{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NIKKI   J EATON","gend":1,"add":"105 SEDGEFIELD CT APT B","city":"DANVILLE","state":"VA","zip":"24541-9998","dob":"1976-05-16","age":"","mstatus":"","insh":"1946677*01","cliId":"","pno":"434\/688-8551","cno":"434\/688-8551","email":"","ename":"","eno":"","pphy":"STEPHENS, AMBER L DO","ppno":"434\/799-4488","pcpadd":"SUITE 201 109 BRIDGE STREET","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"pcpcounty":"","pcpid":174776,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/773-6977","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R04.0","R58.","I10.","Z20.828","R06.02","M79.669","R60.9","G47.33","M54.5","M79.604","M79.605","J45.909","J45.20","J30.9","Z91.81","H66.003","R05.","M54.31","M47.896","M35.00","D64.9","M25.511","M25.512","M17.11","M17.12","J01.90","M13.0","M79.641","M79.642","M25.551","M25.552","Z09.","M79.671","M79.672","R60.0","Z86.711","E66.01","Z68.42","R42.","Z11.59","E66.9","F51.04","I16.0","M79.602","E66.2","M25.562","G89.29","M25.561"],"date":["2020-05-07","2020-05-03","2021-09-03","2020-08-05","2021-09-03","2021-05-18","2021-05-18","2021-08-21","2021-08-26","2021-05-18","2021-05-18","2021-09-03","2021-06-24","2021-06-24","2021-06-24","2020-01-26","2020-01-26","2020-11-15","2020-11-15","2021-08-26","2021-04-13","2021-04-13","2021-03-15","2021-08-26","2021-08-26","2020-05-07","2021-03-04","2021-03-04","2021-03-04","2021-03-04","2021-03-04","2021-06-25","2021-05-27","2021-05-27","2021-05-27","2021-09-03","2021-09-03","2021-09-03","2021-09-03","2020-08-05","2021-04-13","2020-05-28","2020-11-24","2020-11-24","2021-06-04","2021-06-04","2021-06-04","2021-06-04"],"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":[["","43547035610","LISINOPRIL","40MG","30","Select","Select",""],["","69452014430","BENZONATATE","200MG","30","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","59746017509","PREDNISONE","20MG","15","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","00143924920","AMOX\/K","875-125","20","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00677007001","FERROUS","325MG","30","Select","Select",""],["","96295012804","IRON","325MG","30","Select","Select",""],["","29300022019","MONTELUKAST","10MG","30","Select","Select",""],["","60505083305","AZELASTINE","0.10%","30","Select","Select",""],["","16571040250","CETIRIZINE","10MG","30","Select","Select",""],["","57237002801","AMOXICILLIN","500MG","40","Select","Select",""],["","53746046401","IBUPROFEN","400MG","90","Select","Select",""],["","53746010905","HYDROCO\/APAP","5-325MG","10","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","67877022305","GABAPENTIN","300MG","81","Select","Select",""],["","00172409680","BACLOFEN","10MG","90","Select","Select",""],["","69097015915","MELOXICAM","15MG","30","Select","Select",""],["","68382009605","HYDROXYCHLOR","200MG","60","Select","Select",""],["","00904598660","VITAMIN","5000UNIT","30","Select","Select",""],["","00536322201","PAIN","325MG","100","Select","Select",""],["","69315011710","FUROSEMIDE","40MG","30","Select","Select",""],["","00003376474","ELIQUIS","5MG","74","Select","Select",""],["","69315015501","HYDROCHLOROT","12.5MG","60","Select","Select",""],["","00832532510","POT CL MICRO","20MEQ ER","30","Select","Select",""],["","55111012705","CIPROFLOXACN","500MG","14","Select","Select",""],["","68462043890","OLMESA","40MG","30","Select","Select",""],["","68382041205","OMEPRAZOLE","20MG","60","Select","Select",""],["","59676058015","JANSSEN","COVID-19","0","Select","Select",""],["","69097084064","IPRATROPIUM\/","ALBUTER","180","Select","Select",""],["","43547035610","LISINOPRIL ","TAB 40MG","30","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","59746017509","PREDNISONE ","TAB 20MG","15","Select","Select",""],["","00173068220","VENTOLIN ","AER ","18","Select","Select",""],["","00143924920","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","59310057922","PROAIR ","AER ","8","Select","Select",""],["","69452014430","BENZONATATE ","CAP 200MG","30","Select","Select",""],["","00677007001","FERROUS ","TAB 325MG","30","Select","Select",""],["","96295012804","IRON ","TAB 325MG","30","Select","Select",""],["","29300022019","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","00781261305","AMOXICILLIN ","CAP 500MG","40","Select","Select",""],["","60505083305","AZELASTINE ","SPR 0.001","30","Select","Select",""],["","16571040250","CETIRIZINE ","TAB 10MG","30","Select","Select",""],["","53746046401","IBUPROFEN ","TAB 400MG","90","Select","Select",""],["","00172409680","BACLOFEN ","TAB 10MG","90","Select","Select",""],["","53746010905","HYDROCO\/APAP ","TAB 5-325MG","10","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","67877022305","GABAPENTIN ","CAP 300MG","81","Select","Select",""],["","69097015915","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","75834002001","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","68382009605","HYDROXYCHLOR ","TAB 200MG","60","Select","Select",""],["","00003089421","ELIQUIS ","TAB 5MG","60","Select","Select",""],["","68462043890","OLMESA ","TAB 40MG","30","Select","Select",""],["","00536322201","PAIN ","TAB 325MG","100","Select","Select",""],["","00832532510","POT  CL MICRO","TAB 20MEQ ER","30","Select","Select",""],["","69315011710","FUROSEMIDE ","TAB 40MG","30","Select","Select",""],["","59676058015","JANSSEN ","INJ COVID-19","0","Select","Select",""],["","69315015501","HYDROCHLOROT ","TAB 12.5MG","60","Select","Select",""],["","68382041205","OMEPRAZOLE ","CAP 20MG","60","Select","Select",""],["","00085134101","ASMANEX ","AER 220MCG","1","Select","Select",""],["","55111012705","CIPROFLOXACN ","TAB 500MG","14","Select","Select",""],["","69097084064","IPRATROPIUM\/ ","SOL ALBUTER","180","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":""}]}]}