{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CATHY   L ATWELL","gend":1,"add":"3371 CAVERNS DR","city":"KEEZLETOWN","state":"VA","zip":"22832-9998","dob":"1963-04-19","age":"","mstatus":"","insh":"900044561*01","cliId":"8V45FC2WC64","pno":"540\/246-1182","cno":"540\/246-1182","email":"","ename":"","eno":"","pphy":"DESROCHERS, DANIELLE MD","ppno":"540\/743-2887","pcpadd":"135 MEMORIAL DRIVE","pcpcity":"LURAY","pcpstate":"VA","pcpzip":22835,"pcpcounty":"","pcpid":104675,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/743-1288","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z00.00","G21.11","F20.89","M41.34","F79.","N39.0","Z79.899","F20.9","Z12.31","K56.609","N94.89","Z11.59","J69.0","A41.9","J96.01","N17.9","E86.0","R79.89","R65.20","Z46.82","K59.89","K63.89","Z66.","K56.600","E87.2","I24.8","T43.505A","D28.7","E87.6","E83.39","I95.1","M54.2","M79.606","R40.0","R26.89","K11.7","M79.89","R11.2","R19.7","K60.0","J98.4","R07.9","R10.84","R09.02","R00.0","R42.","N83.209","Z01.411","N83.8","N83.9"],"date":["2021-02-02","2021-06-26","2021-05-06","2021-02-02","2021-02-02","2021-03-22","2021-10-05","2021-06-15","2021-06-01","2021-07-08","2021-08-24","2021-07-08","2021-08-03","2021-06-26","2021-10-26","2021-06-26","2021-06-26","2021-06-26","2021-06-26","2021-06-28","2021-06-28","2021-06-28","2021-06-26","2021-07-08","2021-06-26","2021-06-26","2021-06-26","2021-06-26","2021-06-26","2021-06-26","2021-06-26","2021-06-26","2021-05-06","2021-05-06","2021-05-06","2021-05-06","2021-05-06","2021-07-01","2021-07-01","2021-06-27","2021-06-26","2021-06-26","2021-06-26","2021-06-26","2021-06-26","2021-10-13","2021-11-03","2021-11-03","2021-11-03","2021-11-03"],"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":[["","62559015901","FLUVOXAMINE","TAB 50MG","-30","Select","Select",""],["","185012201","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","16729014216","CLOZAPINE","TAB 100MG","140","Select","Select",""],["","16729014216","CLOZAPINE ","","140","Select","Select",""],["","62559015901","FLUVOXAMINE MALEATE","","-30","Select","Select",""],["","185012201","NITROFURANTOIN MONOHYDRATE","","10","Select","Select",""],["","42571016201","AMOXICILLIN\/CLAVULANATE POTASSIUM","","4","Select","Select",""],["","62559015901","FLUVOXAMINE MALEATE                                                   ","TAB 50MG","30","Select","Select",""],["","00185012201","NITROFURANTOIN MONOHYDRATE                                            ","CAP 100MG","10","Select","Select",""],["","16729014216","CLOZAPINE                                                             ","TAB 100MG","140","Select","Select",""],["","42571016201","AMOXICILLIN\/CLAVULANATE POTASSIUM                                     ","TAB 875-125","4","Select","Select",""],["","00536101801","TRAVEL SICKNESS                                                       ","CHW 25MG","30","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","",""],["Yes","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":""}]}]}