{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NATISHA WILLIAMS","gend":1,"add":"141 GREEN TURTLE LN APT 8","city":"CHARLOTTESVILLE","state":"VA","zip":"22901-9998","dob":"1990-06-09","age":"","mstatus":"","insh":"1953130*01","cliId":"","pno":"434\/227-2897","cno":"434\/227-2897","email":"","ename":"","eno":"","pphy":"MAROTTA, RAYMOND P MD","ppno":"434\/973-9744","pcpadd":"STE 201 1450 SACHEM PLACE","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22901,"pcpcounty":"","pcpid":102077,"pcpname":"Family Medicine of Albemarle","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/973-9790","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K50.80","K63.3","K50.919","Z01.818","J35.8","J34.2","J31.0","K50.812","R09.81","J98.9","NO DATA","K50.119","Z00.00","K50.819","Z11.59","Z20.828","K50.912","L40.3","L73.2","L70.0","N89.8","Z12.4","Z11.3","K50.90","K21.9","F32.9"],"date":["2021-06-03","2021-02-25","2021-06-30","2021-06-01","2021-05-25","2021-05-25","2021-05-25","2021-04-23","2021-03-24","2021-05-25","2021-03-24","2021-03-24","2021-05-11","2021-05-11","2020-07-30","2020-08-10","2021-04-28","2021-06-28","2021-06-28","2021-06-28","2021-04-26","2021-04-26","2021-04-26","2021-06-03","2021-06-03","2021-06-03"],"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":[["","00054458111","MERCAPTOPUR ","50MG","30","Select","Select",""],["","68682045570","METRONIDAZOL ","0.75%VAG","70","Select","Select",""],["","69238148503","ERYTHROMYCIN ","500MG BS","6","Select","Select",""],["","45802013132","HALOBETASOL ","0.05%","50","Select","Select",""],["","59762374401","CLINDAMYCIN ","10MG\/ML","60","Select","Select",""],["","00574222545","TRETINOIN ","0.03%","45","Select","Select",""],["","43386009019","GAVILYTE-G ","","4000","Select","Select",""],["","51991081403","AZELASTINE ","0.10%","90","Select","Select",""],["","10702001801","OXYCODONE ","5MG","20","Select","Select",""],["","00093356026","PEG\/NASUL,C ","NACL\/POT","1","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","8","Select","Select",""],["","00093220305","METOCLOPRAM ","10MG","3","Select","Select",""],["","00115168974","BUDESONIDE ","0.5MG\/2","120","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","69618001001","ACETAMIN ","325MG","30","Select","Select",""],["","45802005505","TRIAMCINOLON ","0.10%","454","Select","Select",""],["","70000036502","STOOL ","100MG","30","Select","Select",""],["","00093117701","NEOMYCIN ","500MG","6","Select","Select",""],["","57896048914","POLYETH ","3350 NF","238","Select","Select",""],["","50428041228","SKIN ","4%","237","Select","Select",""],["","43386009660","CLOBETASOL ","0.05%","45","Select","Select",""],["","00054458111","MERCAPTOPUR","50MG","30","Select","Select",""],["","68682045570","METRONIDAZOL","0.75%VAG","70","Select","Select",""],["","45802013132","HALOBETASOL","0.05%","50","Select","Select",""],["","59762374401","CLINDAMYCIN","10MG\/ML","60","Select","Select",""],["","00574222545","TRETINOIN","0.03%","45","Select","Select",""],["","69452015120","VITAMIN","50000UNT","8","Select","Select",""],["","00093356026","PEG\/NASUL,C","NACL\/POT","1","Select","Select",""],["","69238148503","ERYTHROMYCIN","500MG BS","6","Select","Select",""],["","00115168974","BUDESONIDE","0.5MG\/2","120","Select","Select",""],["","43386009019","GAVILYTE-G","","4000","Select","Select",""],["","69618001001","ACETAMIN","325MG","30","Select","Select",""],["","51991081403","AZELASTINE","0.10%","90","Select","Select",""],["","10702001801","OXYCODONE","5MG","20","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","00093220305","METOCLOPRAM","10MG","3","Select","Select",""],["","70000036502","STOOL","100MG","30","Select","Select",""],["","50428041228","SKIN","4%","237","Select","Select",""],["","00093117701","NEOMYCIN","500MG","6","Select","Select",""],["","45802005505","TRIAMCINOLON","0.10%","454","Select","Select",""],["","57896048914","POLYETH","3350 NF","238","Select","Select",""],["","43386009660","CLOBETASOL","0.05%","45","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","",""],["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":""}]}]}