{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CONNIE PALMER","gend":1,"add":"17 PHOEBE POND ROAD","city":"CONCORD","state":"VA","zip":"24538-9998","dob":"1980-08-01","age":"","mstatus":"","insh":"1198133*01","cliId":"","pno":"434\/851-5689","cno":"434\/851-5689","email":"","ename":"","eno":"","pphy":"ALLEGA, GIULIANA MD","ppno":"434\/315-2850","pcpadd":"935 SOUTH MAIN STREET","pcpcity":"FARMVILLE","pcpstate":"VA","pcpzip":23901,"pcpcounty":"","pcpid":135922,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/315-2859","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F10.129","N39.0","F17.210","Z88.0","I10.","F10.19","G47.00","Z71.3","Z71.82","J20.8","M54.5","F43.23","Z68.26","R87.810","F10.230","R65.10","F41.8","Z72.0","D75.1","D69.6","E87.6","F41.1","J98.01","S09.90XA","NO DATA","R00.0","R51.9","U07.1","R06.2","J30.1","Z68.27","F51.02","R11.0","F31.9","K70.10","E78.5","K29.20","Z88.5","Z88.8","Z81.1","Z81.8","Z82.49","F17.200","Z20.828","F10.239","Z79.899","E86.0","H10.32"],"date":["2021-07-17","2020-11-16","2021-08-04","2021-07-29","2021-07-29","2021-08-04","2021-08-04","2021-08-04","2021-08-04","2020-01-15","2020-01-15","2021-08-04","2020-01-15","2020-08-28","2021-02-07","2021-02-07","2021-02-07","2021-02-07","2021-02-07","2021-02-07","2021-02-07","2021-08-04","2021-05-14","2021-02-06","2021-02-06","2021-02-06","2021-02-06","2021-02-28","2021-02-28","2020-10-02","2021-08-04","2020-03-13","2020-03-13","2020-11-18","2021-07-28","2021-02-06","2021-07-28","2021-02-06","2021-07-28","2021-02-06","2021-02-06","2021-02-06","2021-03-14","2021-03-14","2021-07-29","2021-07-29","2021-07-29","2021-08-04"],"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":[["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","00406012301","HYDROCO\/APAP ","5-325MG","20","Select","Select",""],["","00228206910","OXAZEPAM ","15MG","90","Select","Select",""],["","16714035201","FLUOXETINE ","20MG","30","Select","Select",""],["","68645055254","LISINOPRIL ","10MG","7","Select","Select",""],["","55111015330","ONDANSETRON ","4MG","21","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","50111033402","METRONIDAZOL ","500MG","14","Select","Select",""],["","16714043901","NITROFURANTN ","100MG","14","Select","Select",""],["","69315090401","LORAZEPAM ","0.5MG","30","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","14","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","60","Select","Select",""],["","57664050658","METOPROL ","25MG","60","Select","Select",""],["","42806071401","BENZONATATE ","100MG","30","Select","Select",""],["","59746017509","PREDNISONE ","20MG","14","Select","Select",""],["","60758018805","GENTAMICIN ","0.3% OP","5","Select","Select",""],["","50111078751","AZITHROMYCIN ","250MG","6","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":""}]}]}