{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"QUENTIN   O WADDY","gend":0,"add":"30 ACORN WEST DR","city":"LOUISA","state":"VA","zip":"23093-9998","dob":"1986-07-26","age":"","mstatus":"","insh":"1919770*01","cliId":"","pno":"540\/603-6737","cno":"540\/603-6737","email":"","ename":"","eno":"","pphy":"HUOT, RACHEL MD","ppno":"804\/632-1030","pcpadd":"102 W BROADDUS AVE SUITE 200","pcpcity":"BOWLING GREEN","pcpstate":"VA","pcpzip":22427,"pcpcounty":"","pcpid":209163,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/632-1033","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Q23.1","R57.0","E87.2","Z95.2","N17.9","J96.01","R06.89","I95.9","D62.","Z09.","F19.90","R52.","I50.22","I48.0","I42.8","I50.20","I50.21","E87.1","I47.2","I11.0","F12.90","Z87.891","I25.2","I20.8","E87.5","I35.1","I35.0","I31.3","R07.89","I10.","I97.790","I21.4","I42.0","R07.9","J81.0","R00.0","I51.7","I77.810","Z82.49","Z71.83","M54.6","R31.9","E80.6","F17.210","Z79.1","Z23.","I50.9","R68.89","I38.","K06.8","Z79.01","R06.02","R74.8","M75.51"],"date":["2020-10-15","2020-05-03","2020-05-03","2021-11-18","2020-05-04","2020-05-02","2020-05-02","2020-05-02","2020-05-02","2020-05-11","2020-05-11","2020-05-11","2021-11-18","2021-11-18","2020-04-28","2020-04-27","2020-05-08","2020-05-03","2020-05-08","2020-04-28","2020-04-28","2020-10-21","2020-04-28","2020-04-28","2020-05-03","2020-04-30","2020-04-29","2020-04-29","2021-05-13","2020-05-27","2020-05-27","2020-07-11","2020-07-11","2021-05-17","2020-04-27","2020-04-28","2020-04-28","2020-05-28","2020-05-28","2020-05-28","2021-05-17","2021-06-02","2020-04-26","2020-04-26","2020-04-26","2020-10-19","2020-04-30","2020-04-26","2020-04-28","2020-10-21","2021-06-02","2020-04-26","2020-05-08","2021-02-10"],"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":[["","00406055201","OXYCODONE ","5MG","15","Select","Select",""],["","68180051303","LISINOPRIL ","5MG","30","Select","Select",""],["","00054429731","FUROSEMIDE ","20MG","14","Select","Select",""],["","00904404073","ASPIRIN ","81MG","30","Select","Select",""],["","00591352530","LIDOCAINE ","5%","30","Select","Select",""],["","53746051105","SPIRONOLACT ","25MG","45","Select","Select",""],["","00363010412","PAIN ","325MG","30","Select","Select",""],["","65162010150","GABAPENTIN ","100MG","18","Select","Select",""],["","68462016405","CARVEDILOL ","12.5MG","60","Select","Select",""],["","00904674759","IBUPROFEN ","200MG","30","Select","Select",""],["","00363021807","ASPIRIN-81 ","81MG","30","Select","Select",""],["","51672403201","WARFARIN ","5MG","90","Select","Select",""],["","69543013611","TRAMADOL ","50MG","42","Select","Select",""],["","00904671960","ACETAMINOPHE ","325MG","90","Select","Select",""],["","00143993905","AMOXICILLIN ","500MG","4","Select","Select",""],["","00591544210","PREDNISONE ","10MG","42","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","21","Select","Select",""],["","10135012310","ACETAMIN ","325MG","90","Select","Select",""],["","80777027315","MODERNA ","COVID-19","0","Select","Select",""],["","68462016405","CARVEDILOL","12.5MG","60","Select","Select",""],["","00536100836","ASPIRIN","81MG","30","Select","Select",""],["","68180051303","LISINOPRIL","5MG","30","Select","Select",""],["","00054429731","FUROSEMIDE","20MG","14","Select","Select",""],["","00406055201","OXYCODONE","5MG","20","Select","Select",""],["","53746051105","SPIRONOLACT","25MG","15","Select","Select",""],["","65162010150","GABAPENTIN","100MG","18","Select","Select",""],["","51672403201","WARFARIN","5MG","90","Select","Select",""],["","00363010412","PAIN","325MG","30","Select","Select",""],["","00904671960","ACETAMINOPHE","325MG","90","Select","Select",""],["","00591352530","LIDOCAINE","5%","30","Select","Select",""],["","69543013611","TRAMADOL","50MG","42","Select","Select",""],["","00363021807","ASPIRIN-81","81MG","30","Select","Select",""],["","65862001705","AMOXICILLIN","500MG","4","Select","Select",""],["","00591544210","PREDNISONE","10MG","42","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","21","Select","Select",""],["","10135012310","ACETAMIN","325MG","90","Select","Select",""],["","80777027315","MODERNA","COVID-19","0","Select","Select",""],["","00904674759","IBUPROFEN","200MG","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":""}]}]}