{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GEORGE BARKSDALE","gend":0,"add":"265 N MAIN ST APT 311","city":"HARRISONBURG","state":"VA","zip":"22802-9998","dob":"1961-07-15","age":"","mstatus":"","insh":"20071156*01","cliId":"","pno":5402465318,"cno":5402465318,"email":"","ename":"","eno":"","pphy":"DOMINGUS, JEFF DO","ppno":5402989900,"pcpadd":"800 SHENANDOAH AVE SUITE 170,","pcpcity":"ELKTON","pcpstate":"VA","pcpzip":"22827-9998","pcpcounty":"","pcpid":"","pcpname":"Healthy Community Health Center - Stone Port (HCHC-Stone Port)","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5402988991,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B02.9","Z86.73","J43.9","Z21.","E66.9","Z68.33","I11.0","I50.22","I42.8","Z86.14","Z79.899","Z79.02","F17.210","E78.5","G40.909","M54.9","R52.","M54.89","R09.02","R06.89","W19.XXXA","I49.3","I25.10","I51.7","I10.","N28.9","M25.552","M87.9","B20.","I13.0","M25.452","NO DATA","Z88.8","Z80.9","Z80.1","J44.9","G43.709","R26.81","E55.9","E53.8","R29.6","R56.9","S30.0XXA","M54.5","G40.919","R07.89","R07.9","G45.9","R41.82","S39.012A","J44.1","I50.21","S09.90XA","F10.920","M87.00","R26.2","Z23.","R40.4","R41.0","M79.605","R05.4","R58.","R60.9","F10.929","I63.9","R19.7","R05.9","J06.9","R05.1","R06.02","S22.42XA","D84.9","Z95.810","I50.43","N17.9","S19.9XXA","R94.39","F10.99","G47.9","I25.119","I20.0","Z95.5","I25.110","I16.1","G62.9","G47.00","F10.10","I25.9","E78.00","Z98.61"],"date":["2021-04-01","2023-06-12","2023-06-12","2023-01-23","2021-04-01","2021-04-01","2023-06-12","2023-06-12","2023-06-12","2021-04-01","2023-01-23","2023-01-23","2023-06-12","2023-01-23","2023-06-12","2021-04-01","2021-08-23","2021-04-01","2021-08-23","2021-04-01","2021-04-01","2023-06-12","2023-06-12","2021-05-05","2022-02-28","2021-05-05","2021-08-25","2021-08-23","2023-06-12","2021-08-23","2021-08-24","2021-08-23","2021-08-23","2021-08-23","2021-08-23","2023-06-12","2021-01-05","2022-04-12","2022-04-12","2022-04-12","2021-01-05","2022-04-28","2021-01-10","2021-01-10","2021-07-06","2023-06-12","2023-06-11","2021-07-18","2022-04-28","2021-02-17","2021-07-06","2021-07-04","2023-01-23","2021-07-18","2021-08-24","2021-08-24","2022-02-28","2021-07-04","2021-07-04","2021-08-23","2022-04-12","2023-01-23","2023-01-23","2023-01-23","2022-02-28","2022-11-22","2022-11-22","2022-11-22","2022-11-22","2022-11-22","2023-01-23","2022-03-15","2023-04-17","2021-07-04","2021-07-04","2023-01-23","2023-06-11","2023-06-11","2023-06-11","2023-06-12","2023-06-13","2023-06-12","2023-06-12","2023-06-12","2023-06-12","2023-06-12","2023-06-12","2023-06-12","2023-06-12","2023-06-12"],"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":[]},{"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":[["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","68382080601","TRAZODONE","TAB 100MG","30","Select","Select",""],["","00093505798","ATORVASTATIN","TAB 80MG","30","Select","Select",""],["","00597015561","STIOLTO","AER 2.5-2.5","12","Select","Select",""],["","65862035705","CLOPIDOGREL","75 MG","30","Select","Select",""],["","55111053301","DIVALPROEX","TAB 250MG ER","90","Select","Select",""],["","61958250101","BIKTARVY","50-200-25","30","Select","Select",""],["","68682010510","NIFEDIPINE","TAB 30MG ER","30","Select","Select",""],["","00591565801","CYCLOBENZAPR","TAB 10MG","20","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","30","Select","Select",""],["","68382009401","CARVEDILOL","12.5 MG","30","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","59310057922","PROAIR HFA","90 MCG","8.5","Select","Select",""],["","65862044930","VALACYCLOVIR","TAB 1GM","15","Select","Select",""],["","00378020810","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","00173088210","BREO ELLIPTA","INH 200-25","60","Select","Select",""],["","78206012601","DULERA","200-5 MCG","13","Select","Select",""],["","42806031205","DOXYCYCL HYC","TAB 100MG","6","Select","Select",""],["","57664037718","TRAMADOL HCL","TAB 50MG","6","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","10","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","6","Select","Select",""],["","16714066202","GABAPENTIN","300 MG","30","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","00005200010","PREVNAR 20","INJ ","0","Select","Select",""],["","00031875718","ROBIT CGH DM","LIQ 20-200","237","Select","Select",""],["","00904505359","SUDOGEST","TAB 30MG","30","Select","Select",""],["","00031873642","ROBITUSSIN","LIQ CGH\/CONG","420","Select","Select",""],["","00031868515","ROBITUSSN DM","SYP ","420","Select","Select",""],["","00406012305","HYDROCODONE-ACETAMINOPHEN","5 MG-325MG","18","Select","Select",""],["","79903009508",""," ","237","Select","Select",""],["","55111053301","DIVALPROEX SODIUM ER","250 MG","90","Select","Select",""],["","61958250101","BIKTARVY TAB","","30","Select","Select",""],["","68382009405","CARVEDILOL TAB","12.5MG","60","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","68645059090","CLOPIDOGREL TAB","75MG","30","Select","Select",""],["","68682010510","NIFEDIPINE TAB","30MG ER","30","Select","Select",""],["","00093505798","ATORVASTATIN TAB","80MG","30","Select","Select",""],["","68180096301","ALBUTEROL AER HFA","","8","Select","Select",""],["","78206012601","DULERA AER","200-5MCG","13","Select","Select",""],["","65162010211","GABAPENTIN CAP","300MG","30","Select","Select",""],["","00005200010","PREVNAR","20 INJ","0","Select","Select",""],["","55111053301","DIVALPROEX TAB","250MG ER","90","Select","Select",""],["","58160082311","SHINGRIX INJ","50\/0.5ML","1","Select","Select",""],["","55111018015","TIZANIDINE TAB","4MG","30","Select","Select",""],["","00031873618","ROBITUSSIN LIQ CGH\/CONG","","420","Select","Select",""],["","00904505359","SUDOGEST TAB","30MG","30","Select","Select",""],["","68382080601","TRAZODONE TAB","100MG","30","Select","Select",""],["","00031875718","ROBIT CGH DM LIQ","20-200","237","Select","Select",""],["","00031868515","ROBITUSSN DM SYP","","420","Select","Select",""],["","68180096301","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","68382080605","TRAZODONE HCL","100 MG","30","Select","Select",""],["","00904679480","ASPIRIN","81 MG","30","Select","Select",""],["","57896050101","ONE-DAILY MULTI-VITAMIN","","30","Select","Select",""],["","50742026001","NIFEDIPINE ER","30 MG","30","Select","Select",""],["","16714017602","ATORVASTATIN CALCIUM","80 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":""}]}]}