{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANTONIO  N CHAPPELL","gend":0,"add":"PO BOX 1585","city":"SOUTH BOSTON","state":"VA","zip":"24592-9998","dob":"1983-03-21","age":"","mstatus":"","insh":"20025243*01","cliId":"","pno":4349879014,"cno":4349879014,"email":"","ename":"","eno":"","pphy":"HURTADO, RAFAEL MD","ppno":4347923232,"pcpadd":"178 EXECUTIVE DRIVE","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":"24541-9998","pcpcounty":"","pcpid":"","pcpname":"Neurology & Sleep Clinic of Southern VA","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4347923236,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z20.828","G47.33","Z20.822","Z85.47","Z23.","G80.8","E55.9","E29.9","R26.89","I10.","R90.82","G80.9","R29.2","G47.09","G47.10","M79.606","R06.83","Z13.6","R53.81","E53.8","D70.1","C62.91","R13.19","T45.1X5A","G62.9","R56.9","G47.00","R41.89"],"date":["2021-01-27","2023-02-22","2022-01-25","2023-01-23","2021-10-20","2021-10-20","2023-02-22","2023-01-23","2023-02-22","2022-02-23","2023-02-22","2023-02-22","2021-02-11","2021-02-11","2021-06-21","2021-06-21","2021-02-11","2021-04-16","2021-04-16","2021-04-16","2021-04-16","2021-04-16","2021-04-16","2021-04-16","2021-06-21","2021-05-10","2021-08-04","2021-03-01"],"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":[["","58487001981","VIT B12\/FA","TAB ","30","Select","Select",""],["","69452015120","VITAMIN D","2 1250 MCG","4","Select","Select",""],["","50428005345","B-12","TAB 500MCG","30","Select","Select",""],["","80681009900","FOLIC ACID","0.4 MG","90","Select","Select",""],["","80777027399","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","68180051303","LISINOPRIL","5 MG","90","Select","Select",""],["","99073070914","FREESTYLE","KIT FREEDOM","1","Select","Select",""],["","56151147002","TRUE METRIX","KIT METER","1","Select","Select",""],["","00193781801","CONTOUR NEXT","KIT ONE","1","Select","Select",""],["","80777028299","MODERNA BIVA","INJ BA4\/BA5","0","Select","Select",""],["","50428029391","VITAMIN C","1000 MG","300","Select","Select",""],["","50428005345","VITAMIN B-","12 500 MCG","30","Select","Select",""],["","50428041181","VITAMIN C WITH ROSE HIPS","1000 MG","180","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":""}]}]}