{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DWAYNE T CHILDRESS","gend":0,"add":"5828 PATRICK HENRY HWY","city":"CHARLOTTE COURT HOUSE","state":"VA","zip":"23923-9998","dob":"1965-07-02","age":"","mstatus":"","insh":"20025313*01","cliId":"","pno":4346649477,"cno":4346649477,"email":"","ename":"","eno":"","pphy":"HAHESY-CALHOUN, MARIAN MD","ppno":4345425560,"pcpadd":"165 LEGRANDE AVENUE,","pcpcity":"CHARLOTTE COURT HOUSE","pcpstate":"VA","pcpzip":"23923-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4345424670,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z23.","I73.9","S05.01XA","T82.392A","G54.6","Z71.89","G89.29","E11.9","F17.200","Z71.3","M54.40","Z95.828","I70.209"],"date":["2021-12-13","2023-04-24","2021-04-08","2021-06-03","2021-12-13","2023-03-23","2021-12-13","2023-09-18","2021-12-13","2021-12-13","2021-12-13","2021-05-18","2021-05-18"],"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":[["","65862056099","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","60505258008","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","10702005601","OXYCODONE","TAB 10MG","90","Select","Select",""],["","55111019605","CLOPIDOGREL","75 MG","30","Select","Select",""],["","67877041401","METFORMIN","TAB 750MG ER","60","Select","Select",""],["","59651026901","GLIPIZIDE ER","5 MG","30","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","43598032675","CIPRO\/DEXA","SUS 0.3-0.1%","8","Select","Select",""],["","10702005601","OXYCODONE HCL","10 MG","90","Select","Select",""],["","65862056099","PANTOPRAZOLE SODIUM","40 MG","30","Select","Select",""],["","67877041401","METFORMIN HCL ER","750 MG","60","Select","Select",""],["","60505258008","ATORVASTATIN CALCIUM","40 MG","30","Select","Select",""],["","62332008531","FENOFIBRATE","134 MG","30","Select","Select",""],["","10702005601","OXYCODONE TAB","10MG","90","Select","Select",""],["","67877041401","METFORMIN TAB","750MG ER","60","Select","Select",""],["","65862056099","PANTOPRAZOLE TAB","40MG","30","Select","Select",""],["","55111019605","CLOPIDOGREL TAB","75MG","30","Select","Select",""],["","60505258008","ATORVASTATIN TAB","40MG","30","Select","Select",""],["","59651026901","GLIPIZIDE ER TAB","5MG","30","Select","Select",""],["","65862001501","AMOXICILLIN TAB","875MG","20","Select","Select",""],["","43598032675","CIPRO\/DEXA SUS","0.3-0.1%","8","Select","Select",""],["","00310621030","FARXIGA","10 MG","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":""}]}]}