{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ELISE HESTER","gend":1,"add":"2009 DALE DR","city":"BLAIRS","state":"VA","zip":"24527-9998","dob":"2003-03-03","age":"","mstatus":"","insh":"1160006*01","cliId":"","pno":"434\/251-4378","cno":"434\/251-4378","email":"","ename":"","eno":"","pphy":"TRIVEDI, RAJENDRA MD","ppno":"434\/792-3730","pcpadd":"STE 120 501 RISON ST","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"pcpcounty":"","pcpid":117489,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/792-6048","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F43.23","M54.2","F33.9","G47.00","R53.82","R00.2","R07.89","L70.9","J45.20","NO DATA","Z00.00","Z13.220","H57.02","F43.25","E86.0","M54.5","R00.0","R42.","Z79.899"],"date":["2020-04-07","2020-08-17","2020-12-09","2020-09-17","2021-03-30","2020-08-20","2020-07-15","2021-03-30","2021-03-30","2020-06-11","2021-03-30","2020-04-06","2020-06-16","2020-06-17","2020-06-25","2020-06-01","2020-06-25","2020-06-25","2020-09-17"],"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":[["","69452015120","VITAMIN ","50000UNT","6","Select","Select",""],["","00591354360","BUPROPION ","150MG SR","30","Select","Select",""],["","51660052601","ALLERGY ","10MG","30","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","45802065078","LORATADINE ","10MG","30","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00228212750","CLONIDINE ","0.1MG","30","Select","Select",""],["","00168020230","CLINDAMYCIN ","1%","30","Select","Select",""],["","69097012403","TOPIRAMATE ","100MG","30","Select","Select",""],["","16729020001","BUSPIRONE ","5MG","30","Select","Select",""],["","00115166103","PROPRANOLOL ","40MG","60","Select","Select",""],["","35046000116","B-1 ","100MG","30","Select","Select",""],["","00904543760","CALCIUM\/MAGN ","","60","Select","Select",""],["","14539067401","HYDROXYZ ","25MG","30","Select","Select",""],["","60505025103","TIZANIDINE ","2MG","38","Select","Select",""],["","00093816601","QUETIAPINE ","50MG","30","Select","Select",""],["","66993068030","OLANZAPINE ","2.5MG","30","Select","Select",""],["","13668000705","ZOLPIDEM ","5MG","30","Select","Select",""],["","68462041820","LIDOCAINE ","5%","106","Select","Select",""],["","68682019050","CLINDAMY\/BEN ","1-5%","50","Select","Select",""],["","43547030203","ARIPIPRAZOLE ","2MG","30","Select","Select",""],["","10702010201","METHYLPHENID ","20MG","60","Select","Select",""],["","69097015907","MELOXICAM ","15MG","15","Select","Select",""],["","13107015490","PAROXETINE ","10MG","30","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","45802065078","LORATADINE","10MG","30","Select","Select",""],["","51660052601","ALLERGY","10MG","30","Select","Select",""],["","00591354360","BUPROPION","150MG SR","30","Select","Select",""],["","16729020001","BUSPIRONE","5MG","30","Select","Select",""],["","00228212750","CLONIDINE","0.1MG","30","Select","Select",""],["","14539067401","HYDROXYZ","25MG","30","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","35046000116","B-1","100MG","30","Select","Select",""],["","69452015120","VITAMIN","50000UNT","6","Select","Select",""],["","00904543760","CALCIUM\/MAGN","","60","Select","Select",""],["","10702010201","METHYLPHENID","20MG","60","Select","Select",""],["","69097012203","TOPIRAMATE","25MG","38","Select","Select",""],["","00168020230","CLINDAMYCIN","1%","30","Select","Select",""],["","69097015907","MELOXICAM","15MG","15","Select","Select",""],["","60505025103","TIZANIDINE","2MG","38","Select","Select",""],["","13107015490","PAROXETINE","10MG","30","Select","Select",""],["","00115166103","PROPRANOLOL","40MG","60","Select","Select",""],["","68462041820","LIDOCAINE","5%","106","Select","Select",""],["","00093816601","QUETIAPINE","50MG","30","Select","Select",""],["","66993068030","OLANZAPINE","2.5MG","30","Select","Select",""],["","43547030203","ARIPIPRAZOLE","2MG","30","Select","Select",""],["","13668000705","ZOLPIDEM","5MG","30","Select","Select",""],["","68682019050","CLINDAMY\/BEN","1-5%","50","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","",""],["No","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":""}]}]}