{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   AIHTELYELNOC M","gend":1,"add":"EITTAM 452DAOR NUR S","city":"STANARDSVILLE","state":"VA","zip":"22973-9998","dob":"1949-06-24","age":"","mstatus":"","insh":"65200210*59","cliId":"","pno":"39\/4343157-8","cno":"","email":"","ename":"","eno":"","pphy":"TRIBASTONE, ANDREA D MD","ppno":"540\/672-3010","pcpadd":"13198 JAMES MADISON HWY","pcpcity":"ORANGE","pcpstate":"VA","pcpzip":22960,"pcpcounty":"","pcpid":"","pcpname":"ANCHOR HEALTHCARE PLC","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":["M71.21","M25.561","I10.","I50.30","I48.3","R00.2","Z87.891","L57.0","C44.42","M81.0","I48.91","J44.1","I50.33","I21.4","E87.1","M17.11","I50.9","I49.1","I48.0","R60.0","R79.89","R06.02","Z20.822","I20.0","I48.92","I13.0","I50.42","NO DATA","J44.9","D50.9","M06.09","M54.16","M19.90","E55.9","F41.9","E66.9","G60.9","G51.9","G56.02","D64.9","N39.0","A08.4","E86.1","E03.9","D63.8","G62.9","M06.9","Z79.51","Z79.82","Z79.899","R19.7","R11.2","M70.61","M70.62","F11.90","M54.5","M05.79","R11.0","M79.89","M79.604","R79.1","Z98.890","V54.17","E66.01","G51.8","R74.01","I11.0","E87.6","G25.81","K21.9","Z68.34","R00.0","R07.9","M25.531","M25.532","R30.0","M79.605","R06.09","M79.661","L98.8","R22.41","Z91.048","N17.9","E83.42","F41.0","I12.9","N18.9","E86.0","G43.909","G44.209","M79.7","R78.89","R51.","I50.31","I16.1","Z80.9","Z79.83","Z01.810","N18.3","N25.81","I16.0","R52.","H52.7","H35.3131","H25.811","Z96.1","H04.123","Z23.","N18.4","I50.32","J06.9","R07.89","R20.2","N18.2","R21.","Z76.89","D63.1","R06.00","I25.119"],"date":["2020-10-13","2020-07-28","2022-11-10","2022-11-10","2022-06-08","2022-06-08","2021-11-20","2021-06-07","2021-06-07","2022-10-24","2021-11-24","2021-11-24","2021-11-30","2021-11-24","2020-04-14","2020-10-13","2021-11-23","2022-06-08","2022-11-10","2022-11-04","2020-07-17","2021-11-20","2021-11-20","2021-11-23","2021-12-28","2021-12-28","2022-05-18","2022-11-04","2021-12-28","2021-12-28","2022-02-18","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-11-20","2020-03-25","2020-03-25","2020-03-25","2021-11-20","2020-03-25","2020-03-25","2022-09-21","2020-03-25","2020-03-25","2022-09-26","2021-11-20","2020-03-27","2021-03-26","2021-03-26","2022-09-26","2021-03-26","2022-09-26","2021-11-20","2020-07-17","2020-07-17","2020-07-17","2021-10-27","2021-10-27","2021-10-27","2021-10-27","2021-10-27","2021-11-20","2021-11-20","2021-11-20","2021-11-20","2021-11-20","2021-11-20","2020-08-13","2020-08-13","2020-08-13","2021-08-02","2021-08-02","2021-11-23","2020-07-16","2020-07-16","2020-07-16","2021-11-20","2022-03-10","2019-12-22","2019-12-22","2019-12-22","2019-12-22","2019-12-22","2019-12-22","2019-12-22","2019-12-22","2019-12-22","2019-12-22","2019-03-13","2019-11-21","2019-11-20","2019-11-20","2019-04-25","2019-12-23","2019-12-23","2019-11-21","2022-02-18","2022-03-01","2022-03-01","2022-03-01","2022-03-01","2022-03-01","2022-09-21","2022-03-10","2022-03-10","2022-08-03","2022-08-03","2022-08-03","2022-08-03","2022-05-18","2022-05-18","2022-11-04","2022-11-10","2022-11-10"],"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":[["","00003089421","ELIQUIS","TAB 5MG","60","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","00378363705","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","43598072101","HYDROXYCHLOR","TAB 200MG","30","Select","Select",""],["","","FOLIC","TAB 1000MCG","","Select","Select",""],["","","SERTRALINE","TAB 50MG","","Select","Select",""],["","55111015810","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","68645051654","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","62037083110","METOPROL","TAB 50MG ER","30","Select","Select",""],["","65862019899","GABAPENTIN","CAP 100MG","90","Select","Select",""],["","00093005805","TRAMADOL","TAB 50MG","120","Select","Select",""],["","00093216568","NALOXONE","SPR ","2","Select","Select",""],["","","BUDES\/FORMOT","AER 160-4.5","","Select","Select",""],["","68645055354","LISINOPRIL","TAB 20MG","30","Select","Select",""],["","68382039801","POT  CHLORIDE","TAB 20MEQ ER","30","Select","Select",""],["","69315011610","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","","EUTHYROX","TAB 50MCG","","Select","Select",""],["","","METHOTREXATE","TAB 2.5MG","","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","","PREDNISONE","TAB 20MG","","Select","Select",""],["","68382004001","PROMETHAZINE","TAB 12.5MG","20","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","56","Select","Select",""],["","00781518192","LEVOTHYROXIN","TAB 50MCG","30","Select","Select",""],["","24385099875","GNP","TAB ALLERGY","30","Select","Select",""],["","68382009405","CARVEDILOL","TAB 12.5MG","60","Select","Select",""],["","69097022416","ALENDRONATE","TAB 70MG","4","Select","Select",""],["","65162047810","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","","IRON","TAB 325MG","","Select","Select",""],["","","CIPROFLOXACN","TAB 500MG","","Select","Select",""],["","","FERROUS","TAB 325MG","","Select","Select",""],["","00904641292","CALC","CHW 500MG","90","Select","Select",""],["","00904671980","ACETAMINOPHE","TAB 325MG","30","Select","Select",""],["","00172572880","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","57237012401","WARFARIN","TAB 5MG","30","Select","Select",""],["","55111015330","ONDANSETRON","TAB 4MG","20","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","20","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","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":""}]}]}