{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMANDA   K THORN","gend":1,"add":"324 WESTWOOD BLVD","city":"STAUNTON","state":"VA","zip":"24401-9998","dob":"1987-10-09","age":"","mstatus":"","insh":"1959031*01","cliId":"","pno":"540\/280-9070","cno":"540\/280-9070","email":"","ename":"","eno":"","pphy":"HAGA, DAVID MD","ppno":"434\/338-7780","pcpadd":"118 OAKWOOD DR","pcpcity":"MADISON HEIGHTS","pcpstate":"VA","pcpzip":24572,"pcpcounty":"","pcpid":210259,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","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":["M54.12","Z87.891","R22.31","M79.601","M75.41","Z00.00","M25.511","F33.42","F42.9","Z87.59","Z23.","N39.0","R51.","J31.0","Z01.419","J32.9","H92.09","F31.9","G47.00","Z11.51","Z11.8","Z11.3","F33.1","K21.9","G25.81"],"date":["2020-09-08","2020-09-08","2020-09-08","2020-09-08","2020-10-08","2021-02-16","2021-02-16","2020-01-15","2021-04-15","2020-09-29","2020-09-29","2020-01-02","2020-01-02","2020-08-31","2020-12-09","2020-08-31","2020-08-31","2020-10-05","2021-05-04","2020-12-09","2020-12-09","2020-12-09","2021-04-15","2021-05-04","2021-05-04"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","65862007701","CIPROFLOXACN","500MG","14","Select","Select",""],["","65862019405","FLUOXETINE","40MG","30","Select","Select",""],["","43547030403","ARIPIPRAZOLE","10MG","-30","Select","Select",""],["","00603533831","PREDNISONE","10MG","-48","Select","Select",""],["","68382080601","TRAZODONE","100MG","90","Select","Select",""],["","49281072010","FLUBLOK","2020-21","0","Select","Select",""],["","65162083366","DICLOFENAC","1%","100","Select","Select",""],["","42806016105","HYDROXYZ","50MG","30","Select","Select",""],["","16729003415","LETROZOLE","2.5MG","5","Select","Select",""],["","62175061743","PANTOPRAZOLE","40MG","30","Select","Select",""],["","72305002530","EUTHYROX","25MCG","30","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","00143924920","AMOX\/K","875-125","14","Select","Select",""],["","69097084507","CYCLOBENZAPR","5MG","21","Select","Select",""],["","00378180510","LEVOTHYROXIN","75MCG","30","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","49884070155","CLOMIPHENE","50MG","5","Select","Select",""],["","00555077902","MEDROXYPR","10MG","10","Select","Select",""],["","65862007701","CIPROFLOXACN ","500MG","14","Select","Select",""],["","65862019405","FLUOXETINE ","40MG","30","Select","Select",""],["","43547030403","ARIPIPRAZOLE ","10MG","30","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","69097084507","CYCLOBENZAPR ","5MG","21","Select","Select",""],["","00143924920","AMOX\/K ","875-125","14","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","65162083366","DICLOFENAC ","1%","100","Select","Select",""],["","50111043301","TRAZODONE ","50MG","60","Select","Select",""],["","00603533831","PREDNISONE ","10MG","48","Select","Select",""],["","49281072010","FLUBLOK ","2020-21","0","Select","Select",""],["","49884070155","CLOMIPHENE ","50MG","5","Select","Select",""],["","00555077902","MEDROXYPR ","10MG","10","Select","Select",""],["","72305002530","EUTHYROX ","25MCG","30","Select","Select",""],["","59651018030","LETROZOLE ","2.5MG","5","Select","Select",""],["","42806016105","HYDROXYZ ","50MG","30","Select","Select",""],["","00527495432","LEVOTHYROXIN ","75MCG","30","Select","Select",""],["","62175061743","PANTOPRAZOLE ","40MG","30","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","",""],["No","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":""}]}]}