{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TINA DRUMHELLER","gend":1,"add":"1615 CEDAR HILL ROAD","city":"CHARLOTTESVILLE","state":"VA","zip":"22901-9998","dob":"1973-10-19","age":"","mstatus":"","insh":"2042620*02","cliId":"","pno":"434\/825-1591","cno":"434\/825-1591","email":"","ename":"","eno":"","pphy":"MAROTTA, RAYMOND P MD","ppno":"434\/973-9744","pcpadd":"STE 201 1450 SACHEM PLACE","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22901,"pcpcounty":"","pcpid":102077,"pcpname":"Family Medicine of Albemarle","plan":"OHP","program":"ACA","lob":"Small Group","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"434\/466-9846","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":["R22.32","M72.2","M76.821","M54.9","M54.41","L82.1","L70.8","L57.8","Z12.83","L71.8","R00.2","Z01.411","N89.8","N63.32","N64.89","E78.2","H92.01","J02.9","M54.2","M54.5","L91.8","L73.8","M54.16","L57.0","L85.8","E03.9","E89.0","M25.50","M54.12","Z23.","H61.23","Z12.31","R92.8","Z11.52","Z79.899","Z20.822","L72.3","L72.0","D22.5","M20.21","M54.50"],"date":["2020-01-14","2021-10-25","2021-10-25","2020-12-03","2020-12-03","2021-11-17","2021-11-17","2021-11-17","2021-11-17","2021-05-21","2021-05-21","2021-06-01","2021-06-01","2020-10-19","2020-10-19","2021-10-04","2020-10-07","2020-10-07","2021-10-04","2021-03-10","2021-04-09","2021-07-13","2020-01-27","2020-10-13","2020-10-13","2021-10-04","2021-04-23","2020-09-01","2020-09-01","2021-10-04","2020-10-27","2020-10-14","2020-10-19","2021-08-30","2021-08-30","2021-08-30","2021-11-17","2021-11-17","2021-11-17","2021-10-25","2021-10-04"],"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":[["","71858003504","TIROSINT","112MCG","28","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","120","Select","Select",""],["","00093585205","ESCITALOPRAM","20MG","5","Select","Select",""],["","51224012230","AZITHROMYCIN","500MG","3","Select","Select",""],["","00781107801","ATENOLOL","25MG","-45","Select","Select",""],["","10702000301","PROMETHAZINE","25MG","90","Select","Select",""],["","42192013316","SOD","8-4%","473","Select","Select",""],["","00527328046","LEVOTHYROXIN","25MCG","24","Select","Select",""],["","00591405289","IVERMECTIN","1%","45","Select","Select",""],["","45802009735","ESTRADIOL","0.01%","42","Select","Select",""],["","00046087221","PREMARIN","0.625MG","30","Select","Select",""],["","27808015501","ROSUVASTATIN","5MG","90","Select","Select",""],["","68462062652","AZELAIC","15%","50","Select","Select",""],["","51672139409","TRETINOIN","0.05%","45","Select","Select",""],["","55111018015","TIZANIDINE","4MG","60","Select","Select",""],["","16729017001","ESCITALOPRAM ","20MG","90","Select","Select",""],["","71858003504","TIROSINT ","112MCG","28","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","120","Select","Select",""],["","10702000301","PROMETHAZINE ","25MG","90","Select","Select",""],["","00781107801","ATENOLOL ","25MG","45","Select","Select",""],["","51224012230","AZITHROMYCIN ","500MG","3","Select","Select",""],["","42192013316","SOD ","8-4%","473","Select","Select",""],["","68462062652","AZELAIC ","15%","-50","Select","Select",""],["","00527328046","LEVOTHYROXIN ","25MCG","24","Select","Select",""],["","55111018015","TIZANIDINE ","4MG","60","Select","Select",""],["","27808015501","ROSUVASTATIN ","5MG","90","Select","Select",""],["","51672139409","TRETINOIN ","0.05%","45","Select","Select",""],["","00591405289","IVERMECTIN ","1%","45","Select","Select",""],["","00046087221","PREMARIN ","0.625MG","30","Select","Select",""],["","00093354143","ESTRADIOL ","0.01%","-42","Select","Select",""],["","45802066032","CLINDAMYCIN ","1%","50","Select","Select",""],["","45802066032","CLINDAMYCIN","1%","50","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","59267100002","PFIZER ","INJ 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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}