{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"D   ENNAOJLEINADCM ","gend":1,"add":"               TEERTS HT41 308                              ","city":"ALTAVISTA                     ","state":"VA","zip":"24517-1315","dob":"1959-10-01","age":"","mstatus":"","insh":"50012242","cliId":"","pno":"8443470045","cno":"","email":"","ename":"","eno":"","pphy":"BOLUSA-SABUGO, AHGNES U                                     ","ppno":4349475967,"pcpadd":"320 Federal St,","pcpcity":"Lynchburg                     ","pcpstate":"VA","pcpzip":245042306,"pcpcounty":"","pcpid":"","pcpname":"AMHERST COUNTY COMMUNITY HEALTH CENTER","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"UNIT A                                                      ","add3":"","madd1":"803 14TH STREET","madd2":"UNIT A","madd3":"","mcity":"ALTAVISTA                     ","mstate":"VA","mzip":"24517-1315","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G43.709","J40","M19.90","Z00.00","E78.5","Z98.84","R51","Z72.0","K21.9","F41.9","F41.8","E55.9","Z86.718","G62.9","R30.0","S06.0X9A","F17.210","F32.9","S09.90XA","W18.39XA","Y93.89","Y92.89","Z79.899","Z88.5","R63.5","M25.512","M75.82","M75.102","M89.8X9","M75.92","M25.412","M75.112","M19.012","M89.9","E88.09","M79.622","M06.4","R60.0","G47.00","F51.04","Z51.89","Z71.89","Z76.0","L29.9","Z01.89","M25.511","M19.011","R32","G43.111","M24.812","M75.52","M65.812","M85.812","M94.8X1","M65.9","R51.9","Z20.822","R05.9"],"date":["2021-09-09","2019-02-26","2021-06-24","2019-03-18","2021-06-24","2020-07-01","2019-03-18","2021-06-24","2021-06-24","2020-12-24","2021-06-24","2020-12-24","2020-01-12","2019-06-20","2019-09-19","2020-01-12","2020-01-12","2020-01-12","2020-01-12","2020-01-12","2020-01-12","2020-01-12","2021-06-24","2020-01-12","2020-07-01","2021-07-20","2021-04-16","2020-12-24","2021-01-21","2021-02-02","2021-02-02","2021-08-20","2021-09-02","2021-01-07","2021-01-14","2021-07-20","2021-02-02","2021-07-20","2021-06-24","2021-06-24","2021-02-26","2021-02-26","2021-02-26","2021-06-24","2021-02-26","2021-07-26","2021-05-10","2021-12-21","2021-05-13","2021-07-20","2021-08-20","2021-08-20","2021-08-20","2021-08-20","2021-08-20","2021-10-22","2021-12-10","2021-10-22"],"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":[["","70377002911","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","60","Select","Select",""],["","00093081201","NORTRIPTYLIN","CAP 50MG","30","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","8","Select","Select",""],["","13668000805","ZOLPIDEM","TAB 10MG","30","Select","Select",""],["","59746011506","PROCHLORPER","TAB 10MG","60","Select","Select",""],["","60505025203","TIZANIDINE","TAB 4MG","180","Select","Select",""],["","66993068130","OLANZAPINE","TAB 5MG","12","Select","Select",""],["","42806016005","HYDROXYZ","TAB 25MG","120","Select","Select",""],["","51991074890","DULOXETINE","CAP 60MG","30","Select","Select",""],["","00832030000","CHLORPROMAZ","TAB 10MG","14","Select","Select",""],["","59651000305","OMEPRAZOLE","CAP 40MG","90","Select","Select",""],["","67877026218","RIZATRIPTAN","TAB 10MG","12","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00054418325","DEXAMETHASON","TAB 2MG","24","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","69097015907","MELOXICAM","TAB 15MG","90","Select","Select",""],["","47781030801","NITROFUR","CAP 100MG","10","Select","Select",""],["","59779092312","ALLERGY","TAB 25MG","100","Select","Select",""],["","50428661736","CVS","CAP 25MG","48","Select","Select",""],["","00093005805","TRAMADOL","TAB 50MG","20","Select","Select",""],["","00781185220","AMOX\/K","TAB 875-125","20","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","00378020810","FUROSEMIDE","TAB 20MG","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":""}]}]}