{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANNA   M BARTS","gend":1,"add":"1600 KENTUCK CHURCH RD LOT 7","city":"RINGGOLD","state":"VA","zip":"24586-9998","dob":"1999-06-07","age":"","mstatus":"","insh":"20023648*01","cliId":"","pno":"434\/822-7020","cno":"434\/822-7020","email":"","ename":"","eno":"","pphy":"STEPHENS, AMBER L DO","ppno":"434\/799-4488","pcpadd":"SUITE 201 109 BRIDGE STREET","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"pcpcounty":"","pcpid":174776,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/773-6977","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.2","F41.0","F90.9","F43.22","R42.","R53.83","R35.0","R31.9","Z20.828","Z11.59","Z13.9","F44.5","F41.1","F90.1","G40.909","K52.9","F32.9","J45.909","F17.210","Z79.1","Z88.1","Z79.899","N89.8","R22.1","S39.012A","S60.212A"],"date":["2020-01-22","2021-10-07","2021-10-07","2021-10-07","2020-08-12","2020-08-12","2020-08-12","2020-08-12","2021-01-27","2020-09-25","2021-06-24","2021-06-24","2021-06-24","2021-06-24","2021-05-14","2020-09-06","2020-09-06","2020-09-06","2020-09-06","2020-09-06","2020-09-06","2020-09-06","2020-01-03","2020-01-03","2020-06-28","2020-02-06"],"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":[["","68180011302","LEVETIRACETA ","500MG","180","Select","Select",""],["","00093585101","ESCITALOPRAM ","10MG","30","Select","Select",""],["","42858030101","HYDROMORPHON ","2MG","90","Select","Select",""],["","65862052730","VENLAFAXINE ","37.5 ER","60","Select","Select",""],["","68462015713","ONDANSETRON ","4MG ODT","10","Select","Select",""],["","00781707787","METRONIDAZOL ","0.75%VAG","70","Select","Select",""],["","68180011302","LEVETIRACETA","500MG","180","Select","Select",""],["","00093585101","ESCITALOPRAM","10MG","30","Select","Select",""],["","42858030101","HYDROMORPHON","2MG","90","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","10","Select","Select",""],["","65862052730","VENLAFAXINE","37.5 ER","60","Select","Select",""],["","00781707787","METRONIDAZOL","0.75%VAG","70","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":""}]}]}