{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"VIOLET   M SNEAD","gend":1,"add":"314 HAMILTON BLVD APT B","city":"SOUTH BOSTON","state":"VA","zip":"24592-9998","dob":"1935-01-06","age":"","mstatus":"","insh":"900038648*01","cliId":"9JF3K18XA92","pno":"434\/575-7250","cno":"434\/575-7250","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":["E11.649","E11.42","E11.9","I10.","N39.0","C50.912","R60.0","E78.2","R06.00","Z95.2","Z23.","M19.012","M12.812","J45.40","E11.40","L60.3","I73.9","M25.812","R11.0","M62.81","R63.8","Z00.00","I89.0","F34.1","I87.2","H92.21","H91.91","I08.3","I35.0","H34.8310","J45.909","H60.501","H33.311","H35.371","H43.813","H43.311","C50.919","T14.8XXA","H43.11","H60.509","I83.813","R50.9","I83.93","L03.114","A41.9","J96.01","H52.223","H52.13","E11.65","Z66.","J96.02","R65.20","Z96.652","E78.5","I27.20","R11.2","M75.102","Z79.82","R06.02","Z76.89","L03.119","L98.9","R07.9","M79.602","M25.512","R19.8","R09.02","S46.112A","S46.812A","J96.11","E10.9","M75.122","H35.09"],"date":["2020-04-07","2020-04-07","2021-10-13","2021-08-26","2020-11-17","2021-10-01","2021-02-24","2021-07-12","2021-07-12","2021-07-12","2021-10-11","2021-08-20","2021-08-20","2021-06-24","2021-08-26","2021-07-21","2021-07-21","2020-10-28","2020-11-05","2020-11-05","2020-11-05","2021-02-08","2021-08-20","2021-02-08","2021-02-24","2020-03-05","2020-02-20","2020-07-21","2021-08-17","2021-07-13","2021-08-17","2020-02-20","2021-03-03","2021-07-16","2021-03-03","2021-03-03","2020-02-04","2020-02-04","2021-03-03","2020-02-14","2020-08-17","2021-06-24","2021-02-24","2021-06-28","2021-06-28","2021-07-07","2021-07-16","2021-07-16","2021-07-16","2021-06-24","2021-06-24","2021-06-24","2021-06-24","2021-06-24","2021-06-24","2021-06-24","2021-06-24","2021-06-24","2021-06-25","2021-07-06","2021-07-07","2021-07-07","2021-06-24","2021-08-05","2021-07-30","2021-06-24","2021-06-24","2021-08-05","2021-08-05","2021-08-17","2021-10-13","2021-08-05","2021-09-13"],"priorHcc":["","",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":[["","65862056099","PANTOPRAZOLE ","40MG","-30","Select","Select",""],["","61314064511","NEO\/POLY\/HC ","1% OTIC","-10","Select","Select",""],["","50111091701","TORSEMIDE ","20MG","30","Select","Select",""],["","65862020199","LOSARTAN ","25MG","-30","Select","Select",""],["","53746051105","SPIRONOLACT ","25MG","15","Select","Select",""],["","56151146001","TRUE ","GLUCOSE","200","Select","Select",""],["","65162010150","GABAPENTIN ","100MG","360","Select","Select",""],["","00169643810","LEVEMIR ","FLEXTOUC","9","Select","Select",""],["","00002879959","HUMALOG ","100\/ML","3","Select","Select",""],["","65862001305","SERTRALINE ","100MG","-90","Select","Select",""],["","66733082259","INSULIN ","100\/ML","3","Select","Select",""],["","67877021620","CEFUROXIME ","500MG","20","Select","Select",""],["","08290320119","BD  PEN NEEDL","31GX5MM","-100","Select","Select",""],["","11917006938","CAPSAICIN ","0.10%","42","Select","Select",""],["","00781569031","EZETIMIBE ","10MG","30","Select","Select",""],["","00093314705","CEPHALEXIN ","500MG","8","Select","Select",""],["","000093101042","MUPIROCIN ","2%","-22","Select","Select",""],["","65862056099","","40MG","30","Select","Select",""],["","65862056099","PANTOPRAZOLE","40MG","30","Select","Select",""],["","61314064511","NEO\/POLY\/HC","1% OTIC","10","Select","Select",""],["","65862020199","LOSARTAN","25MG","-30","Select","Select",""],["","50111091701","TORSEMIDE","20MG","30","Select","Select",""],["","53746051105","SPIRONOLACT","25MG","15","Select","Select",""],["","00002879959","HUMALOG","100\/ML","3","Select","Select",""],["","65862001305","SERTRALINE","100MG","90","Select","Select",""],["","56151146004","TRUE","GLUCOSE","-450","Select","Select",""],["","00169643810","LEVEMIR","FLEXTOUC","9","Select","Select",""],["","65162010250","GABAPENTIN","300MG","90","Select","Select",""],["","66733082259","INSULIN","100\/ML","3","Select","Select",""],["","08290320119","BD PEN NEEDL","31GX5MM","-100","Select","Select",""],["","67877021620","CEFUROXIME","500MG","-20","Select","Select",""],["","11917006938","CAPSAICIN","0.10%","42","Select","Select",""],["","00781569031","EZETIMIBE","10MG","30","Select","Select",""],["","00093101042","MUPIROCIN","2%","22","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","8","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","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":""}]}]}