{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PATSY   J LEBOEUF","gend":1,"add":"742 MAGNOLIA DR","city":"SOUTH BOSTON","state":"VA","zip":"24592-9998","dob":"1960-09-26","age":"","mstatus":"","insh":"900036633*01","cliId":"5C40TQ3CQ05","pno":"434\/572-3696","cno":"434\/572-3696","email":"","ename":"","eno":"","pphy":"PATEL, BABITA B MD","ppno":"434\/517-5180","pcpadd":"1129 N MAIN ST","pcpcity":"SOUTH BOSTON","pcpstate":"VA","pcpzip":24592,"pcpcounty":"","pcpid":157457,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/517-6179","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I50.30","R06.00","I10.","J44.9","Z68.32","R06.2","E66.9","J45.909","M79.7","J45.998","I82.409","I48.91","Z79.01","I82.403","J42.","Z12.31","C50.911","Z17.0","I82.593","Z12.11","C50.919","J45.901","I82.509","E78.5","R12.","R06.89","T78.40XA","T63.441A","I70.213","I87.2"],"date":["2021-09-23","2021-09-20","2021-09-23","2021-09-23","2020-03-17","2021-09-20","2021-09-20","2021-09-20","2021-09-20","2020-01-14","2020-02-14","2020-03-17","2021-06-15","2020-11-30","2020-02-03","2021-03-15","2020-02-03","2020-02-03","2020-01-16","2020-07-23","2020-03-17","2021-04-14","2021-06-15","2021-09-23","2021-08-06","2021-09-20","2021-09-24","2021-09-24","2021-09-23","2021-09-23"],"priorHcc":[null,null,null,null,"",null,null,null,null,"","","","","","","","","","","","","","",null,null,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":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","57237012499","WARFARIN ","5MG","90","Select","Select",""],["","16729011917","MONTELUKAST ","10MG","90","Select","Select",""],["","00487950125","ALBUTEROL ","0.08%","225","Select","Select",""],["","00487980125","IPRATROPIUM ","0.02%INH","125","Select","Select",""],["","49281063315","FLUZONE ","2020-21","0","Select","Select",""],["","59746017509","PREDNISONE ","20MG","20","Select","Select",""],["","00487950125","","0.08%","-225","Select","Select",""],["","57237012499","WARFARIN","5MG","90","Select","Select",""],["","00487950125","ALBUTEROL","0.08%","225","Select","Select",""],["","00487980125","IPRATROPIUM","0.02%INH","-125","Select","Select",""],["","16729011917","MONTELUKAST","10MG","90","Select","Select",""],["","49281063315","FLUZONE","2020-21","0","Select","Select",""],["","59746017509","PREDNISONE","20MG","20","Select","Select",""],["","49502050002","EPIPEN","0.3MG","-2","Select","Select",""],["","49502010202","EPINEPHRINE","0.3MG","2","Select","Select",""],["","49502050002","EPIPEN ","INJ 0.3MG","-2","Select","Select",""],["","49502010202","EPINEPHRINE ","INJ 0.3MG","2","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","",""],["Yes","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":""}]}]}