{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DIANE AGEE","gend":1,"add":"222 COURTLAND ST APT 311","city":"DANVILLE","state":"VA","zip":24541,"dob":"1959-06-29","age":"","mstatus":"","insh":"20022922*01","cliId":"","pno":"434\/770-4806","cno":"434\/770-4806","email":"","ename":"","eno":"","pphy":"LAHURD, NEIL J DO","ppno":"434\/835-4876","pcpadd":"949 PINEY FOREST ROAD","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"pcpcounty":"","pcpid":185602,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/835-4875","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.81","F25.0","F41.9","F20.9","V62.84","F25.1","Z00.00","F60.0","R41.0","R45.1","F33.1","N39.0","B96.20","E03.9","E55.9","E78.2","E87.6","E87.1","K59.00","F45.21","G30.0","F02.80","F22.","H25.13","H52.4","G25.81","N95.1","E78.5","F31.9","Z23.","F41.1","F31.60","F20.89","L81.4","L82.1","I83.93","D22.5","D48.5","D22.62","D22.71","D22.72","Z12.83","Z08.","Z85.820"],"date":["2021-07-30","2020-03-12","2021-04-02","2020-04-30","2020-05-11","2020-04-30","2020-08-06","2020-04-24","2020-04-21","2020-04-21","2020-04-21","2020-04-21","2020-04-21","2021-07-21","2021-07-21","2021-07-21","2021-07-21","2021-07-21","2021-05-04","2021-07-21","2021-07-21","2021-07-21","2021-02-04","2021-02-09","2021-02-09","2021-07-21","2021-05-04","2020-04-16","2020-04-16","2020-09-23","2021-07-21","2021-07-21","2021-07-21","2021-08-17","2021-08-17","2021-08-17","2021-08-17","2021-08-17","2021-08-17","2021-08-17","2021-08-17","2021-08-17","2021-08-17","2021-08-17"],"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":[["","60505015801","BUPROPION ","75MG","28","Select","Select",""],["","00555089902","ESTRADIOL ","0.5MG","21","Select","Select",""],["","29300017216","MEMANTINE ","HCL 10MG","56","Select","Select",""],["","67877024910","QUETIAPINE ","50MG","84","Select","Select",""],["","68180035302","SERTRALINE ","100MG","42","Select","Select",""],["","68382013905","TOPIRAMATE ","50MG","56","Select","Select",""],["","00536106210","STOOL ","100MG","56","Select","Select",""],["","45802065078","LORATADINE ","10MG","28","Select","Select",""],["","65862056099","PANTOPRAZOLE ","40MG","28","Select","Select",""],["","00378180377","LEVOTHYROXIN ","50MCG","28","Select","Select",""],["","43547040611","CLONAZEPAM ","0.5MG","56","Select","Select",""],["","60505257908","ATORVASTATIN ","20MG","28","Select","Select",""],["","64380073706","VITAMIN ","50000UNT","4","Select","Select",""],["","68462026190","ROSUVASTATIN ","5MG","28","Select","Select",""],["","00456120330","LINZESS ","72MCG","30","Select","Select",""],["","52536016201","PERPHENAZINE ","2MG","84","Select","Select",""],["","23155050110","HYDROXYZ ","25MG","60","Select","Select",""],["","00781223410","OMEPRAZOLE ","40MG","28","Select","Select",""],["","00904675180","ASPIRIN ","81MG EC","30","Select","Select",""],["","00536113560","REGULOID ","400MG","168","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","60505015801","BUPROPION","75MG","21","Select","Select",""],["","65862056099","PANTOPRAZOLE","40MG","21","Select","Select",""],["","68180035302","SERTRALINE","100MG","42","Select","Select",""],["","67877024910","QUETIAPINE","50MG","84","Select","Select",""],["","60505257908","ATORVASTATIN","20MG","21","Select","Select",""],["","68382013814","TOPIRAMATE","25MG","14","Select","Select",""],["","43547040611","CLONAZEPAM","0.5MG","28","Select","Select",""],["","64380073706","VITAMIN","50000UNT","3","Select","Select",""],["","29300017216","MEMANTINE","HCL 10MG","42","Select","Select",""],["","45802065078","LORATADINE","10MG","21","Select","Select",""],["","00555089902","ESTRADIOL","0.5MG","21","Select","Select",""],["","00378180377","LEVOTHYROXIN","50MCG","21","Select","Select",""],["","00536106210","STOOL","100MG","42","Select","Select",""],["","52536016201","PERPHENAZINE","2MG","84","Select","Select",""],["","68462026190","ROSUVASTATIN","5MG","28","Select","Select",""],["","00781223410","OMEPRAZOLE","40MG","28","Select","Select",""],["","00185067401","HYDROXYZ","25MG","45","Select","Select",""],["","00456120330","LINZESS","72MCG","30","Select","Select",""],["","00536113560","REGULOID","400MG","168","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","00904675180","ASPIRIN","81MG EC","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","",""],["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":""}]}]}