{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JACQUELINE PALMER","gend":1,"add":"119 SAUNDERS DR","city":"DANVILLE","state":"VA","zip":"24541-9998","dob":"1988-10-08","age":"","mstatus":"","insh":"1360349*01","cliId":"","pno":"434\/709-6308","cno":"434\/709-6308","email":"","ename":"","eno":"","pphy":"CAPLAN, MICHAEL A MD","ppno":"434\/791-1345","pcpadd":"SUITE H 125 EXECUTIVE DRIVE","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"pcpcounty":"","pcpid":185831,"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":["M72.2","S52.591A","M25.531","K52.9","R11.0","R53.83","R19.7","J32.9","G43.909","E66.01","Z72.0","M54.5","S39.012A","R55.","F43.22","K21.9","S52.501A","Z20.828","N64.59","Z32.02","J31.0","E04.2","Z01.411","J01.90","R51.9","N92.6","M54.2","M25.511","V54.12","Y99.9","J00.","S16.1XXA","M25.519","M79.671","R50.9","R11.10"],"date":["2021-03-04","2021-05-06","2021-05-06","2021-04-25","2021-04-25","2021-04-25","2021-04-25","2020-02-14","2021-07-16","2020-02-14","2020-02-14","2020-03-30","2020-03-29","2020-03-29","2020-03-29","2021-03-04","2021-04-02","2020-10-18","2020-12-10","2020-12-10","2021-03-04","2021-03-04","2020-06-11","2020-10-18","2020-10-05","2020-10-05","2020-12-03","2020-12-03","2021-04-05","2021-04-05","2020-10-15","2020-11-27","2020-11-27","2021-03-04","2021-09-14","2021-09-14"],"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":[["","16729017217","AMITRIPTYLIN ","25MG","30","Select","Select",""],["","65862014736","SUMATRIPTAN ","50MG","9","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","21","Select","Select",""],["","55111014512","FLUCONAZOLE ","150MG","1","Select","Select",""],["","29300022019","MONTELUKAST ","10MG","30","Select","Select",""],["","17772010201","TROKENDI ","50MG","30","Select","Select",""],["","55111015930","OMEPRAZOLE ","40MG","30","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","00832105415","BACLOFEN ","10MG","180","Select","Select",""],["","69543038810","KETOROLAC ","10MG","20","Select","Select",""],["","72618300002","NURTEC ","75MG ODT","8","Select","Select",""],["","68382005105","MELOXICAM ","15MG","30","Select","Select",""],["","50111078810","AZITHROMYCIN ","500MG","2","Select","Select",""],["","42192060716","BROM\/PSE\/DM ","","240","Select","Select",""],["","68645056354","IBUPROFEN ","800MG","30","Select","Select",""],["","00023649810","UBRELVY ","50MG","9","Select","Select",""],["","55111015330","ONDANSETRON ","4MG","30","Select","Select",""],["","16571020106","DICLOFENAC ","75MG DR","60","Select","Select",""],["","50580029512","IMODIUM ","2MG","24","Select","Select",""],["","00093220305","METOCLOPRAM ","10MG","28","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","16729017217","AMITRIPTYLIN","25MG","30","Select","Select",""],["","65862014736","SUMATRIPTAN","50MG","9","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","21","Select","Select",""],["","17772010201","TROKENDI","50MG","30","Select","Select",""],["","55111015930","OMEPRAZOLE","40MG","30","Select","Select",""],["","55111014512","FLUCONAZOLE","150MG","1","Select","Select",""],["","29300022019","MONTELUKAST","10MG","30","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","69543038810","KETOROLAC","10MG","20","Select","Select",""],["","00832105415","BACLOFEN","10MG","180","Select","Select",""],["","50111078810","AZITHROMYCIN","500MG","2","Select","Select",""],["","42192060716","BROM\/PSE\/DM","","240","Select","Select",""],["","72618300002","NURTEC","75MG ODT","8","Select","Select",""],["","16571020106","DICLOFENAC","75MG DR","60","Select","Select",""],["","68382005105","MELOXICAM","15MG","30","Select","Select",""],["","00023649810","UBRELVY","50MG","9","Select","Select",""],["","50580029512","IMODIUM","2MG","24","Select","Select",""],["","00093220305","METOCLOPRAM","10MG","28","Select","Select",""],["","55111015330","ONDANSETRON","4MG","30","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","68645056354","IBUPROFEN","800MG","30","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":""}]}]}