{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARY WHETZEL","gend":1,"add":"550 NEW YORK AVE","city":"HARRISONBURG","state":"VA","zip":"22801-9998","dob":"1959-09-23","age":"","mstatus":"","insh":"2248552*01","cliId":"","pno":"540\/434-7220","cno":"540\/434-7220","email":"","ename":"","eno":"","pphy":"YODER, JESSICA A MD","ppno":"","pcpadd":"1661 S MAIN ST","pcpcity":"HARRISONBURG","pcpstate":"VA","pcpzip":22801,"pcpcounty":"","pcpid":188285,"pcpname":"SRMHMG - Sentara South Main Health Center","plan":"OHP","program":"ACA","lob":"Individual","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/431-7100","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.65","I10.","F41.8","G47.00","E78.5","E83.42","F10.11","E66.01","M54.5","Z79.891","Z51.81","Z12.11","M79.674","L60.0","E11.9","S92.325A","M79.672","M75.32","M25.512","M43.06","Z00.00","Z23.","S92.325D","M75.21","M17.0","M19.012","M71.572","M77.52","R60.9","D48.5","D22.5","L82.1","L57.0","M75.22","M79.10","M77.42","M79.7","M75.52","Z11.1","M79.89","F10.20","Z68.39"],"date":["2021-03-16","2021-03-16","2021-03-16","2021-03-16","2021-03-16","2021-03-16","2021-03-16","2021-03-16","2021-08-25","2021-08-25","2021-08-25","2021-05-23","2020-12-15","2020-11-24","2020-12-15","2020-11-03","2020-12-09","2020-02-27","2021-03-03","2020-08-10","2020-10-28","2020-10-28","2020-11-24","2020-01-13","2020-10-28","2020-02-27","2020-12-09","2020-12-09","2020-12-09","2021-03-03","2021-03-03","2021-03-03","2021-03-03","2020-02-27","2021-03-03","2020-12-15","2021-06-18","2020-02-27","2020-10-05","2020-06-04","2020-06-04","2020-06-04"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","65862037401","ESCITALOPRAM","10MG","30","Select","Select",""],["","68180046803","LOVASTATIN","20MG","30","Select","Select",""],["","65162062711","TRAMADOL","50MG","90","Select","Select",""],["","62756014202","METFORMIN","500MG ER","60","Select","Select",""],["","13668033005","TRAZODONE","50MG","60","Select","Select",""],["","68180098103","LISINOPRIL","20MG","60","Select","Select",""],["","59762372004","ALPRAZOLAM","0.5MG","30","Select","Select",""],["","68585000612","MAGNESIUM-OX","400MG","180","Select","Select",""],["","00713068631","NYSTATIN","100000","30","Select","Select",""],["","00378668999","PANTOPRAZOLE","40MG","90","Select","Select",""],["","64980033912","MAG","400MG","180","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","21","Select","Select",""],["","61314064511","NEO\/POLY\/HC","1% OTIC","-10","Select","Select",""],["","69097067905","PREGABALIN","75MG","-60","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","00378395105","ATORVASTATIN","20MG","-90","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","",""],["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":""}]}]}