{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"YVONNE   R CSASZAR","gend":1,"add":"165 BRUSH ARBOR CT","city":"DANVILLE","state":"VA","zip":"24540-9998","dob":"1948-04-01","age":"","mstatus":"","insh":"900045381*01","cliId":"4JG6F61DD46","pno":"434\/857-2939","cno":"434\/857-2939","email":"","ename":"","eno":"","pphy":"PRUITT, DAVID E MD","ppno":"434\/315-5340","pcpadd":"935 SOUTH MAIN STREET","pcpcity":"FARMVILLE","pcpstate":"VA","pcpzip":23901,"pcpcounty":"","pcpid":182209,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/315-2059","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E03.9","E55.9","E78.5","I10.","C50.919","R59.9","K59.9"],"date":["2021-03-18","2021-09-23","2021-09-23","2021-09-23","2021-10-06","2021-10-06","2021-10-06"],"priorHcc":["",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":[["","000254200801","COLCHICINE ","0.6MG","10","Select","Select",""],["","070377002811","ATORVASTATIN ","20MG","90","Select","Select",""],["","051991074890","DULOXETINE ","60MG","90","Select","Select",""],["","060505025203","TIZANIDINE ","4MG","180","Select","Select",""],["","069097081507","GABAPENTIN ","400MG","60","Select","Select",""],["","000245531911","KLOR-CON ","20MEQ ER","90","Select","Select",""],["","070710120901","ALLOPURINOL ","100MG","90","Select","Select",""],["","000378021610","FUROSEMIDE ","40MG","90","Select","Select",""],["","000469260130","MYRBETRIQ ","25MG","30","Select","Select",""],["","047781030301","NITROFURANTN ","100MG","14","Select","Select",""],["","00254200801","","0.6MG","-10","Select","Select",""],["","00469260130","MYRBETRIQ","25MG","30","Select","Select",""],["","00254200801","COLCHICINE","0.6MG","10","Select","Select",""],["","70377002811","ATORVASTATIN","20MG","-90","Select","Select",""],["","60505025203","TIZANIDINE","4MG","180","Select","Select",""],["","47781030301","NITROFURANTN","100MG","14","Select","Select",""],["","69097081507","GABAPENTIN","400MG","60","Select","Select",""],["","00378021610","FUROSEMIDE","40MG","90","Select","Select",""],["","55111072901","ALLOPURINOL","100MG","-90","Select","Select",""],["","00245531911","KLOR-CON","20MEQ ER","90","Select","Select",""],["","51991074890","DULOXETINE","60MG","90","Select","Select",""],["","65862084003","MOXIFLOXACIN","HCL 0.5%","3","Select","Select",""],["","65862084003","MOXIFLOXACIN ","SOL HCL 0.5%","3","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":""}]}]}