{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RHONDA   M EBELT","gend":1,"add":"309 IRIS LN","city":"DANVILLE","state":"VA","zip":"24540-9998","dob":"1962-02-06","age":"","mstatus":"","insh":"900047544*01","cliId":"8KY3H79RC09","pno":"434\/473-2867","cno":"434\/473-2867","email":"","ename":"","eno":"","pphy":"LAHURD, NEIL J DO","ppno":"434\/835-4876","pcpadd":"949 PINEY FOREST ROAD","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"pcpcounty":"","pcpid":185602,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R06.00","R91.8","J44.9","R47.02","J04.0","R53.83","L65.9","L60.3","B37.9","R13.10","R49.8","R07.0","R05.","R09.81","R73.09","Z79.899","Z13.29","E78.5","E78.01","E55.9","R49.0","B37.89","K21.9","R06.02","Z72.0","J44.1","Z20.822","I10.","J20.9","J45.50","J43.2","J47.9","F17.210","F41.9","Z88.2","R00.0","F17.290","Z76.89","J44.0","J96.21","Z99.81","E78.2","R00.2","Z79.51","Z23.","R06.2","J96.01"],"date":["2021-04-27","2021-10-04","2021-10-14","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-06-29","2021-06-29","2021-08-24","2021-06-29","2021-07-13","2021-10-04","2021-07-13","2021-10-07","2021-07-13","2021-07-13","2021-10-04","2021-08-19","2021-08-19","2021-10-04","2021-08-27","2021-10-04","2021-10-04","2021-10-07","2021-10-04","2021-08-24","2021-08-27","2021-08-27","2021-10-04","2021-09-23","2021-10-04","2021-10-14","2021-10-14","2021-10-14","2021-10-07","2021-10-04","2021-10-04","2021-10-04","2021-10-04","2021-10-04","2021-10-04","2021-10-04","2021-10-07"],"priorHcc":["",null,null,"","","","","","","","","",null,"","",null,"",null,"","",null,"","",null,null,null,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":[["","378064205","PREDNISONE","TAB 20MG","15","Select","Select",""],["","65162005703","RALOXIFENE","TAB 60MG","90","Select","Select",""],["","51991074890","DULOXETINE","CAP 60MG","90","Select","Select",""],["","378699152","ALBUTEROL","NEB 0.63MG\/3","75","Select","Select",""],["","69452015120","VITAMIN D","CAP 50000UNT","12","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","173088210","BREO ELLIPTA","INH 200-25","60","Select","Select",""],["","378699152","ALBUTEROL SULFATE","","75","Select","Select",""],["","65862057490","MONTELUKAST SODIUM ","","90","Select","Select",""],["","69097014260","ALBUTEROL SULFATE HFA","","7","Select","Select",""],["","65162005703","RALOXIFENE HYDROCHLORIDE","","90","Select","Select",""],["","69452015120","VITAMIN D ","","12","Select","Select",""],["","173088710","TRELEGY ELLIPTA ","","60","Select","Select",""],["","51991074890","DULOXETINE HYDROCHLORIDE","","90","Select","Select",""],["","65862057490","MONTELUKAST SODIUM","","90","Select","Select",""],["","00173088710","TRELEGY ELLIPTA","","60","Select","Select",""],["","65862053750","LEVOFLOXACIN","","7","Select","Select",""],["","60432053760","NYSTATIN","100000","120","Select","Select",""],["","70377002711","ATORVASTATIN CALCIUM","10MG","-90","Select","Select",""],["","59651000305","OMEPRAZOLE DR","40MG","30","Select","Select",""],["","68180021509","LOSARTAN POTASSIUM\/HYDROCHLOROTHIAZIDE","50-12.5","90","Select","Select",""],["","65862057490","MONTELUKAST SODIUM                                                    ","TAB 10MG","90","Select","Select",""],["","00173088710","TRELEGY ELLIPTA                                                       ","AER ELLIPTA","60","Select","Select",""],["","00378699152","ALBUTEROL SULFATE                                                     ","NEB 0.63MG\/3","75","Select","Select",""],["","00173088210","BREO ELLIPTA                                                          ","INH 200-25","60","Select","Select",""],["","69097014260","ALBUTEROL SULFATE HFA                                                 ","AER HFA","7","Select","Select",""],["","00378064205","PREDNISONE                                                            ","TAB 20MG","15","Select","Select",""],["","65162005703","RALOXIFENE HYDROCHLORIDE                                              ","TAB 60MG","90","Select","Select",""],["","70377002711","ATORVASTATIN CALCIUM                                                  ","TAB 10MG","90","Select","Select",""],["","51991074890","DULOXETINE HYDROCHLORIDE                                              ","CAP 60MG","90","Select","Select",""],["","68180021509","LOSARTAN POTASSIUM\/HYDROCHLOROTHIAZIDE                                ","TAB 50-12.5","90","Select","Select",""],["","65862053750","LEVOFLOXACIN                                                          ","TAB 500MG","7","Select","Select",""],["","60432053760","NYSTATIN                                                              ","SUS 100000","-120","Select","Select",""],["","59651000305","OMEPRAZOLE DR                                                         ","CAP 40MG","30","Select","Select",""],["","68180030360","CEFUROXIME AXETIL                                                     ","TAB 500MG","14","Select","Select",""],["","69452015120","VITAMIN D                                                             ","CAP 50000UNT","12","Select","Select",""],["","27241011804","FENOFIBRATE MICRONIZED                                                ","CAP 67MG","30","Select","Select",""],["","50111056001","TRAZODONE HYDROCHLORIDE                                               ","TAB 50MG","90","Select","Select",""],["","60432045516","HYDROCODONE\/HOMATROPINE                                               ","SYP 5-1.5\/5","120","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":""}]}]}