{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JESSICA   R BURDETTE","gend":1,"add":"119 SANDY RIDGE ROAD","city":"WAYNESBORO","state":"VA","zip":"22980-9998","dob":"1986-04-21","age":"","mstatus":"","insh":"1169746*01","cliId":"","pno":"434-284-0009","cno":"434-284-0009","email":"","ename":"","eno":"","pphy":"WILLIAMS, MARYANNE D MD","ppno":"804\/957-9061","pcpadd":"25 S. UNION STREET","pcpcity":"PETERSBURG","pcpstate":"VA","pcpzip":23803,"pcpcounty":"","pcpid":105793,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K50.012","K52.9","Z33.1","Z34.90","Z23.","O82.","Z87.59","Z3A.36","Z37.0","R53.1","R42.","R10.30","R11.0","O21.2","R10.12","O26.892","Z3A.21","R10.11","O24.410","O24.420","Z34.83","NO DATA","O40.2XX1","Z3A.35","O99.345","O80.","R01.1","I31.3","M25.50","K63.89","K63.5","K64.0"],"date":["2021-07-27","2020-05-06","2020-05-06","2020-11-10","2020-05-18","2020-06-18","2020-06-18","2020-06-18","2020-06-18","2021-03-03","2021-04-14","2021-03-03","2021-03-03","2020-03-05","2020-03-05","2020-03-05","2020-03-05","2021-06-28","2020-05-20","2020-06-18","2020-06-18","2020-07-15","2020-06-16","2020-06-16","2020-07-15","2020-06-18","2021-04-14","2021-04-14","2021-07-27","2021-08-06","2021-08-06","2021-08-06"],"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":[["","27241009903","DULOXETINE ","60MG","30","Select","Select",""],["","68462039710","OMEPRAZOLE ","40MG","30","Select","Select",""],["","53885065701","ONETOUCH ","VERIO","1","Select","Select",""],["","56151146004","TRUE ","GLUCOSE","100","Select","Select",""],["","08290324911","INSULIN ","0.5\/31G","30","Select","Select",""],["","68462015813","ONDANSETRON ","8MG ODT","30","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","30","Select","Select",""],["","00193731221","CONTOUR ","NEXT","100","Select","Select",""],["","53885004401","ONE ","VERIO FL","1","Select","Select",""],["","65702040810","ACCU-CHEK ","AVIVA PL","100","Select","Select",""],["","00002831517","HUMULIN ","U-100","3","Select","Select",""],["","65862094088","AUROVELA ","Jan-20","28","Select","Select",""],["","00406055201","OXYCODONE ","5MG","20","Select","Select",""],["","68180087613","NORETHINDRON ","0.35MG","28","Select","Select",""],["","57894006103","STELARA ","90MG\/ML","2","Select","Select",""],["","00555902658","JUNEL ","Jan-20","28","Select","Select",""],["","50111056001","TRAZODONE ","50MG","30","Select","Select",""],["","29033000305","SUCRALFATE ","1GM","40","Select","Select",""],["","00406012301","HYDROCO\/APAP ","5-325MG","10","Select","Select",""],["","68462030329","HEATHER ","0.35MG","28","Select","Select",""],["","68645014059","FAMOTIDINE ","20MG","60","Select","Select",""],["","68180029606","DULOXETINE","60MG","30","Select","Select",""],["","68462039710","OMEPRAZOLE","40MG","30","Select","Select",""],["","68462015813","ONDANSETRON","8MG ODT","30","Select","Select",""],["","00193737701","CONTOUR","NEXT","1","Select","Select",""],["","53885027210","ONETOUCH","VERIO","100","Select","Select",""],["","56151146004","TRUE","GLUCOSE","100","Select","Select",""],["","65702040810","ACCU-CHEK","AVIVA PL","100","Select","Select",""],["","53885004401","ONE","VERIO FL","1","Select","Select",""],["","08290324911","INSULIN","0.5\/31G","30","Select","Select",""],["","00002831517","HUMULIN","U-100","3","Select","Select",""],["","64380080707","IBUPROFEN","800MG","30","Select","Select",""],["","00406055201","OXYCODONE","5MG","20","Select","Select",""],["","65862094088","AUROVELA","Jan-20","28","Select","Select",""],["","00555902658","JUNEL","Jan-20","28","Select","Select",""],["","50111056001","TRAZODONE","50MG","30","Select","Select",""],["","68180087613","NORETHINDRON","0.35MG","28","Select","Select",""],["","00406012301","HYDROCO\/APAP","5-325MG","10","Select","Select",""],["","57894006103","STELARA","90MG\/ML","1","Select","Select",""],["","29033000305","SUCRALFATE","1GM","40","Select","Select",""],["","68462030329","HEATHER","0.35MG","28","Select","Select",""],["","68645014059","FAMOTIDINE","20MG","60","Select","Select",""],["","62332002331","FLUOXETINE ","CAP 20MG","30","Select","Select",""],["","43598044774","NICOTINE ","DIS 14MG\/24H","28","Select","Select",""],["","31722071730","ATOMOXETINE ","CAP 40MG","30","Select","Select",""],["","49035019502","EQ ","DIS 14MG\/24H","28","Select","Select",""],["","00406051201","OXYCOD\/APAP ","TAB 5-325MG","8","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":""}]}]}