{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TERRI   W BREEDEN","gend":1,"add":"116 HOUFF ROAD","city":"WEYERS CAVE","state":"VA","zip":"24486-9998","dob":"1956-11-09","age":"","mstatus":"","insh":"2126002*01","cliId":"","pno":"540\/885-0197","cno":"540\/885-0197","email":"","ename":"","eno":"","pphy":"HERRING, DAVID S MD","ppno":"540\/941-2400","pcpadd":"760 TOWN CENTER DRIVE SUITE 760A","pcpcity":"WAYNESBORO","pcpstate":"VA","pcpzip":22980,"pcpcounty":"","pcpid":196035,"pcpname":"SMJMG - Sentara Primary Care","plan":"OHP","program":"ACA","lob":"Small Group","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"540\/255-8090","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"844\/831-8777","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M47.812","I99.8","I65.29","F17.200","I77.1","H60.502","M54.12","M54.16","I65.23","I70.209","M62.838","I73.00","M79.672","Z00.00","I10.","Z01.419","S29.012A","H68.012","R09.81","Z12.31","R42.","R51.9","I70.222","I70.1","E78.5","K21.9","F17.210","Z79.899","Z79.82","Z88.1","Z88.2","Z20.822","I73.9","Z87.891","Z79.02","Z88.0","E78.2","M25.50","G56.03","M16.12","M24.152","M24.852","B37.0","K52.832","Z13.31","H60.13","G56.02","I25.10","Z72.0","M54.2","I70.202","T14.90XA","M75.42","K52.839","R03.0","M81.0","E28.39","H60.92","H61.22","Z13.820","Z78.0","B00.9"],"date":["2021-03-22","2021-02-24","2021-08-25","2021-02-24","2021-02-11","2021-04-05","2021-09-14","2021-01-20","2021-03-22","2020-12-14","2021-06-25","2021-09-30","2020-01-27","2021-09-30","2021-09-30","2021-10-04","2020-03-02","2020-03-02","2020-03-02","2021-11-19","2020-10-21","2020-10-05","2021-02-11","2021-02-11","2021-03-22","2021-09-30","2021-02-11","2021-03-22","2021-03-22","2021-03-22","2021-03-22","2021-02-11","2021-09-30","2021-03-22","2021-03-22","2021-03-22","2021-09-30","2021-04-22","2021-05-26","2020-02-10","2020-02-10","2020-02-10","2020-02-24","2020-04-24","2021-09-30","2020-09-21","2021-02-08","2021-02-08","2021-02-08","2021-06-28","2021-08-20","2021-07-27","2021-10-25","2021-11-10","2021-11-10","2021-11-19","2021-11-19","2021-11-12","2021-11-12","2021-11-19","2021-11-19","2021-09-30"],"priorHcc":["","","","","","","","","","","",null,"",null,null,null,"","","",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":[["","68645053254","LISINOPRIL ","20MG","90","Select","Select",""],["","00172208380","HYDROCHLOROT ","25MG","90","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","30","Select","Select",""],["","43598021055","SSD ","1%","50","Select","Select",""],["","60432053716","NYSTATIN ","100000","-200","Select","Select",""],["","00527293441","PREDNISONE ","20MG","10","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","90","Select","Select",""],["","60505530601","ACYCLOVIR ","400MG","25","Select","Select",""],["","67877021620","CEFUROXIME ","500MG","20","Select","Select",""],["","68382072001","BUDESONIDE ","3MG","90","Select","Select",""],["","59762444002","METHYLPRED ","4MG","21","Select","Select",""],["","33342002208","LEVOFLOXACIN ","500MG","10","Select","Select",""],["","65862029490","ROSUVASTATIN ","10MG","-90","Select","Select",""],["","55111019630","CLOPIDOGREL ","75MG","30","Select","Select",""],["","67877025130","TRIAMCINOLON ","0.10%","30","Select","Select",""],["","88888888887","DMR ","","1","Select","Select",""],["","50111078810","AZITHROMYCIN ","500MG","3","Select","Select",""],["","00172208380","HYDROCHLOROT","25MG","90","Select","Select",""],["","68645053254","LISINOPRIL","20MG","90","Select","Select",""],["","43598021055","SSD","1%","50","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","30","Select","Select",""],["","60432053716","NYSTATIN","100000","-200","Select","Select",""],["","00527293441","PREDNISONE","20MG","10","Select","Select",""],["","68180072003","AMLODIPINE","5MG","90","Select","Select",""],["","60505530601","ACYCLOVIR","400MG","25","Select","Select",""],["","68382072001","BUDESONIDE","3MG","90","Select","Select",""],["","67877021620","CEFUROXIME","500MG","20","Select","Select",""],["","59762444002","METHYLPRED","4MG","21","Select","Select",""],["","65862029490","ROSUVASTATIN","10MG","90","Select","Select",""],["","45802006435","TRIAMCINOLON","0.10%","30","Select","Select",""],["","33342002208","LEVOFLOXACIN","500MG","10","Select","Select",""],["","55111019630","CLOPIDOGREL","75MG","-30","Select","Select",""],["","50111078810","AZITHROMYCIN","500MG","3","Select","Select",""],["","88888888887","DMR","","1","Select","Select",""],["","00591039860","DICLO\/MISOPR","75-0.2MG","60","Select","Select",""],["","50228046501","NABUMETONE","500MG","60","Select","Select",""],["","00143924920","AMOX\/K","875-125","-20","Select","Select",""],["","00591039860","DICLO\/MISOPR ","TAB 75-0.2MG","60","Select","Select",""],["","43598032675","CIPRO\/DEXA ","SUS 0.3-0.1%","8","Select","Select",""],["","00143924920","AMOX\/K ","TAB 875-125","-20","Select","Select",""],["","50228046501","NABUMETONE ","TAB 500MG","60","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":""}]}]}