{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PHYLLIS   T ANDREWS","gend":1,"add":"PO BOX 403","city":"BOYDTON","state":"VA","zip":"23917-9998","dob":"1963-01-06","age":"","mstatus":"","insh":"20023209*01","cliId":"","pno":"434\/265-2068","cno":"434\/265-2068","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":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/738-6054","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z23.","NO DATA","Z01.812","Z11.59","Z12.11","D12.5","K64.8","I10.","J30.89","K21.9","R73.09","E78.2","E55.9","E04.9","E05.90","E04.2","Z68.35"],"date":["2021-11-20","2020-06-24","2020-07-31","2020-07-31","2020-08-04","2020-08-04","2020-08-04","2020-05-14","2020-05-14","2020-05-14","2020-05-14","2020-05-14","2020-05-14","2020-05-14","2021-04-20","2021-04-20","2021-04-20"],"priorHcc":[null,"","","","","","","","","","","","","","","",""]}},{"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":[["","65862000899","METFORMIN ","500MG","60","Select","Select",""],["","16729000617","SIMVASTATIN ","40MG","30","Select","Select",""],["","68180098003","LISINOPRIL ","10MG","60","Select","Select",""],["","49884064101","METHIMAZOLE ","10MG","30","Select","Select",""],["","45802091987","CETIRIZINE ","10MG","30","Select","Select",""],["","69452014420","BENZONATATE ","200MG","30","Select","Select",""],["","10572030201","PEG-3350\/KCL ","\/SODIUM","4000","Select","Select",""],["","67877032105","IBUPROFEN ","800MG","270","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","16729000617","SIMVASTATIN","40MG","30","Select","Select",""],["","49884064101","METHIMAZOLE","10MG","30","Select","Select",""],["","68180098003","LISINOPRIL","10MG","60","Select","Select",""],["","65862000899","METFORMIN","500MG","60","Select","Select",""],["","45802091987","CETIRIZINE","10MG","30","Select","Select",""],["","10572030201","PEG-3350\/KCL","\/SODIUM","4000","Select","Select",""],["","67877032105","IBUPROFEN","800MG","270","Select","Select",""],["","69452014420","BENZONATATE","200MG","30","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","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":""}]}]}