{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROSALIND   J COOK","gend":1,"add":"153 SUNSET DR","city":"WAYNESBORO","state":"VA","zip":"22980-9998","dob":"1983-12-02","age":"","mstatus":"","insh":"2124956*01","cliId":"","pno":"540\/221-1240","cno":"540\/221-1240","email":"","ename":"","eno":"","pphy":"REED, JOHN P MD","ppno":"540\/932-5687","pcpadd":"53 S MEDICAL PARK DR","pcpcity":"FISHERSVILLE","pcpstate":"VA","pcpzip":22939,"pcpcounty":"","pcpid":151163,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/932-5688","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R19.00","R10.11","K86.2","Z01.419","Z23.","K86.89","K82.8","Z00.00","Z83.3","E66.9","R93.2","K80.20","R61.","R19.7","R10.9","R11.2","L02.93","K63.5","Z86.19","K76.0","K86.9","L30.4","D22.5","L82.1","L81.4","L85.3","L57.8","Z80.8","Z11.59","L82.0","R20.8","L53.8","L29.8","D12.0","Z88.2","Z79.899","Z68.41","Z87.891","K81.1","E66.01","Z88.1","Z79.1","Z83.71","K80.50","K29.40","D13.2","D12.2","R21.","M17.0","M25.561","J20.9","J04.0","Z20.822"],"date":["2020-01-07","2020-07-29","2020-02-17","2020-08-19","2021-11-11","2020-02-07","2020-03-02","2021-05-18","2021-05-18","2021-05-18","2020-01-07","2020-01-07","2020-02-17","2020-02-17","2020-02-17","2020-07-29","2021-05-28","2020-02-17","2020-04-20","2020-07-29","2020-09-09","2021-04-09","2021-02-05","2021-02-05","2021-02-05","2021-02-05","2021-02-05","2021-02-05","2021-02-05","2021-02-05","2021-02-05","2021-02-05","2021-02-05","2020-02-17","2020-03-02","2020-03-02","2020-03-02","2020-03-02","2020-03-02","2020-03-02","2020-03-02","2020-03-02","2020-03-02","2020-03-02","2020-02-17","2020-02-17","2020-02-17","2020-06-22","2021-08-30","2021-11-08","2021-11-17","2021-11-17","2021-11-17"],"priorHcc":["","","","",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":[["","55111015930","OMEPRAZOLE","40MG","-90","Select","Select",""],["","43386009019","GAVILYTE-G","","-4000","Select","Select",""],["","68645049254","PANTOPRAZOLE","40MG","28","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","28","Select","Select",""],["","51672127501","CLOTRIMAZOLE","1%","15","Select","Select",""],["","69618002903","BISMUTH","262MG","28","Select","Select",""],["","50111033402","METRONIDAZOL","500MG","28","Select","Select",""],["","00555901658","SPRINTEC","28 DAY","28","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","Select","Select",""],["","23155001801","TETRACYCLINE","500MG","28","Select","Select",""],["","00527193206","CLARITHROMYC","500MG","28","Select","Select",""],["","00713063515","MOMETASONE","0.10%","45","Select","Select",""],["","00781261305","AMOXICILLIN","500MG","56","Select","Select",""],["","50111078751","AZITHROMYCIN","250MG","6","Select","Select",""],["","00527128201","DICYCLOMINE","20MG","30","Select","Select",""],["","55111015930","OMEPRAZOLE ","40MG","90","Select","Select",""],["","43386009019","GAVILYTE-G ","","4000","Select","Select",""],["","68645049254","PANTOPRAZOLE ","40MG","28","Select","Select",""],["","23155001801","TETRACYCLINE ","500MG","28","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","28","Select","Select",""],["","69618002903","BISMUTH ","262MG","28","Select","Select",""],["","50111033402","METRONIDAZOL ","500MG","28","Select","Select",""],["","00781261305","AMOXICILLIN ","500MG","56","Select","Select",""],["","00527193206","CLARITHROMYC ","500MG","28","Select","Select",""],["","51672127501","CLOTRIMAZOLE ","1%","15","Select","Select",""],["","00555901658","SPRINTEC ","28 DAY","28","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0","Select","Select",""],["","00527128201","DICYCLOMINE ","20MG","30","Select","Select",""],["","00713063515","MOMETASONE ","0.10%","45","Select","Select",""],["","50111078751","AZITHROMYCIN ","250MG","6","Select","Select",""],["","59746017509","PREDNISONE ","TAB 20MG","20","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":""}]}]}