{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GARY   L PANNELL","gend":0,"add":"504 WARREN AVE","city":"LYNCHBURG","state":"VA","zip":"24501-9998","dob":"1954-10-20","age":"","mstatus":"","insh":"900042492*01","cliId":"","pno":"434\/426-7558","cno":"","email":"","ename":"","eno":"","pphy":"FQHC-ACCESS NETWORK, COMMUNITY FQHC","ppno":"434\/200-3366","pcpadd":"800 5TH STREET","pcpcity":"LYNCHBURG","pcpstate":"VA","pcpzip":24504,"pcpcounty":"","pcpid":"","pcpname":"COMMUNITY ACCESS NETWORK","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/200-3106","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.5","D12.4","M54.9","M79.605","M79.604","M47.816","M47.817","F43.0","M54.16","M54.17","M51.36","M51.37","M43.06","M43.07","I10.","Z68.31","K92.1","M62.830","M54.06","R20.1","R15.9","R19.4","R32.","E78.2","F32.9","F41.1","I70.0","G83.4","S39.92XA","K64.8","K57.30","G47.00","M89.49","F41.9","R06.00","M47.26","Z71.9","M51.26","M51.27"],"date":["2021-07-02","2021-07-28","2021-06-22","2021-06-22","2021-07-07","2021-12-15","2021-12-01","2021-12-15","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2021-07-07","2021-07-07","2021-09-29","2021-07-28","2021-07-28","2021-11-10","2021-11-10","2021-11-10","2021-05-13","2021-07-27","2021-07-02","2021-09-29","2021-09-29","2021-09-29","2021-09-29","2021-09-29","2021-04-27","2021-07-28","2021-07-28","2021-05-13","2021-05-13","2021-05-13","2021-05-13","2021-06-22","2021-06-29","2021-04-27","2021-04-27"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","60432026415","FLUTICASONE PROPIONATE                                                ","50MCG","48","Select","Select",""],["","57237017190","ROSUVASTATIN CALCIUM                                                  ","40MG","90","Select","Select",""],["","68180051902","LISINOPRIL\/HYDROCHLOROTHIAZIDE                                        ","20-12.5","90","Select","Select",""],["","68382080601","TRAZODONE HYDROCHLORIDE                                               ","100MG","90","Select","Select",""],["","29300012510","MELOXICAM                                                             ","15MG","90","Select","Select",""],["","61442010310","DICLOFENAC SODIUM DR                                                  ","75MG DR","60","Select","Select",""],["","00527133010","BACLOFEN                                                              ","10MG","90","Select","Select",""],["","43547028111","ESCITALOPRAM OXALATE                                                  ","10MG","90","Select","Select",""],["","43547040011","CYCLOBENZAPRINE HYDROCHLORIDE                                         ","10MG","30","Select","Select",""],["","00904674880","BISACODYL EC                                                          ","5MG EC","2","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA                                                 ","HFA","8","Select","Select",""],["","76385012301","METHOCARBAMOL                                                         ","500MG","60","Select","Select",""],["","51991096257","POLYETHYLENE GLYCOL 3350                                              ","3350 NF","510","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}