{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DELLA   M DUFFIE","gend":1,"add":"PO BOX 138","city":"DRAKES BRANCH","state":"VA","zip":"23937-9998","dob":"1945-03-05","age":"","mstatus":"","insh":"900041099*01","cliId":"7HE2XD4AP83","pno":"434\/547-3767","cno":"434\/547-3767","email":"","ename":"","eno":"","pphy":"HAHESY-CALHOUN, MARIAN MD","ppno":"434\/542-5560","pcpadd":"165 LEGRANDE AVENUE","pcpcity":"CHARLOTTE COURT HOUSE","pcpstate":"VA","pcpzip":23923,"pcpcounty":"","pcpid":105455,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/542-4670","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I25.10","I35.1","I48.91","I50.30","Z79.01","I10.","E78.2","J44.9","E03.9","I70.0","E55.9","K58.0","K55.1","Z83.79","K21.9","F17.200","L81.4","L81.5","Z08.","Z85.820","L57.0","Z85.828","Z09.","Z87.2","R06.00","E78.5","Z71.89","Z71.3","D64.9","R91.8","R12.","F41.9","I48.0","R31.9","Z00.00","R09.89","I35.9","I35.0","I65.29","Z23.","I08.8","I65.23","R79.89","R77.8","R07.89","Z12.31","R07.9","L28.2","E87.1"],"date":["2021-10-25","2021-05-18","2021-10-31","2021-10-25","2021-09-21","2021-10-31","2021-09-21","2021-05-18","2021-11-11","2021-02-02","2021-02-02","2021-08-11","2021-08-11","2021-08-11","2021-08-11","2021-08-11","2021-07-19","2021-07-19","2021-07-19","2021-07-19","2021-07-19","2021-07-19","2021-07-19","2021-07-19","2021-05-18","2021-08-03","2021-08-03","2021-08-03","2021-02-02","2021-10-31","2021-02-02","2021-02-02","2021-10-25","2021-08-03","2021-08-03","2021-08-03","2021-08-03","2021-10-25","2021-10-25","2021-11-08","2021-11-04","2021-09-28","2021-10-31","2021-10-31","2021-10-31","2021-10-18","2021-10-31","2021-11-11","2021-11-11"],"priorHcc":[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":[["","000832532510","POT  CL MICRO","20MEQ ER","45","Select","Select",""],["","000597036055","PRADAXA ","150MG","60","Select","Select",""],["","068462026390","ROSUVASTATIN ","20MG","90","Select","Select",""],["","068382065001","ISOSORB ","30MG ER","30","Select","Select",""],["","059762372004","ALPRAZOLAM ","0.5MG","90","Select","Select",""],["","069315011710","FUROSEMIDE ","40MG","45","Select","Select",""],["","065862056099","PANTOPRAZOLE ","40MG","90","Select","Select",""],["","000185505001","METOLAZONE ","2.5MG","6","Select","Select",""],["","058160082311","SHINGRIX ","50\/0.5ML","-1","Select","Select",""],["","043199001101","HYOSCYAMINE ","0.125MG","120","Select","Select",""],["","068180097201","LEVOTHYROXIN ","137MCG","90","Select","Select",""],["","061874007560","VIBERZI ","75MG","60","Select","Select",""],["","016729021815","CLOPIDOGREL ","75MG","90","Select","Select",""],["","052817036000","METOPROL ","25MG","180","Select","Select",""],["","064380073706","VITAMIN ","50000UNT","12","Select","Select",""],["","00832532510","","20MEQ ER","45","Select","Select",""],["","68382065001","ISOSORB","30MG ER","30","Select","Select",""],["","43199001101","HYOSCYAMINE","0.125MG","60","Select","Select",""],["","00832532510","POT CL MICRO","20MEQ ER","45","Select","Select",""],["","52817036000","METOPROL","25MG","180","Select","Select",""],["","59762372004","ALPRAZOLAM","0.5MG","90","Select","Select",""],["","68462026390","ROSUVASTATIN","20MG","90","Select","Select",""],["","00597036055","PRADAXA","150MG","60","Select","Select",""],["","69315011710","FUROSEMIDE","40MG","45","Select","Select",""],["","65862056099","PANTOPRAZOLE","40MG","90","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","-1","Select","Select",""],["","64380073706","VITAMIN","50000UNT","12","Select","Select",""],["","00185505001","METOLAZONE","2.5MG","6","Select","Select",""],["","68180097201","LEVOTHYROXIN","137MCG","90","Select","Select",""],["","61874007560","VIBERZI","75MG","60","Select","Select",""],["","16729021815","CLOPIDOGREL","75MG","90","Select","Select",""],["","23155050001","HYDROXYZ ","TAB 10MG","15","Select","Select",""],["","00054001729","PREDNISONE ","TAB 10MG","20","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":""}]}]}