{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DEBORAH   F CRIDER","gend":1,"add":"260 TELLURIDE DR","city":"BROADWAY","state":"VA","zip":"22815-9998","dob":"1956-10-10","age":"","mstatus":"","insh":"20009407*01","cliId":"","pno":"540\/246-7582","cno":"540\/246-7582","email":"","ename":"","eno":"","pphy":"HOTCHKISS, JEROME J MD","ppno":"540\/433-4913","pcpadd":"1380 LITTLE SORRELL DRIVE SUITE 100","pcpcity":"HARRISONBURG","pcpstate":"VA","pcpzip":22801,"pcpcounty":"","pcpid":145877,"pcpname":"Healthy Community Health Center - Stone Port (HCHC-Stone Port)","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/433-4915","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N39.3","R39.81","F11.20","F25.0","G21.19","Z79.899","S06.0X0A","R63.5","G25.9","T50.905A","Z23.","E05.90","E55.9","M81.0","I25.10","J44.9","I10.","I25.2","Z95.1","F17.210","Z88.1","Z88.6","Z88.0","Z91.030","Z91.041","R42.","Z76.89","R60.0"],"date":["2021-09-16","2021-09-16","2021-10-20","2021-04-22","2021-04-22","2021-01-08","2021-04-16","2021-02-05","2020-09-17","2021-02-05","2021-06-25","2021-05-17","2021-05-17","2021-01-06","2021-04-16","2021-04-16","2021-04-16","2021-04-16","2021-04-16","2021-04-16","2021-04-16","2021-04-16","2021-04-16","2021-04-16","2021-04-16","2021-04-16","2020-02-18","2020-05-11"],"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":[["","66993068330","OLANZAPINE ","10MG","30","Select","Select",""],["","12496120803","SUBOXONE ","8-2MG","14","Select","Select",""],["","47781035703","BUPREN\/NALOX ","8-2MG","14","Select","Select",""],["","00378718705","METFORMIN ","1000MG","30","Select","Select",""],["","23155007001","METHIMAZOLE ","5MG","15","Select","Select",""],["","00093719801","FLUOXETINE ","40MG","30","Select","Select",""],["","68180047903","SIMVASTATIN ","20MG","30","Select","Select",""],["","13668021630","ARIPIPRAZOLE ","2MG","7","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","17","Select","Select",""],["","00904506860","MI-ACID ","80MG","120","Select","Select",""],["","45802065078","LORATADINE ","10MG","30","Select","Select",""],["","54738051801","SIMETHICONE ","80MG","120","Select","Select",""],["","00143980305","DOXYCYCL ","100MG","20","Select","Select",""],["","00603243721","BENZTROPINE ","0.5MG","181","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","65862049101","QUETIAPINE ","100MG","30","Select","Select",""],["","00093598627","EPINEPHRINE ","0.3MG","2","Select","Select",""],["","12496120803","SUBOXONE","8-2MG","14","Select","Select",""],["","33342007007","OLANZAPINE","10MG","30","Select","Select",""],["","00378718705","METFORMIN","1000MG","30","Select","Select",""],["","47781035703","BUPREN\/NALOX","8-2MG","14","Select","Select",""],["","65862019401","FLUOXETINE","40MG","30","Select","Select",""],["","23155007001","METHIMAZOLE","5MG","15","Select","Select",""],["","68180047903","SIMVASTATIN","20MG","30","Select","Select",""],["","00093317431","ALBUTEROL","HFA","17","Select","Select",""],["","00904506860","MI-ACID","80MG","120","Select","Select",""],["","45802065078","LORATADINE","10MG","30","Select","Select",""],["","00143980305","DOXYCYCL","100MG","20","Select","Select",""],["","54738051801","SIMETHICONE","80MG","120","Select","Select",""],["","13668021830","ARIPIPRAZOLE","10MG","30","Select","Select",""],["","00603243721","BENZTROPINE","0.5MG","60","Select","Select",""],["","65862049101","QUETIAPINE","100MG","30","Select","Select",""],["","00093598627","EPINEPHRINE","0.3MG","2","Select","Select",""],["","69547035302","NARCAN","","2","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","",""],["Yes","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":""}]}]}