{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALYSSA   D MARSH","gend":1,"add":"PO BOX 701","city":"DANVILLE","state":"VA","zip":24541,"dob":"1987-06-22","age":"","mstatus":"","insh":"1136102*01","cliId":"","pno":"540\/263-8356","cno":"540\/263-8356","email":"","ename":"","eno":"","pphy":"WINFIELD, ALBERT C MD","ppno":"434\/791-4110","pcpadd":"173 EXECUTIVE DRIVE","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"pcpcounty":"","pcpid":134296,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/791-4003","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O26.899","Z91.89","V23.9","O99.210","Z86.79","G43.819","R51.","O10.912","O26.892","O99.212","E66.01","O99.352","Z3A.19","O24.410","O10.312","E66.9","O34.219","V23.5","O99.342","F41.9","Z3A.16","N89.8","Z32.01","Z71.89","Z71.3","Z36.82","Z68.42","Z3A.20","O36.4XX0","Z3A.35","O13.4","O34.211","O99.213","Z37.0","Z3A.38","Z30.2","M79.7","N91.2","F41.8","Z23.","G56.03","F43.21","F43.11","T78.40XA","I95.81","N96.","G89.4","O02.1","Z98.890","D62.","J45.909","K66.0","O26.893","O99.02","O99.214","O99.52","Z79.82"],"date":["2020-01-28","2020-01-28","2020-01-28","2020-01-28","2020-01-28","2020-01-28","2020-01-28","2020-01-28","2020-01-28","2021-02-03","2021-06-11","2020-01-28","2020-01-28","2020-01-13","2020-01-13","2020-01-13","2020-01-13","2021-02-03","2020-01-13","2020-01-13","2020-01-13","2020-10-28","2020-10-28","2020-10-28","2020-10-28","2021-02-03","2021-02-03","2021-02-03","2020-02-10","2020-02-10","2021-06-11","2021-06-11","2021-06-11","2021-06-11","2021-06-11","2021-06-11","2020-10-23","2020-10-23","2020-10-23","2020-10-23","2020-01-06","2020-04-22","2020-04-22","2020-05-20","2020-02-17","2020-02-17","2020-02-17","2020-02-10","2020-03-02","2021-06-11","2021-06-11","2021-06-11","2021-06-11","2021-06-11","2021-06-11","2021-06-11","2021-06-11"],"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":[["","00536123441","ASPIRIN ","81MG EC","30","Select","Select",""],["","39328010610","PRENATAL ","27-1MG","30","Select","Select",""],["","45802065078","LORATADINE ","10MG","30","Select","Select",""],["","00603020922","MAG ","400MG","90","Select","Select",""],["","59779060027","CVS ","81MG EC","90","Select","Select",""],["","00536440601","VITAMIN ","25MG","90","Select","Select",""],["","59779086322","SLEEP-AID ","25MG","14","Select","Select",""],["","65862085901","FAMOTIDINE ","20MG","60","Select","Select",""],["","69097083412","SERTRALINE ","50MG","30","Select","Select",""],["","50924097110","SOFTCLIX ","LANCETS","100","Select","Select",""],["","67877032005","IBUPROFEN ","600MG","30","Select","Select",""],["","00406055201","OXYCODONE ","5MG","10","Select","Select",""],["","00904671980","ACETAMINOPHE ","325MG","60","Select","Select",""],["","13668011005","DULOXETINE ","30MG","60","Select","Select",""],["","87701040776","GNP ","45MG","60","Select","Select",""],["","65702040810","ACCU-CHEK ","AVIVA PL","100","Select","Select",""],["","59746017509","PREDNISONE ","20MG","42","Select","Select",""],["","10702025350","BUT\/APAP\/CAF ","","30","Select","Select",""],["","13668001105","CITALOPRAM ","40MG","30","Select","Select",""],["","45802048678","DOCUSATE ","100MG","60","Select","Select",""],["","10702001001","HYDROXYZ ","10MG","30","Select","Select",""],["","47781030301","NITROFURANTN ","100MG","10","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","60","Select","Select",""],["","53746010901","HYDROCO\/APAP ","5-325MG","15","Select","Select",""],["","68308015215","NYSTATIN ","100000","15","Select","Select",""],["","16571040110","CETIRIZINE ","5MG","30","Select","Select",""],["","65862050320","AMOX\/K ","875-125","14","Select","Select",""],["","70710113908","FLUCONAZOLE ","150MG","1","Select","Select",""],["","00093220401","METOCLOPRAM ","5MG","30","Select","Select",""],["","65862085901","FAMOTIDINE","20MG","60","Select","Select",""],["","45802065078","LORATADINE","10MG","30","Select","Select",""],["","00536440601","VITAMIN","25MG","90","Select","Select",""],["","59779060027","CVS","81MG EC","30","Select","Select",""],["","59779086322","SLEEP-AID","25MG","14","Select","Select",""],["","50924097110","SOFTCLIX","LANCETS","100","Select","Select",""],["","00536123441","ASPIRIN","81MG EC","30","Select","Select",""],["","39328010610","PRENATAL","27-1MG","30","Select","Select",""],["","00093220401","METOCLOPRAM","5MG","30","Select","Select",""],["","00603020922","MAG","400MG","90","Select","Select",""],["","00406055201","OXYCODONE","5MG","10","Select","Select",""],["","87701040776","GNP","45MG","60","Select","Select",""],["","65702040810","ACCU-CHEK","AVIVA PL","100","Select","Select",""],["","13668011005","DULOXETINE","30MG","60","Select","Select",""],["","00904671980","ACETAMINOPHE","325MG","60","Select","Select",""],["","00378064205","PREDNISONE","20MG","14","Select","Select",""],["","10702001001","HYDROXYZ","10MG","30","Select","Select",""],["","10702025350","BUT\/APAP\/CAF","","30","Select","Select",""],["","47781030301","NITROFURANTN","100MG","10","Select","Select",""],["","13668001005","CITALOPRAM","20MG","30","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","60","Select","Select",""],["","45802048678","DOCUSATE","100MG","60","Select","Select",""],["","16571040110","CETIRIZINE","5MG","30","Select","Select",""],["","49483060450","IBUPROFEN","800MG","60","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","1","Select","Select",""],["","65862050320","AMOX\/K","875-125","14","Select","Select",""],["","69097083412","SERTRALINE","50MG","30","Select","Select",""],["","53746010901","HYDROCO\/APAP","5-325MG","15","Select","Select",""],["","68308015215","NYSTATIN","100000","15","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","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}