{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KATHLEEN   A SWARTZ","gend":1,"add":"501 VES RD APT C401","city":"LYNCHBURG","state":"VA","zip":"24503-9998","dob":"1948-06-19","age":"","mstatus":"","insh":"900044484*01","cliId":"1A32WT8DE05","pno":"434\/386-3942","cno":"434\/386-3942","email":"","ename":"","eno":"","pphy":"LORD, ARCHIBALD MD","ppno":"434\/534-6868","pcpadd":"1088 LONDON LINKS RD","pcpcity":"FOREST","pcpstate":"VA","pcpzip":24551,"pcpcounty":"","pcpid":210259,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"MA-NON DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/534-8808","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H25.11","H26.492","H35.3132","H35.371","E03.9","E55.9","E78.2","E11.40","N30.40","N30.20","N13.30","N32.81","E11.9","K58.0","M79.7","Z71.9","R31.9","N13.2","N13.1","N20.0","N28.82","N28.1","K63.89","R30.0","R39.89","G25.0","N13.39","Z85.41","Z92.3","N13.4","K86.89","D35.02","R14.0"],"date":["2021-04-14","2021-04-29","2021-03-05","2021-03-05","2021-08-10","2021-05-03","2021-08-10","2021-08-10","2021-01-12","2021-01-12","2021-01-12","2021-02-04","2021-02-22","2021-08-19","2021-08-19","2021-08-19","2021-07-20","2021-07-20","2021-07-20","2021-01-06","2021-01-06","2021-01-06","2021-01-06","2021-02-16","2021-02-16","2021-03-09","2021-03-22","2021-03-22","2021-03-22","2021-02-05","2021-02-05","2021-02-05","2021-08-19"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","068462010340","FLUCONAZOLE ","150MG","1","Select","Select",""],["","023155010210","METFORMIN ","500MG","360","Select","Select",""],["","057237001999","DULOXETINE ","60MG","90","Select","Select",""],["","016729000316","GLIMEPIRIDE ","4MG","90","Select","Select",""],["","023155048901","DESMOPRESSIN ","0.1MG","180","Select","Select",""],["","061314063705","PREDNISOLONE ","1% OP","5","Select","Select",""],["","069238183007","LEVOTHYROXIN ","25MCG","90","Select","Select",""],["","064980051505","OFLOXACIN ","0.3% OP","5","Select","Select",""],["","000603548432","PROPRANOLOL ","40MG","90","Select","Select",""],["","065162037210","OXYBUTYNIN ","10MG ER","30","Select","Select",""],["","043386033001","TRIMETHOPRIM ","100MG","5","Select","Select",""],["","057237007710","ONDANSETRON ","4MG ODT","10","Select","Select",""],["","065862042001","SMZ\/TMP ","800-160","10","Select","Select",""],["","024208060203","PROLENSA ","0.07%","-3","Select","Select",""],["","50111056101","TRAZODONE ","100MG","30","Select","Select",""],["","65862042001","","800-160","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}