-06","2021-09-06","2021-09-06","2022-10-02","2022-09-04","2022-03-02","2022-02-27","2022-02-28","2022-03-02","2022-02-27","2022-09-04","2022-10-02","2022-03-17","2022-02-28","2022-02-24","2022-02-27","2022-02-24","2022-02-24","2022-02-24","2022-02-24","2022-02-27","2022-02-27","2022-02-27","2022-10-03","2022-10-03","2022-02-24","2022-02-24","2022-02-24","2022-11-23","2022-11-23"],"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":[["","76385011350","CARVEDILOL","TAB 25MG","180","Select","Select",""],["","10006073038","MAG","TAB 400MG","60","Select","Select",""],["","00093117410","PENICILLN","TAB 500MG","56","Select","Select",""],["","70436015301","POT  CHLORIDE","TAB 20MEQ ER","30","Select","Select",""],["","50458057930","XARELTO","TAB 20MG","90","Select","Select",""],["","68382075810","METFORMIN","TAB 500MG","120","Select","Select",""],["","53746051401","SPIRONOLACT","TAB 50MG","90","Select","Select",""],["","69452013217","DOFETILIDE","CAP 250MCG","180","Select","Select",""],["","45802065078","LORATADINE","TAB 10MG","90","Select","Select",""],["","00904679480","ASPIRIN","CHW 81MG","30","Select","Select",""],["","68180097903","LISINOPRIL","TAB 40MG","90","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","16","Select","Select",""],["","00378021610","FUROSEMIDE","TAB 40MG","30","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","31","Select","Select",""],["","55111032101","GLIMEPIRIDE","TAB 2MG","30","Select","Select",""],["","65162062710","TRAMADOL","TAB 50MG","15","Select","Select",""],["","70000041502","CLEARLAX","POW ","238","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","100","Select","Select",""],["","00173088710","TRELEGY","AER ELLIPTA","60","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","10","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","31","Select","Select",""],["","00832532510","POT  CL MICRO","TAB 20MEQ ER","30","Select","Select",""],["","63323001002","GENTAMICIN","INJ 40MG\/ML","105","Select","Select",""],["","00049053028","PFIZERPEN","INJ 20000000","280","Select","Select",""],["","59310058020","PROAIR","AER ","1","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","00338004904","SOD","INJ 0.009","576","Select","Select",""],["","33332032001","AFLURIA","INJ 2020-21","0","Select","Select",""],["","60569049412","MAGOX","TAB 400MG","180","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","49281072010","FLUBLOK","INJ 2020-21","0","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}