{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DONNA   H LAWSON","gend":1,"add":"639 SPENCER RD","city":"CONCORD","state":"VA","zip":"24538-9998","dob":"1970-12-19","age":"","mstatus":"","insh":"1736037*02","cliId":"","pno":"434\/993-3366","cno":"434\/993-3366","email":"","ename":"","eno":"","pphy":"PHYSICIAN, PRIMARY CARE (MISC)","ppno":"","pcpadd":"4417 CORPORATION LN","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":799999,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"434\/665-7079","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":["G47.33","M47.817","M79.642","M17.0","M25.541","G89.4","Z79.899","Z20.828","R07.9","R04.2","M25.571","J40.","K50.90","I10.","Z88.1","Z88.5","R10.31","R05.","Z12.11","K50.10","K63.5","R11.0","R53.83","J02.9","Z01.411","F33.9","F39.","Z03.89","R07.89","R06.00","Z86.16","Z82.49","K63.89","K64.8","Z11.1","N39.0","K50.80","Z71.9","G57.12","R00.0","Z01.419"],"date":["2021-09-30","2021-11-15","2021-08-25","2021-08-25","2021-11-15","2021-11-15","2021-11-15","2021-05-18","2021-01-18","2020-01-27","2021-11-15","2020-04-08","2021-09-30","2021-09-30","2021-01-18","2021-01-18","2020-07-15","2020-12-21","2021-02-22","2021-02-22","2021-02-22","2021-01-18","2020-01-27","2020-01-27","2020-02-17","2020-07-21","2021-01-11","2021-01-11","2021-01-18","2021-01-18","2021-01-18","2021-09-30","2021-02-22","2021-02-22","2020-01-27","2020-07-22","2021-02-12","2021-02-12","2021-11-15","2021-09-30","2021-09-30"],"priorHcc":[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":[["","68001016200","PROMETHAZINE","25MG","90","Select","Select",""],["","00406012510","HYDROCO\/APAP","10-325MG","150","Select","Select",""],["","29300016815","TIZANIDINE","2MG","90","Select","Select",""],["","00074024302","HUMIRA","40\/0.4ML","2","Select","Select",""],["","69452015120","VITAMIN","50000UNT","12","Select","Select",""],["","67877057305","BENZONATATE","100MG","30","Select","Select",""],["","43547028910","BUPROPION","150MG SR","60","Select","Select",""],["","65862064130","AZITHROMYCIN","250MG","6","Select","Select",""],["","68180051901","LISINOP\/HCTZ","20-12.5","60","Select","Select",""],["","65862001905","CEPHALEXIN","500MG","21","Select","Select",""],["","68001038700","TRIAMT\/HCTZ","37.5-25","30","Select","Select",""],["","00904675816","ROBAFEN","10-100MG","240","Select","Select",""],["","68001024617","ONDANSETRON","4MG ODT","-180","Select","Select",""],["","59746017310","PREDNISONE","10MG","48","Select","Select",""],["","68180021509","LOSARTAN\/HCT","50-12.5","30","Select","Select",""],["","60432060616","PROMETH\/COD","6.25-10","180","Select","Select",""],["","68001025320","FLUCONAZOLE","150MG","3","Select","Select",""],["","10702001150","HYDROXYZ","25MG","15","Select","Select",""],["","69367016304","PHENAZOPYRID","200MG","12","Select","Select",""],["","52268001201","SUPREP","PREP KIT","354","Select","Select",""],["","00054350049","LIDOCAINE","2% VISC","150","Select","Select",""],["","29300016815","TIZANIDINE ","2MG","-30","Select","Select",""],["","00074055402","HUMIRA ","40\/0.4ML","2","Select","Select",""],["","43547028910","BUPROPION ","150MG SR","-60","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","12","Select","Select",""],["","68001016200","PROMETHAZINE ","25MG","90","Select","Select",""],["","68001024617","ONDANSETRON ","4MG ODT","240","Select","Select",""],["","00406012510","HYDROCO\/APAP ","10-325MG","150","Select","Select",""],["","67877057305","BENZONATATE ","100MG","30","Select","Select",""],["","65862064130","AZITHROMYCIN ","250MG","6","Select","Select",""],["","68180021509","LOSARTAN\/HCT ","50-12.5","30","Select","Select",""],["","00904675816","ROBAFEN ","10-100MG","240","Select","Select",""],["","59746017306","PREDNISONE ","10MG","70","Select","Select",""],["","10702001150","HYDROXYZ ","25MG","15","Select","Select",""],["","68180051902","LISINOP\/HCTZ ","20-12.5","60","Select","Select",""],["","69367016304","PHENAZOPYRID ","200MG","12","Select","Select",""],["","00054350049","LIDOCAINE ","2% VISC","150","Select","Select",""],["","52268001201","SUPREP ","PREP KIT","-354","Select","Select",""],["","65862001905","CEPHALEXIN ","500MG","21","Select","Select",""],["","68001038700","TRIAMT\/HCTZ ","37.5-25","30","Select","Select",""],["","60432060616","PROMETH\/COD ","6.25-10","180","Select","Select",""],["","68001025320","FLUCONAZOLE ","150MG","3","Select","Select",""],["","68001045600","ESCITALOPRAM","20MG","90","Select","Select",""],["","68001035600","METOPROL","25MG ER","30","Select","Select",""],["","68001035600","METOPROL ","TAB 25MG ER","30","Select","Select",""],["","68001045600","ESCITALOPRAM ","TAB 20MG","90","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":""}]}]}