{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LYNZEE SOUTHWICK","gend":1,"add":"2888 CLOVERDALE RD","city":"BREMO BLUFF","state":"VA","zip":"23022-9998","dob":"1996-01-22","age":"","mstatus":"","insh":"1294278*01","cliId":"","pno":"434\/842-7000","cno":"434\/842-7000","email":"","ename":"","eno":"","pphy":"LANFORD, RANDOLPH E MD","ppno":"434\/842-3244","pcpadd":"4064 JAMES MADISON HIGHWAY","pcpcity":"FORK UNION","pcpstate":"VA","pcpzip":23055,"pcpcounty":"","pcpid":105418,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/842-1110","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F32.9","F41.1","K51.00","F41.9","Z23.","K90.0","NO DATA","D62.","R39.9"],"date":["2020-01-16","2021-04-15","2021-08-03","2020-03-18","2021-05-06","2020-07-20","2020-07-20","2020-07-20","2021-01-04"],"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":[["","68001019603","ESCITALOPRAM","10MG","30","Select","Select",""],["","00904671740","CETIRIZINE ","10MG","30","Select","Select",""],["","43199001201","HYOSCYAMINE ","0.125MG","90","Select","Select",""],["","64380078706","BUSPIRONE ","7.5MG","30","Select","Select",""],["","68001019603","ESCITALOPRAM ","10MG","30","Select","Select",""],["","13668001005","CITALOPRAM ","20MG","90","Select","Select",""],["","00472037045","BETAMETH ","0.10%","45","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","16","Select","Select",""],["","64380078706","BUSPIRONE","7.5MG","30","Select","Select",""],["","00904671740","CETIRIZINE","10MG","30","Select","Select",""],["","43199001201","HYOSCYAMINE","0.125MG","90","Select","Select",""],["","13668001005","CITALOPRAM","20MG","30","Select","Select",""],["","00168004046","BETAMETH","0.10%","45","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","16","Select","Select",""],["","62559039050","VANCOMYCIN","125MG","56","Select","Select",""],["","00904583315","LORATADINE-D","10-240MG","20","Select","Select",""],["","65162077810","BUDESONIDE","3MG DR","15","Select","Select",""],["","00121086720","VANCOMYCIN ","CAP 125MG","40","Select","Select",""],["","65162077810","BUDESONIDE ","CAP 3MG DR","15","Select","Select",""],["","00904583315","LORATADINE-D ","TAB 10-240MG","20","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","",""],["No","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":""}]}]}