{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WILLIAM MAY","gend":0,"add":"9740 COAL RUN LN","city":"DAYTON","state":"VA","zip":"22821-9998","dob":"1962-09-01","age":"","mstatus":"","insh":"1455086*01","cliId":"","pno":"540\/908-1649","cno":"540\/908-1649","email":"","ename":"","eno":"","pphy":"MORGAN, ALAN J MD","ppno":"540\/564-7300","pcpadd":"1661 S MAIN ST","pcpcity":"HARRISONBURG","pcpstate":"VA","pcpzip":22801,"pcpcounty":"","pcpid":188285,"pcpname":"SRMHMG - Sentara South Main Health Center","plan":"OHP","program":"ACA","lob":"Small Group","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/431-7100","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C44.529","D04.5","R30.0","N20.1","R26.2","M62.81","R27.8","D48.5","D22.5","L82.1","Z85.820","L82.0","R10.9","R82.998","I69.351","Z23.","I69.398","C43.59","G40.909","F32.0","R25.2","N28.89","Z85.828","Z87.891","Z79.899","Z88.1","R11.10","K80.20","R31.9","N28.1","N13.30","K76.9","Z87.442","N28.9","R25.9","Z79.82","Z12.11","G24.8","M79.671","M67.01","M21.371","I63.412","I69.320","I69.390","E78.5","Z12.5","C44.319"],"date":["2020-08-12","2020-08-12","2020-09-02","2020-10-21","2021-07-06","2021-07-06","2020-03-12","2021-10-13","2021-07-19","2021-10-13","2021-07-19","2021-10-13","2020-06-25","2020-06-25","2021-10-08","2021-10-08","2021-11-10","2020-11-05","2021-11-10","2021-10-08","2021-11-10","2020-09-28","2021-07-19","2020-09-28","2021-02-16","2020-09-28","2020-09-28","2020-09-11","2020-09-11","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2020-01-14","2021-02-16","2021-10-08","2021-06-18","2021-06-21","2021-06-21","2021-06-21","2021-11-10","2021-10-08","2021-09-02","2021-10-08","2021-10-08","2021-10-13"],"priorHcc":["","","","","","","",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":[["","00832105410","BACLOFEN","10MG","240","Select","Select",""],["","13668013701","ESCITALOPRAM","20MG","90","Select","Select",""],["","70377000812","ROSUVASTATIN","20MG","90","Select","Select",""],["","00093010901","CARBAMAZEPIN","200MG","75","Select","Select",""],["","57237001401","TAMSULOSIN","0.4MG","30","Select","Select",""],["","00054023525","MORPHINE","15MG","6","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","00832105410","BACLOFEN ","10MG","240","Select","Select",""],["","00093010901","CARBAMAZEPIN ","200MG","225","Select","Select",""],["","70377000812","ROSUVASTATIN ","20MG","90","Select","Select",""],["","13668013701","ESCITALOPRAM ","20MG","90","Select","Select",""],["","57237001401","TAMSULOSIN ","0.4MG","30","Select","Select",""],["","00054023525","MORPHINE ","15MG","6","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","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","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","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":""}]}]}