{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  ETTEILUJNAMWEN D ","gend":1,"add":"LLEDDAW 5571DAOR NOSLEN ","city":"CHARLOTTE COURT HOUSE","state":"VA","zip":"23923-9998","dob":"1972-04-06","age":"","mstatus":"","insh":"29400210*17","cliId":"","pno":"45\/4349653-7","cno":"","email":"","ename":"","eno":"","pphy":"HALL, CLARENCE E MD","ppno":"434\/645-9191","pcpadd":"12522 W COLONIAL TRAIL HWY","pcpcity":"CREWE","pcpstate":"VA","pcpzip":23930,"pcpcounty":"","pcpid":"","pcpname":"CREWE MEDICAL CENTER INC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J96.20","G47.33","Z20.828","I77.6","J84.10","M54.5","M54.6","M54.2","J96.11","M35.03","G73.7","R09.02","R82.90","Z23.","R39.81","N39.3","J98.4","J84.9","D89.9","Z71.9","J45.909","R05.","R10.9","M31.7","R63.4","I50.1","Z79.899","G89.29","H04.121","H04.122","Z51.81","S70.12XA","M25.552","M53.3","M79.605","Z79.1","Z79.52","V49.40XA","Y92.410","H53.9","R06.02","R61.","D84.9","K21.9","B37.0","Z92.29","J20.9","NO DATA","R11.10","T50.Z95A","H52.03","H25.13","Z83.511","E66.9","Z01.810","R06.09","Z03.89","R06.00","I25.10","R06.83","J90.","J84.89","Z99.81","L53.9","F41.9","R22.33"],"date":["2021-09-15","2020-10-22","2021-01-07","2021-04-06","2021-04-06","2021-01-25","2021-01-25","2021-01-25","2021-12-14","2021-12-20","2021-12-20","2021-04-06","2021-04-06","2021-04-01","2021-12-18","2021-12-18","2021-12-18","2021-11-23","2020-09-29","2021-11-23","2021-03-18","2020-11-04","2020-03-05","2020-05-27","2020-12-16","2020-07-17","2021-08-05","2020-03-03","2020-05-04","2020-05-04","2021-03-18","2021-06-07","2021-06-07","2021-06-07","2021-06-07","2021-06-07","2021-06-07","2021-06-07","2021-06-07","2020-03-03","2021-04-02","2020-09-23","2021-11-23","2021-11-23","2020-10-22","2020-02-27","2020-07-17","2021-04-02","2021-04-02","2021-04-02","2021-08-05","2021-08-05","2021-08-05","2021-11-23","2019-04-19","2019-03-12","2019-03-12","2019-03-12","2019-04-19","2019-09-26","2019-04-30","2019-09-18","2019-10-25","2019-09-18","2019-04-10","2019-02-27"],"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":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","69315090505","LORAZEPAM","TAB 1MG","60","Select","Select",""],["","62542030117","HYD","SUS 10-8\/5ML","240","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","56","Select","Select",""],["","","ONDANSETRON","TAB 4MG","","Select","Select",""],["","31722053401","METHOCARBAM","TAB 750MG","20","Select","Select",""],["","","VITAMIN","CAP 50000UNT","","Select","Select",""],["","59746017310","PREDNISONE","TAB 10MG","10","Select","Select",""],["","00378668977","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","64380071206","BENZONATATE","CAP 100MG","60","Select","Select",""],["","","ACETYLCYST","SOL 0.1","","Select","Select",""],["","00378932132","WIXELA","AER 250\/50","60","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","3","Select","Select",""],["","62332025050","DOXYCYC","CAP 100MG","20","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","8","Select","Select",""],["","76204060030","IPRATROPIUM\/","SOL ALBUTER","90","Select","Select",""],["","","LIDOCAINE","PAD 0.05","","Select","Select",""],["","68462050201","AZATHIOPRINE","TAB 50MG","24","Select","Select",""],["","","SMZ-TMP","TAB 400-80MG","","Select","Select",""],["","76204020060","ALBUTEROL","NEB 0.00083","360","Select","Select",""],["","00054429931","FUROSEMIDE","TAB 40MG","30","Select","Select",""],["","00378027105","DIAZEPAM","TAB 2MG","9","Select","Select",""],["","00173069600","ADVAIR","AER 250\/50","60","Select","Select",""],["","","AMOX\/K","TAB 875-125","","Select","Select",""],["","66993058597","FLUTIC\/SALME","AER 250\/50","60","Select","Select",""],["","","SMZ\/TMP","TAB 800-160","","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","64380086107","POT  CHLORIDE","TAB 10MEQ ER","30","Select","Select",""],["","50228043605","NAPROXEN","TAB 500MG","20","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","20","Select","Select",""],["","","BUDESONIDE","SUS 1MG\/2ML","","Select","Select",""],["","","DEXILANT","CAP 60MG DR","","Select","Select",""],["","","RANITIDINE","TAB 75MG","","Select","Select",""],["","","DICYCLOMINE","CAP 10MG","","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","","HYPERSAL","NEB 0.07","","Select","Select",""],["","60432053760","NYSTATIN","SUS 100000","60","Select","Select",""],["","","SODIUM","NEB 0.07","","Select","Select",""],["","","CLOTRIMAZOLE","TRO 10MG","","Select","Select",""],["","","DOXYCYCL","TAB 100MG","","Select","Select",""],["","65862053820","LEVOFLOXACIN","TAB 750MG","7","Select","Select",""],["","55111012701","CIPROFLOXACN","TAB 500MG","20","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":""}]}]}