{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MICHAEL  C CALDWELL","gend":0,"add":"204 POST CEDAR PL","city":"RICHMOND","state":"VA","zip":"23223-9998","dob":"1975-06-18","age":"","mstatus":"","insh":"2519260*01","cliId":"","pno":8047679261,"cno":8047679261,"email":"","ename":"","eno":"","pphy":"OLESON, KATHLEEN NP","ppno":"","pcpadd":"590 PETER JEFFERSON PKWY STE 175","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":"22911-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","C90.00","C90.01","Z45.2","Z94.84","D64.9","R11.0","D69.6","D70.9","Z79.891","Z71.89","Z12.11","D61.818","I10.","B37.9","K12.30","Z79.82","Z87.891"],"date":["2023-04-24","2023-04-05","2023-04-24","2023-03-30","2023-03-02","2023-03-02","2023-03-02","2023-03-02","2023-03-02","2023-03-02","2023-03-02","2023-01-24","2023-03-01","2023-03-01","2023-03-01","2023-03-01","2023-03-01","2023-03-01"],"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":[["","12496121203","SUBOXONE","12 MG-3 MG","14","Select","Select",""],["","68001023703","CLONIDINE","TAB 0.1MG","9","Select","Select",""],["","55111015330","ONDANSETRON","TAB 4MG","90","Select","Select",""],["","49035051026","BACITR ZINC","OIN 500\/GM","28","Select","Select",""],["","68382004101","PROMETHAZINE","TAB 25MG","9","Select","Select",""],["","65162027250","SULFAMETHOXAZOLE-TRIMETHOPRIM","800-160 MG","12","Select","Select",""],["","64380076921","PEG","3350-ELECTROLYTE 420G","4000","Select","Select",""],["","31722077701","ACYCLOVIR","400 MG","60","Select","Select",""],["","43598058130","BUPRENORPHINE-NALOXONE","12 MG-3 MG","14","Select","Select",""],["","57896044101","BISACODYL","5 MG","4","Select","Select",""],["","55111015430","ONDANSETRON HCL","8 MG","60","Select","Select",""],["","68645059459","FAMOTIDINE","20 MG","60","Select","Select",""],["","59746011506","PROCHLORPERAZINE MALEATE","10 MG","60","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":""}]}]}