{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"C L  ADNERBHTIMS-KRAL","gend":1,"add":"HGIH 671EVA DNAL","city":"APPOMATTOX","state":"VA","zip":24522,"dob":"1967-06-29","age":"","mstatus":"","insh":"45200210*52","cliId":"","pno":"54\/4340650-4","cno":"","email":"","ename":"","eno":"","pphy":"CLUTTER, JULIET","ppno":"434\/597-5967","pcpadd":"134 ELON RD","pcpcity":"MADISON HEIGHTS","pcpstate":"VA","pcpzip":24522,"pcpcounty":"","pcpid":"","pcpname":"JOHNSON HEALTH CENTER","plan":"OHP","program":"Medicaid","lob":"OHCC","region":"WESTERN\/ CHARLOTTESVILLE","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":["B96.89","N76.0","I10.","Z01.419","E11.9","R07.9","R11.11","J18.9","R00.2","R06.02","I50.9","E11.65","E78.5","Z90.49","I42.0","R00.0","R07.89","I50.20","I25.10","D86.9","R51.","R11.2","R19.7","R05.","J45.909","Z20.828","Z79.84","Z79.899","I11.0","Z20.822","G47.33","I47.2","I50.23","Z79.51","I16.0","I42.9","E66.9","Z68.36","I47.1","I95.1","J98.11","E87.70","A41.9","I42.8","I50.22","N39.0","E87.1","B96.20","G47.30","N20.0","K80.20","Z79.4","J45.20","R87.810","R87.610","L30.4","R73.9","R78.81","R10.9","I21.4","Z95.5","Z79.82","Z79.01","I25.5","E66.01","B37.3","Z23.","L73.2","Z12.4","N93.9","D69.6","D68.9","J96.01","M25.561","E88.81","I16.1","E66.09","R77.8","R11.0","B37.0","B37.81","G47.10","R06.83","R94.31","R65.20","I48.91","M25.511","M75.81","R21.","B35.6","E55.9","M17.11","R05.9","Z83.3","Z86.59","M67.813","D69.59","R04.2","Z87.440","Z80.9","L02.411","N89.8","Z79.1","J02.9","Z20.9","E11.51","E83.42","Z68.41","NO DATA","Z79.02","R94.39","J98.4"],"date":["2021-07-19","2019-02-01","2021-12-17","2019-02-01","2021-12-17","2021-11-14","2021-11-14","2020-11-12","2021-05-25","2021-12-03","2021-11-15","2021-11-03","2021-11-15","2021-06-08","2021-11-04","2021-09-22","2021-11-14","2021-12-01","2021-12-17","2021-12-03","2019-03-12","2019-03-09","2019-03-09","2021-03-05","2020-11-12","2020-11-12","2021-11-15","2021-11-02","2021-11-15","2021-07-19","2021-11-15","2021-07-20","2021-11-15","2021-06-08","2021-06-08","2021-06-08","2021-06-08","2021-06-08","2021-11-15","2021-06-08","2021-06-08","2021-06-09","2021-07-20","2021-07-19","2021-12-27","2021-07-20","2021-07-19","2021-07-19","2021-07-20","2021-07-19","2021-07-19","2021-07-19","2021-12-03","2020-03-05","2020-02-27","2020-07-17","2021-06-08","2021-07-20","2021-07-20","2021-11-15","2021-11-14","2021-11-15","2021-11-14","2021-11-15","2021-12-01","2019-09-19","2021-03-12","2020-05-06","2020-02-17","2020-06-30","2019-03-12","2019-03-12","2019-03-12","2021-04-22","2021-11-03","2021-11-04","2021-11-04","2021-11-04","2021-11-14","2020-02-03","2020-02-03","2021-04-23","2021-04-23","2021-04-23","2021-07-19","2021-11-19","2019-01-18","2019-01-18","2020-06-12","2020-06-12","2021-03-12","2021-04-22","2021-10-06","2021-11-02","2019-02-04","2019-02-06","2019-03-12","2019-03-12","2019-03-12","2019-03-12","2020-01-08","2020-01-08","2020-02-03","2020-02-03","2020-11-12","2021-11-15","2021-11-15","2021-11-15","2021-11-15","2021-11-15","2021-11-15","2021-12-03"],"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":[["","","TRAMADOL"," TRAMADOL ","21","Select","Select",""],["","","METRONIDAZOL"," METRONIDAZOL ","20","Select","Select",""],["","","CLONIDINE"," CLONIDINE ","60","Select","Select",""],["","","AMLODIPINE"," AMLODIPINE ","30","Select","Select",""],["","","RELION"," RELION ","50","Select","Select",""],["","","ATORVASTATIN"," ATORVASTATIN ","30","Select","Select",""],["","","METFORMIN"," METFORMIN ","60","Select","Select",""],["","","VICTOZA"," VICTOZA ","6","Select","Select",""],["","","DICLOFENAC"," DICLOFENAC ","60","Select","Select",""],["","","FLUCONAZOLE"," FLUCONAZOLE ","1","Select","Select",""],["","","OSELTAMIVIR"," OSELTAMIVIR ","10","Select","Select",""],["","","CORICIDN"," CORICIDN ","28","Select","Select",""],["","","TAMIFLU"," TAMIFLU ","10","Select","Select",""],["","","CEFUROXIME"," CEFUROXIME ","8","Select","Select",""],["","","PROAIR"," PROAIR ","8","Select","Select",""],["","","ONDANSETRON"," ONDANSETRON ","10","Select","Select",""],["","","ALBUTEROL"," ALBUTEROL ","8","Select","Select",""],["","","SUPREP"," SUPREP ","354","Select","Select",""],["","","SMZ\/TMP"," SMZ\/TMP ","20","Select","Select",""],["","","IBUPROFEN"," IBUPROFEN ","30","Select","Select",""],["","","TERBINAFINE","CRE 0.01","","Select","Select",""],["","","TRIAMCINOLON","OIN 0.001","","Select","Select",""],["","","FLUBLOK","INJ 2020-21","","Select","Select",""],["","","LORATADINE","TAB 10MG","","Select","Select",""],["","","PROMETH\/COD","SOL 6.25-10","","Select","Select",""],["","","HYDROCHLOROT","TAB 25MG","","Select","Select",""],["","","LISINOPRIL","TAB 10MG","","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","","NYSTATIN","SUS 100000","","Select","Select",""],["","","NAPROXEN","TAB 500MG","","Select","Select",""],["","","GAVILYTE-G","SOL ","","Select","Select",""],["","","MUPIROCIN","OIN 0.02","","Select","Select",""],["","","AZITHROMYCIN","TAB 250MG","","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","",""],[""],[""],[""],[""]],"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":""}]}]}