{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ASHLEY L COOK","gend":1,"add":"3891 CHURCHVILLE  AVE APT 201 ","city":"CHURCHVILLE ","state":"VA","zip":"24421-9998","dob":"1989-04-12","age":"","mstatus":"","insh":11013637,"cliId":"1K46NC1EV49","pno":5406071846,"cno":5406071846,"email":"","ename":"","eno":"","pphy":"LE, NGOC H","ppno":5402485110,"pcpadd":"3881 Churchville Ave","pcpcity":"Churchville ","pcpstate":"VA","pcpzip":244212525,"pcpcounty":"","pcpid":"P0113773","pcpname":"AUGUSTA HEALTH FAMILY PRACTICE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"3891 CHURCHVILLE  AVE APT 201 ","madd2":"","madd3":"","mcity":"CHURCHVILLE ","mstate":"VA","mzip":"24421-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["N92.0","F32.9","J30.9","N94.6","R11.0","G47.9","F33.2","F33.1","Z20.828","F31.81","F90.0","Z79.899","Z97.5","Z32.01","Z32.02","S61.011A","W26.0XXA","Z23","J30.2","G89.4","F31.9","J00","R07.0","R11.2","Z20.822","F41.9","J01.90","J02.9","R50.9"],"date":["2020-06-10","2021-11-10","2020-07-28","2020-07-28","2021-11-10","2020-07-28","2020-09-01","2020-11-03","2020-12-18","2021-06-11","2021-03-12","2021-06-11","2021-04-02","2021-04-02","2021-04-02","2021-05-13","2021-05-13","2021-05-13","2021-08-13","2021-05-21","2021-08-13","2021-08-09","2021-08-09","2021-08-09","2021-11-13","2021-11-10","2021-11-13","2021-10-03","2021-10-03"],"priorHcc":["",null,"","",null,"","","","","","","","","","","","","","","","","","","",null,null,null,"",""]}},{"a":[]}]},{"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":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","66993068130","OLANZAPINE","TAB 5MG","","Select","Select",""],["","51991074890","DULOXETINE","CAP 60MG","","Select","Select",""],["","65862022701","LAMOTRIGINE","TAB 25MG","","Select","Select",""],["","93083205","CLONAZEPAM","TAB 0.5MG","","Select","Select",""],["","67877014601","TEMAZEPAM","CAP 15MG","","Select","Select",""],["","55111015330","ONDANSETRON","TAB 4MG","","Select","Select",""],["","13668001990","VENLAFAXINE","CAP 75MG ER","","Select","Select",""],["","65162019011","NAPROXEN","TAB 500MG","","Select","Select",""],["","66993068130","OLANZAPINE ","TAB 5MG","30","Select","Select",""],["","51991074790","DULOXETINE ","CAP 30MG","30","Select","Select",""],["","65162019011","NAPROXEN ","TAB 500MG","100","Select","Select",""],["","93083205","CLONAZEPAM ","TAB 0.5MG","60","Select","Select",""],["","65862022701","LAMOTRIGINE ","TAB 25MG","60","Select","Select",""],["","67877014601","TEMAZEPAM ","CAP 15MG","30","Select","Select",""],["","65862069730","VENLAFAXINE ","CAP 150MG ER","30","Select","Select",""],["","55111015330","ONDANSETRON ","TAB 4MG","60","Select","Select",""],["","11534018701","BUT\/APAP\/CAF ","","30","Select","Select",""],["","69097094312","GABAPENTIN ","300MG","120","Select","Select",""],["","69097094312","GABAPENTIN","300MG","120","Select","Select",""],["","11534018701","BUT\/APAP\/CAF","","30","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","67877054360","CEFDINIR","300MG","20","Select","Select",""],["","59746017509","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","68180016011","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","67877054360","CEFDINIR ","CAP 300MG","20","Select","Select",""],["","49281042150","FLUZONE ","INJ 2021-22","0.5","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}