{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JEFFERY   T ANDERSON","gend":0,"add":"1115 FILLMORE ST APT 3","city":"LYNCHBURG","state":"VA","zip":"24501-9998","dob":"1965-08-19","age":"","mstatus":"","insh":"20023151*01","cliId":"","pno":"434\/319-5805","cno":"434\/319-5805","email":"","ename":"","eno":"","pphy":"MAITLAND, LAURI DO","ppno":"434\/200-5200","pcpadd":"2323 MEMORIAL AVE SUITE 10","pcpcity":"LYNCHBURG","pcpstate":"VA","pcpzip":24501,"pcpcounty":"","pcpid":182209,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/200-1641","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.4","H04.123","H00.012","H25.13","Z98.890","E78.2","Z51.81","J43.9","K21.9","E03.9","Z72.0","D72.829","Z12.5","F31.9","R91.1","J30.9","Z23.","R91.8","C44.91","L03.019","M25.561","Z00.00","K22.2","D75.1","H16.139","L82.0","E78.5","S50.811A","M79.644","Z88.0","F17.210","X58.XXXA","Y92.89","R61."],"date":["2021-09-13","2021-02-10","2021-02-10","2021-02-10","2020-02-12","2021-04-01","2020-11-12","2021-07-30","2020-11-12","2021-04-01","2021-07-30","2021-04-01","2020-11-12","2021-04-01","2021-07-30","2020-11-12","2021-04-01","2021-05-06","2021-05-06","2021-05-06","2021-04-01","2021-04-01","2021-04-01","2021-07-30","2020-01-29","2020-01-29","2020-11-17","2021-07-27","2021-07-27","2021-07-27","2021-07-27","2021-07-27","2021-07-27","2020-11-17"],"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":[["","29300015201","QUETIAPINE ","400MG","30","Select","Select",""],["","50111044102","TRAZODONE ","150MG","30","Select","Select",""],["","51991074790","DULOXETINE ","30MG","30","Select","Select",""],["","65862002306","MIRTAZAPINE ","45MG ODT","30","Select","Select",""],["","10702001110","HYDROXYZ ","25MG","90","Select","Select",""],["","45802091987","CETIRIZINE ","10MG","30","Select","Select",""],["","16729000617","SIMVASTATIN ","40MG","30","Select","Select",""],["","62332000291","FAMOTIDINE ","40MG","30","Select","Select",""],["","55111053405","DIVALPROEX ","500MG ER","90","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","16","Select","Select",""],["","66993058497","FLUTIC\/SALME ","100\/50","180","Select","Select",""],["","00054004641","IPRATROPIUM ","0.06%","15","Select","Select",""],["","00093645198","ESOMEPRA ","40MG DR","90","Select","Select",""],["","72205000490","ROSUVASTATIN ","20MG","30","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","21922000909","DICLOFENAC ","1%","100","Select","Select",""],["","00173069500","ADVAIR ","100\/50","180","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","67877049005","EZETIMIBE ","10MG","90","Select","Select",""],["","68462056417","MUPIROCIN ","2%","30","Select","Select",""],["","57237023305","SMZ-TMP ","800-160","10","Select","Select",""],["","51991074790","DULOXETINE","30MG","30","Select","Select",""],["","55111053405","DIVALPROEX","500MG ER","90","Select","Select",""],["","10702001110","HYDROXYZ","25MG","90","Select","Select",""],["","29300015201","QUETIAPINE","400MG","30","Select","Select",""],["","50111044102","TRAZODONE","150MG","30","Select","Select",""],["","00054004641","IPRATROPIUM","0.06%","15","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","16","Select","Select",""],["","45802091987","CETIRIZINE","10MG","30","Select","Select",""],["","16729000617","SIMVASTATIN","40MG","30","Select","Select",""],["","65862002306","MIRTAZAPINE","45MG ODT","30","Select","Select",""],["","66993058497","FLUTIC\/SALME","100\/50","180","Select","Select",""],["","72205000490","ROSUVASTATIN","20MG","30","Select","Select",""],["","62332000291","FAMOTIDINE","40MG","30","Select","Select",""],["","00093645198","ESOMEPRA","40MG DR","90","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","45802008801","ALBUTEROL","HFA","8","Select","Select",""],["","00173069500","ADVAIR","100\/50","60","Select","Select",""],["","67877049005","EZETIMIBE","10MG","90","Select","Select",""],["","21922000909","DICLOFENAC","1%","100","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","68462056417","MUPIROCIN","2%","30","Select","Select",""],["","57237023305","SMZ-TMP","800-160","10","Select","Select",""],["","65862064163","AZITHROMYCIN","250MG","6","Select","Select",""],["","27808006502","PROMETH\/COD","6.25-10","240","Select","Select",""],["","31722052010","HYDRALAZINE ","TAB 25MG","90","Select","Select",""],["","27808006502","PROMETH\/COD ","SOL 6.25-10","240","Select","Select",""],["","65862064163","AZITHROMYCIN ","TAB 250MG","6","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":""}]}]}