{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHAD A GROOMS","gend":0,"add":"34 TREVILIANS SQ APT 19","city":"LOUISA","state":"VA","zip":"23093-9998","dob":"1972-01-14","age":"","mstatus":"","insh":"20071754*01","cliId":"","pno":4343262200,"cno":4343262200,"email":"","ename":"","eno":"","pphy":"RICHMOND, MICHAEL DO","ppno":5409679401,"pcpadd":"SUITE 9 115 JEFFERSON HWY","pcpcity":"LOUISA","pcpstate":"VA","pcpzip":"23093-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5409679405,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.5","E11.00","E11.65","Z20.822","Z79.4","NO DATA","N17.0","R57.1","N18.6","G93.41","M62.82","I12.0","R56.9","I95.9","E11.22","E87.6","J45.909","Z23.","E11.649","M10.061","M10.071","M10.9","R73.9","E11.01","G93.9","N17.9","G93.49","R51.9","I12.9","N18.9","M1A.9XX0","R53.81","I10.","R60.9","E66.9","E86.1","F43.21","J96.01","E87.2","E66.01","Z68.38","M1A.29X0","M17.12","Z68.39","R06.03","R11.0","Z71.89","R52.","Z74.3","D64.9","T82.42XA","R06.02","R07.9","R42.","I49.9","R00.2","R06.00","M06.4","I48.91","E87.5","N17.8","R34.","Z99.2","G93.40","L89.150","Z87.891","Z88.8","Z45.2","M1A.9XX1","M19.90","I51.7","R40.20","R40.4","R00.0"],"date":["2021-05-11","2021-11-28","2021-11-16","2021-11-03","2021-11-28","2021-11-27","2021-11-15","2021-11-27","2021-11-18","2021-11-03","2021-11-28","2021-11-16","2021-11-28","2021-11-03","2021-11-28","2021-11-03","2021-11-03","2021-11-03","2021-11-03","2021-11-03","2021-11-03","2021-11-28","2021-11-16","2021-11-16","2021-11-16","2021-11-28","2021-11-27","2021-11-27","2021-11-30","2021-11-30","2021-11-26","2021-11-30","2021-11-23","2021-11-18","2021-11-24","2021-11-28","2021-04-12","2021-11-05","2021-11-05","2021-11-28","2021-11-28","2021-02-02","2021-02-02","2021-02-02","2021-11-04","2021-11-30","2021-11-05","2021-11-16","2021-11-16","2021-11-23","2021-11-30","2021-03-25","2021-03-25","2021-03-25","2021-03-25","2021-03-25","2021-03-25","2021-03-25","2021-11-04","2021-11-06","2021-11-16","2021-11-16","2021-11-30","2021-11-16","2021-11-16","2021-11-30","2021-11-30","2021-12-17","2021-01-08","2021-01-08","2021-04-22","2021-11-03","2021-11-03","2021-11-03"],"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":[["","00254200801","COLCHICINE","TAB 0.6MG","30","Select","Select",""],["","55111072901","ALLOPURINOL","TAB 100MG","15","Select","Select",""],["","00093342210","CYCLOBENZAPR","TAB 10MG","45","Select","Select",""],["","31722070290","LOSARTAN POT","TAB 100MG","30","Select","Select",""],["","60505009500","DOXAZOSIN","TAB 4MG","30","Select","Select",""],["","65862086001","FAMOTIDINE","TAB 40MG","30","Select","Select",""],["","67877025130","TRIAMCINOLON","CRE 0.001","60","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","59779045875","CVS ALLERGY","TAB 10MG","30","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00115169449","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","16571040250","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","43547040111","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","76385011050","CARVEDILOL","TAB 3.125MG","60","Select","Select",""],["","69584009350","BUSPIRONE","TAB 15MG","30","Select","Select",""],["","00002831501","HUMULIN N","INJ U-100","10","Select","Select",""],["","00088222033","LANTUS","INJ 100\/ML","10","Select","Select",""],["","23155053102","CALC ACETATE","CAP 667MG","180","Select","Select",""],["","08290324911","INSULIN SYRG","MIS 0.5\/31G","30","Select","Select",""],["","00193709021","CONTOUR","TES BLD GLUC","100","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","53885013610","ONETOUCH","MIS LANCETS","100","Select","Select",""],["","80777027310","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","00006483703","PNEUMOVAX 23","INJ 25\/0.5","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":[]}},{"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":""}]}]}