{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HILDA RUNION","gend":1,"add":"218 BROADWAY AVE","city":"BROADWAY","state":"VA","zip":"22815-9998","dob":"1932-12-08","age":"","mstatus":"","insh":"900042028*01","cliId":"8P94KV2FJ74","pno":"540\/896-5525","cno":"540\/896-5525","email":"","ename":"","eno":"","pphy":"HALEY, JAMES A MD","ppno":"540\/433-3344","pcpadd":"1751 ERICKSON AVE","pcpcity":"HARRISONBURG","pcpstate":"VA","pcpzip":22801,"pcpcounty":"","pcpid":972968,"pcpname":"Rockingham Family Physicians, PC","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/433-0031","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M17.0","M25.561","M25.562","R26.2","M62.81","E03.9","N18.32","M48.061","M54.5","M51.16","M54.16","M48.062","M51.36","I10.","I70.1","E78.9","E55.9","F32.9","E78.01","G47.00","M47.817","M41.86","Z79.899","R10.31","D63.1","N26.1","K57.30","K80.20","I51.7","R93.5","M89.49","Z96.1","H40.053","G89.29","M17.12","M17.11","M23.222","M19.90","E03.8","M54.59"],"date":["2021-01-05","2021-08-18","2021-10-13","2021-01-05","2021-01-05","2021-04-21","2021-06-07","2021-10-20","2021-08-18","2021-03-05","2021-10-20","2021-03-24","2021-04-21","2021-09-07","2021-06-07","2021-04-21","2021-06-07","2021-09-07","2021-09-07","2021-09-07","2021-01-27","2021-03-05","2021-10-20","2021-06-07","2021-04-21","2021-06-07","2021-06-01","2021-09-07","2021-06-01","2021-06-01","2021-01-26","2021-06-09","2021-06-09","2021-07-19","2021-10-13","2021-08-18","2021-07-19","2021-09-07","2021-09-07","2021-10-20"],"priorHcc":["","",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":[["","42806054701","VITAMIN ","1.25MG","13","Select","Select",""],["","67877026410","DULOXETINE ","30MG","30","Select","Select",""],["","13668000805","ZOLPIDEM ","10MG","30","Select","Select",""],["","00781518010","LEVOTHYROXIN ","25MCG","90","Select","Select",""],["","00093729501","CARVEDILOL ","12.5MG","180","Select","Select",""],["","00093505898","ATORVASTATIN ","40MG","-90","Select","Select",""],["","68382009906","PAROXETINE ","30MG","90","Select","Select",""],["","42858075040","BUPRENORPHIN ","5MCG\/HR","4","Select","Select",""],["","72205001190","PREGABALIN ","25MG","60","Select","Select",""],["","43547040111","FUROSEMIDE ","20MG","90","Select","Select",""],["","68645051554","AMLODIPINE ","5MG","90","Select","Select",""],["","31722099601","HYDROCO\/APAP ","5-325MG","15","Select","Select",""],["","72305002530","EUTHYROX ","25MCG","-90","Select","Select",""],["","42806054701","","1.25MG","13","Select","Select",""],["","42806054701","VITAMIN","1.25MG","13","Select","Select",""],["","00093729501","CARVEDILOL","12.5MG","180","Select","Select",""],["","00781518010","LEVOTHYROXIN","25MCG","90","Select","Select",""],["","13668000805","ZOLPIDEM","10MG","30","Select","Select",""],["","00093505898","ATORVASTATIN","40MG","90","Select","Select",""],["","68382009906","PAROXETINE","30MG","90","Select","Select",""],["","57237001899","DULOXETINE","30MG","180","Select","Select",""],["","42858075040","BUPRENORPHIN","5MCG\/HR","4","Select","Select",""],["","72205001190","PREGABALIN","25MG","60","Select","Select",""],["","68645051554","AMLODIPINE","5MG","90","Select","Select",""],["","72305002530","EUTHYROX","25MCG","-90","Select","Select",""],["","31722099601","HYDROCO\/APAP","5-325MG","15","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","43547040111","FUROSEMIDE","20MG","90","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","49281012165","FLUZONE ","INJ 2021-22","1","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","",""],["Yes","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":""}]}]}