{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CAROL   V ADAMS","gend":1,"add":"17 LEWIS CT","city":"PALMYRA","state":"VA","zip":"22963-9998","dob":"1957-07-14","age":"","mstatus":"","insh":"2187344*01","cliId":"","pno":"434\/989-5889","cno":"434\/989-5889","email":"","ename":"","eno":"","pphy":"BISHOP, RAYMOND MD","ppno":"434\/591-5056","pcpadd":"138 HERITAGE DR STE A","pcpcity":"PALMYRA","pcpstate":"VA","pcpzip":22963,"pcpcounty":"","pcpid":210191,"pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","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":["H25.093","D31.31","D23.112","H52.4","Z85.3","C50.911","Z92.3","Z90.11","M85.80","Z79.811","N95.1","R23.2","M25.50","G35.","Z79.899","Z88.0","Z88.6","Z91.030","Z82.49","Z87.891","K62.5","Z00.00","E78.5","N64.89","C50.411","Z17.0","R92.2","Z98.890","E55.9","N94.10","Z79.890","M22.2X9","Z11.59","R74.8","M89.8X9","M54.5","E04.1","R74.01","K76.0","M85.89","R29.890","Z78.0","Z87.828"],"date":["2020-02-10","2020-02-10","2020-02-10","2020-02-10","2021-10-19","2021-02-15","2021-08-16","2020-01-28","2021-08-16","2021-10-26","2021-08-16","2021-08-16","2021-08-16","2021-08-16","2021-10-19","2020-01-28","2020-01-28","2020-01-28","2020-01-28","2021-10-19","2020-03-09","2021-07-29","2020-09-09","2020-10-06","2021-10-26","2021-10-26","2021-10-26","2021-08-25","2021-10-19","2021-08-16","2021-02-15","2021-06-16","2021-07-14","2021-08-25","2021-08-25","2021-08-25","2021-10-07","2021-08-16","2021-08-25","2021-10-19","2021-10-19","2021-10-19","2021-10-19"],"priorHcc":["","","","",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":[["","60505258008","ATORVASTATIN","40MG","30","Select","Select",""],["","16729003410","LETROZOLE","2.5MG","-30","Select","Select",""],["","00093720298","PRAVASTATIN","40MG","90","Select","Select",""],["","59676058015","JANSSEN","COVID-19","0","Select","Select",""],["","33332042010","AFLURIA","2020-21","0","Select","Select",""],["","52817033200","CYCLOBENZAPR","10MG","30","Select","Select",""],["","60505258008","ATORVASTATIN ","40MG","-30","Select","Select",""],["","16729003410","LETROZOLE ","2.5MG","30","Select","Select",""],["","33332042010","AFLURIA ","2020-21","0","Select","Select",""],["","59676058015","JANSSEN ","COVID-19","0","Select","Select",""],["","00093720298","PRAVASTATIN ","40MG","13","Select","Select",""],["","52817033200","CYCLOBENZAPR ","10MG","-30","Select","Select",""],["","51991070505","ALPRAZOLAM ","0.5MG","5","Select","Select",""],["","51991070505","ALPRAZOLAM","0.5MG","5","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":""}]}]}