{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TARSHA   C ADKINS","gend":1,"add":"3643 GLENLAND RD LOT B","city":"HURT","state":"VA","zip":"24563-9998","dob":"1985-03-10","age":"","mstatus":"","insh":"20022916*01","cliId":"","pno":"434\/483-7492","cno":"434\/483-7492","email":"","ename":"","eno":"","pphy":"HUNDLEY, SUSAN DUPUY MD","ppno":"434\/738-6420","pcpadd":"380 WASHINGTON STREET","pcpcity":"BOYDTON","pcpstate":"VA","pcpzip":23917,"pcpcounty":"","pcpid":125561,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N32.81","R35.0","G40.309","M62.838","R27.8","N76.0","Z11.3","K21.9","R13.10","E03.9","R10.13","K59.09","Z71.9"],"date":["2020-10-22","2020-03-18","2021-09-03","2020-10-22","2020-10-22","2020-03-30","2020-03-30","2020-09-14","2020-09-14","2020-01-28","2020-08-31","2020-08-31","2020-08-31"],"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":[["","00555901658","SPRINTEC ","28 DAY","28","Select","Select",""],["","68682045570","METRONIDAZOL ","0.75%VAG","70","Select","Select",""],["","65862022701","LAMOTRIGINE ","25MG","120","Select","Select",""],["","00536100901","FERROUS ","325MG","30","Select","Select",""],["","61442011201","ACYCLOVIR ","400MG","60","Select","Select",""],["","68382025601","OXYBUTYNIN ","10MG ER","90","Select","Select",""],["","59651000305","OMEPRAZOLE ","40MG","30","Select","Select",""],["","70710113908","FLUCONAZOLE ","150MG","2","Select","Select",""],["","00456120330","LINZESS ","72MCG","30","Select","Select",""],["","00054418425","DEXAMETHASON ","4MG","6","Select","Select",""],["","00603233832","APAP\/CODEINE ","300-30MG","3","Select","Select",""],["","65162019050","NAPROXEN ","500MG","25","Select","Select",""],["","67877032005","IBUPROFEN ","600MG","20","Select","Select",""],["","00116200116","CHLORHEX ","0.12%","473","Select","Select",""],["","00093226301","AMOXICILLIN ","500MG","19","Select","Select",""],["","68462030529","NORETHINDRON ","0.35MG","84","Select","Select",""],["","51672130406","TERCONAZOLE ","0.40%","45","Select","Select",""],["","65862092585","INCASSIA ","0.35MG","84","Select","Select",""],["","70461032003","FLUCLVX ","2020-21","0","Select","Select",""],["","68682045570","METRONIDAZOL","0.75%VAG","70","Select","Select",""],["","00555901658","SPRINTEC","28 DAY","84","Select","Select",""],["","00536100901","FERROUS","325MG","30","Select","Select",""],["","65862022701","LAMOTRIGINE","25MG","120","Select","Select",""],["","61442011201","ACYCLOVIR","400MG","60","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","2","Select","Select",""],["","68382025601","OXYBUTYNIN","10MG ER","90","Select","Select",""],["","55111015810","OMEPRAZOLE","20MG","14","Select","Select",""],["","00054418425","DEXAMETHASON","4MG","6","Select","Select",""],["","67877032005","IBUPROFEN","600MG","20","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","00093226301","AMOXICILLIN","500MG","19","Select","Select",""],["","71930005552","APAP\/CODEINE","300-30MG","20","Select","Select",""],["","00456120330","LINZESS","72MCG","30","Select","Select",""],["","68462030529","NORETHINDRON","0.35MG","84","Select","Select",""],["","65862092585","INCASSIA","0.35MG","84","Select","Select",""],["","70461032003","FLUCLVX","2020-21","0","Select","Select",""],["","51672130406","TERCONAZOLE","0.40%","45","Select","Select",""],["","65162019050","NAPROXEN","500MG","25","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","",""],["No","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":""}]}]}