{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HEATHER   M BROOKS","gend":1,"add":"40 MORTON CREEK ROAD","city":"LYNCHBURG","state":"VA","zip":"24504-9998","dob":"1997-06-24","age":"","mstatus":"","insh":"1973796*02","cliId":"","pno":"434\/841-4973","cno":"434\/841-4973","email":"","ename":"","eno":"","pphy":"BEVERLY, WALTER MD","ppno":"434\/332-7367","pcpadd":"925 VILLAGE HWY","pcpcity":"RUSTBURG","pcpstate":"VA","pcpzip":24588,"pcpcounty":"","pcpid":105680,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"434\/401-4773","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":["F33.9","R59.0","R53.83","R60.1","R20.0","R00.0","K58.9","R10.2","G60.0","R10.32","M79.642","R76.8","R52.","H10.45","J30.9","J30.89","J30.2","R06.02","R06.2","J30.1","R59.9","F41.8","M35.00","L29.9","L85.3","R42.","R07.89","G71.00","R10.13","R11.2","N94.89","K29.50","K31.89","G43.009","M62.838","N94.10","D69.6","K21.9","Z88.0","Z88.8","Z79.899","R10.30","R11.0","Z71.9","F41.1","S93.601A","M79.671","K59.00","E28.2","E78.2","M79.7","R10.9","S60.222A","H93.13","F32.9","F41.9","R00.2","R30.0","K58.2","I49.9","J02.0","Z20.828","R10.31","F90.0","H93.19","R10.33","R12.","M89.8X8","G43.709","S93.601D","R41.840","K37.","H04.123","K62.5","I10.","G71.09","R14.0","M41.9","R10.84","M41.25","M54.6","Z87.39","M41.115","M79.18","Z20.822","R05.9","Z00.01","Z13.29","Z13.220"],"date":["2021-10-27","2020-05-26","2020-05-26","2020-05-26","2020-05-26","2020-07-27","2021-06-24","2021-07-22","2021-10-28","2020-09-10","2021-03-05","2021-03-24","2021-04-20","2020-05-21","2020-05-21","2020-05-21","2020-05-21","2020-05-21","2020-05-21","2020-05-21","2020-05-28","2020-06-17","2020-06-17","2020-06-17","2020-06-17","2020-03-20","2020-01-07","2020-01-07","2021-08-25","2021-06-24","2020-09-16","2021-08-25","2021-01-22","2021-10-13","2021-04-01","2021-06-03","2021-06-03","2021-06-03","2021-07-16","2021-06-03","2021-06-24","2020-12-21","2021-01-18","2021-08-25","2020-03-03","2020-06-04","2020-07-16","2021-08-25","2020-12-21","2021-07-16","2020-12-21","2021-07-16","2021-03-05","2020-03-20","2020-03-20","2020-03-20","2020-08-07","2020-08-14","2021-09-24","2021-01-22","2021-02-03","2021-04-20","2021-06-03","2021-06-21","2020-02-27","2021-01-18","2021-01-18","2021-06-03","2020-01-15","2020-07-16","2021-06-16","2020-01-24","2021-11-18","2021-06-24","2021-06-24","2021-11-12","2021-08-25","2021-11-03","2021-07-16","2021-11-03","2021-11-03","2021-11-03","2021-11-03","2021-11-03","2021-10-23","2021-10-23","2021-09-24","2021-09-24","2021-09-24"],"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":[["","00093031401","KETOROLAC ","10MG","20","Select","Select",""],["","52817031910","BACLOFEN ","5MG","60","Select","Select",""],["","59762040101","SUCRALFATE ","1GM","120","Select","Select",""],["","43199001301","HYOSCYAMINE ","0.125MG","60","Select","Select",""],["","52268001201","SUPREP ","PREP KIT","-354","Select","Select",""],["","65862018830","ONDANSETRON ","8MG","15","Select","Select",""],["","65862014736","SUMATRIPTAN ","50MG","9","Select","Select",""],["","31722072690","MONTELUKAST ","10MG","30","Select","Select",""],["","68382009705","PAROXETINE ","10MG","30","Select","Select",""],["","60505084805","AZELASTINE ","0.15%","30","Select","Select",""],["","00115165901","PROPRANOLOL ","10MG","-90","Select","Select",""],["","52817033010","CYCLOBENZAPR ","5MG","60","Select","Select",""],["","00456111030","VIIBRYD ","10MG","-14","Select","Select",""],["","00143980350","DOXYCYCL ","100MG","28","Select","Select",""],["","00054429731","FUROSEMIDE ","20MG","15","Select","Select",""],["","65649000330","TRULANCE ","3MG","90","Select","Select",""],["","59651000101","OMEPRAZOLE ","10MG","60","Select","Select",""],["","49884068905","METOCLOPRAM ","10MG","10","Select","Select",""],["","65862001705","AMOXICILLIN ","500MG","20","Select","Select",""],["","68382009601","HYDROXYCHLOR ","200MG","90","Select","Select",""],["","00406012405","HYDROCO\/APAP ","7.5-325","-15","Select","Select",""],["","11523723403","MIRALAX ","3350 NF","-238","Select","Select",""],["","45802086802","POLYETH ","3350 NF","238","Select","Select",""],["","00093031401","KETOROLAC","10MG","20","Select","Select",""],["","00456120330","LINZESS ","72MCG","30","Select","Select",""],["","52817031910","BACLOFEN","5MG","60","Select","Select",""],["","59762040101","SUCRALFATE","1GM","-120","Select","Select",""],["","52268001201","SUPREP","PREP KIT","-354","Select","Select",""],["","43199001301","HYOSCYAMINE","0.125MG","60","Select","Select",""],["","65862018830","ONDANSETRON","8MG","15","Select","Select",""],["","31722072690","MONTELUKAST","10MG","30","Select","Select",""],["","68382009705","PAROXETINE","10MG","30","Select","Select",""],["","65862014736","SUMATRIPTAN","50MG","9","Select","Select",""],["","45802002683","AZELASTINE","0.15%","-30","Select","Select",""],["","00115165901","PROPRANOLOL","10MG","90","Select","Select",""],["","52817033010","CYCLOBENZAPR","5MG","60","Select","Select",""],["","00054429731","FUROSEMIDE","20MG","15","Select","Select",""],["","00456111030","VIIBRYD","10MG","14","Select","Select",""],["","00143980350","DOXYCYCL","100MG","28","Select","Select",""],["","49884068905","METOCLOPRAM","10MG","10","Select","Select",""],["","65649000330","TRULANCE","3MG","90","Select","Select",""],["","59651000101","OMEPRAZOLE","10MG","60","Select","Select",""],["","65862001705","AMOXICILLIN","500MG","20","Select","Select",""],["","57664076188","HYDROXYCHLOR","200MG","90","Select","Select",""],["","11523723403","MIRALAX","3350 NF","-238","Select","Select",""],["","00406012405","HYDROCO\/APAP","7.5-325","-15","Select","Select",""],["","45802086802","POLYETH","3350 NF","238","Select","Select",""],["","00456120330","LINZESS","72MCG","30","Select","Select",""],["","69238117009","DOXEPIN","25MG","60","Select","Select",""],["","69238117109","DOXEPIN ","CAP 50MG","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":""}]}]}