{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RHEA DURET","gend":1,"add":"19100 WOLF RUN LN","city":"TIMBERVILLE","state":"VA","zip":"22853-9998","dob":"1968-07-08","pno":"540\/271-0007","cno":"540\/271-0007","email":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","insh":"2085934*01","cliId":"","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":["L82.1","D23.5","L21.8","Z08.","Z00.00","K21.9","F41.9","M25.511","Z91.09","G89.29","M25.512","M54.2","Z12.31","M67.431","M47.22","M79.671","S93.431A","J01.00","R51.9","R05.","M79.641","R53.83","Z11.59","Z20.828","Z03.818","Z20.822","G89.18","M72.2","Z01.419","G47.9"],"date":["2021-01-20","2021-01-20","2021-01-20","2021-01-20","2021-03-26","2021-10-01","2021-10-01","2021-10-01","2020-09-23","2021-10-01","2021-10-01","2021-08-03","2021-01-06","2021-08-25","2021-08-03","2021-10-11","2021-01-07","2021-09-21","2021-09-21","2021-09-21","2021-08-11","2021-03-26","2021-03-26","2021-03-04","2021-09-19","2021-09-19","2021-08-25","2021-10-11","2021-10-15","2021-10-01"],"priorHcc":["","","","","",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":[["","13668044201","CELECOXIB","200MG","60","Select","Select",""],["","00093719801","FLUOXETINE","40MG","90","Select","Select",""],["","58160081912","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","68382050010","OMEPRAZOLE","40MG","-90","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","6","Select","Select",""],["","65862050320","AMOX\/K","875-125","-20","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","13668033005","TRAZODONE","50MG","30","Select","Select",""],["","68382050010","OMEPRAZOLE ","CAP 40MG","-90","Select","Select",""],["","13668044201","CELECOXIB ","CAP 200MG","60","Select","Select",""],["","00093719801","FLUOXETINE ","CAP 40MG","90","Select","Select",""],["","58160081912","SHINGRIX ","INJ 50\/0.5ML","1","Select","Select",""],["","00406012305","HYDROCO\/APAP ","TAB 5-325MG","12","Select","Select",""],["","13668033005","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0","Select","Select",""],["","49281042050","FLUZONE ","INJ 2020-21","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":""}]}]}