{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KAWAINA   J ACREE","gend":1,"add":"111 ROSEHILL DR APT 2","city":"SOUTH BOSTON","state":"VA","zip":"24592-9998","dob":"1977-04-14","age":"","mstatus":"","insh":"900038801*01","cliId":"5UP7CU1AV46","pno":"434\/222-3744","cno":"434\/222-3744","email":"","ename":"","eno":"","pphy":"KETCHERSID, MARIE K MD","ppno":"434\/517-6180","pcpadd":"2232 WILBORN AVENUE","pcpcity":"SOUTH BOSTON","pcpstate":"VA","pcpzip":24592,"pcpcounty":"","pcpid":157457,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"Non-DSNP","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":["G71.11","M79.604","F32.9","M79.605","M48.062","K52.9","K56.699","K56.600","Z20.828","Z28.21","Z90.49","Z90.710","Z98.890","Z79.899","Z88.0","R10.30","R10.31","R10.84","N83.201","R41.841","F41.9","K56.609","R11.2","F33.1","G71.00","H04.123","H52.13","D50.8","M21.371","M21.372","F33.42","R53.81","E55.9","Z13.6","M79.10","M79.674","I87.8","R91.8","K29.60","K22.2","K21.0","Z98.51","M79.671","K59.00","Z90.721","H52.4","K21.00","R10.9","R63.4","Z01.89","Z01.810","Z01.812","Q43.8","N83.01","N39.0","K64.8","D12.5","K29.50","B96.81","Z68.21","K64.9","Z86.010","E78.2","R10.13","K29.00"],"date":["2021-02-17","2020-05-19","2020-07-29","2020-05-19","2020-07-09","2020-12-09","2020-12-10","2020-12-08","2020-12-08","2020-12-08","2021-09-01","2021-09-01","2020-12-08","2021-09-01","2021-09-01","2021-07-19","2020-12-11","2021-09-01","2021-07-19","2020-08-04","2021-07-29","2021-01-05","2020-12-09","2020-03-06","2020-07-29","2021-06-30","2020-06-25","2020-07-29","2020-10-08","2020-10-08","2021-02-16","2021-02-17","2021-02-17","2021-02-17","2020-05-12","2021-04-06","2020-12-09","2020-12-10","2021-10-20","2021-10-20","2020-02-21","2021-09-01","2021-04-06","2021-07-19","2021-07-19","2021-06-30","2021-10-20","2021-10-20","2021-10-20","2021-07-22","2021-08-30","2021-07-22","2021-07-19","2021-07-19","2021-07-19","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2021-10-20","2021-08-30","2021-09-01","2021-09-01"],"priorHcc":["","","","","","","","","","",null,null,"",null,null,"","",null,"","",null,"","","","","","","","","","","","","","","","","",null,null,"",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":[["","57237007730","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","57237001206","MIRTAZAPINE","TAB 30MG ODT","30","Select","Select",""],["","603116158","DICYCLOMINE","SOL 10MG\/5ML","-200","Select","Select",""],["","80777027310","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","64380073706","VITAMIN D","CAP 50000UNT","4","Select","Select",""],["","49483061850","NAPROXEN","TAB 500MG","20","Select","Select",""],["","75834001060","ERGOCALCIFER","SOL 8000\/ML","60","Select","Select",""],["","69543013611","TRAMADOL HCL","TAB 50MG","10","Select","Select",""],["","65862002206","MIRTAZAPINE ODT ","","30","Select","Select",""],["","57237007730","ONDANSETRON ODT ","","12","Select","Select",""],["","603116158","DICYCLOMINE HCL ","","-200","Select","Select",""],["","527128210","DICYCLOMINE HYDROCHLORIDE ","","-20","Select","Select",""],["","64380073706","VITAMIN D ","","4","Select","Select",""],["","75834001060","ERGOCALCIFEROL","","60","Select","Select",""],["","80777027310","MODERNA COVID-19 VACCINE","","0","Select","Select",""],["","57237001206","MIRTAZAPINE ODT","","30","Select","Select",""],["","00603116158","DICYCLOMINE HCL","","60","Select","Select",""],["","57237007730","ONDANSETRON ODT","","12","Select","Select",""],["","00527128210","DICYCLOMINE HYDROCHLORIDE","","-20","Select","Select",""],["","10572030201","PEG-3350\/NACL\/NA BICARBONATE\/KCL","\/SODIUM","4000","Select","Select",""],["","47781030301","NITROFURANTOIN MONOHYDRATE\/MACROCRYSTALS","100MG","14","Select","Select",""],["","51927474700","METRONIDAZOLE BENZOATE","BENZOATE","140","Select","Select",""],["","00781602352","CLARITHROMYCIN","250\/5ML","300","Select","Select",""],["","23155065205","METRONIDAZOLE","500MG","28","Select","Select",""],["","55111015810","OMEPRAZOLE","20MG","28","Select","Select",""],["","57237001206","MIRTAZAPINE ODT                                                       ","TAB 30MG ODT","30","Select","Select",""],["","69543013611","TRAMADOL HCL                                                          ","TAB 50MG","10","Select","Select",""],["","49483061850","NAPROXEN                                                              ","TAB 500MG","20","Select","Select",""],["","00527128210","DICYCLOMINE HYDROCHLORIDE                                             ","TAB 20MG","20","Select","Select",""],["","57237007730","ONDANSETRON ODT                                                       ","TAB 4MG ODT","12","Select","Select",""],["","00603116158","DICYCLOMINE HCL                                                       ","SOL 10MG\/5ML","200","Select","Select",""],["","64380073706","VITAMIN D                                                             ","CAP 50000UNT","4","Select","Select",""],["","75834001060","ERGOCALCIFEROL                                                        ","SOL 8000\/ML","60","Select","Select",""],["","13107000334","MIRTAZAPINE                                                           ","TAB 30MG","-30","Select","Select",""],["","80777027310","MODERNA COVID-19 VACCINE                                              ","INJ COVID-19","0","Select","Select",""],["","47781030301","NITROFURANTOIN MONOHYDRATE\/MACROCRYSTALS                              ","CAP 100MG","14","Select","Select",""],["","10572030201","PEG-3350\/NACL\/NA BICARBONATE\/KCL                                      ","SOL \/SODIUM","4000","Select","Select",""],["","00781602352","CLARITHROMYCIN                                                        ","SUS 250\/5ML","-100","Select","Select",""],["","70000021306","ALLERGY RELIEF                                                        ","TAB 10MG","30","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE                                                ","SPR 50MCG","16","Select","Select",""],["","51927474700","METRONIDAZOLE BENZOATE                                                ","POW BENZOATE","140","Select","Select",""],["","23155065205","METRONIDAZOLE                                                         ","TAB 500MG","28","Select","Select",""],["","55111015810","OMEPRAZOLE                                                            ","CAP 20MG","28","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":""}]}]}