{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GREVA BORBOLLA","gend":1,"add":"100 RIDGE ST APT 118","city":"CHARLOTTESVILLE","state":"VA","zip":"22902-9998","dob":"1940-03-13","age":"","mstatus":"","insh":"20024143*01","cliId":"","pno":"434\/260-2416","cno":"434\/260-2416","email":"","ename":"","eno":"","pphy":"PLEWS-OGAN, MARGARET MD","ppno":"434\/924-1931","pcpadd":"PRIMARY CARE 4TH FLR","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22908,"pcpcounty":"","pcpid":114418,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"434\/227-3178,4342028286","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/243-5906","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I49.5","R10.9","R10.84","M54.6","K21.9","I10.","F32.9","I48.0","Z79.01","H40.1133","Z48.810","H40.1113","I44.7","R07.9","R06.09","I48.91","Z96.1","NO DATA","I25.10","R09.89","J98.4","J84.9","T46.2X5A","E78.00","I50.32","Z01.419","N83.201","T46.2X4S","S90.32XA","W22.8XXA","Y93.9","Y92.9","M81.0","E55.9","Z95.0","Z12.4","Z12.31","Z01.818","M54.5","H18.891","R05.","M25.511","I50.9","J30.2","I16.0","G89.29","R06.00","T46.2X1A"],"date":["2021-08-27","2020-11-24","2020-11-24","2020-11-24","2020-11-24","2021-08-27","2020-11-24","2021-10-19","2020-11-24","2021-05-11","2021-04-27","2021-04-27","2021-04-07","2020-01-23","2020-01-23","2020-01-23","2021-05-11","2021-04-19","2021-04-19","2021-04-19","2021-06-15","2021-09-14","2021-06-15","2021-06-16","2021-06-16","2021-01-27","2021-01-27","2021-09-14","2021-03-24","2021-03-24","2021-03-24","2021-03-24","2021-06-15","2021-06-15","2020-10-07","2021-01-27","2021-01-27","2021-02-04","2021-09-15","2021-02-09","2020-01-09","2021-08-03","2021-09-14","2021-08-03","2021-08-03","2021-08-03","2021-08-23","2021-08-27"],"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":[["","68180035106","SERTRALINE ","25MG","30","Select","Select",""],["","00536118497","COUGH\/CHEST ","DM","236","Select","Select",""],["","51672405506","AMIODARONE ","100MG","30","Select","Select",""],["","62332002830","LOSARTAN ","50MG","30","Select","Select",""],["","55111015810","OMEPRAZOLE ","20MG","30","Select","Select",""],["","00023932110","ALPHAGAN ","0.10%","10","Select","Select",""],["","00904679489","ASPIRIN ","81MG","30","Select","Select",""],["","60505257808","ATORVASTATIN ","10MG","30","Select","Select",""],["","00904188372","OYSTER ","500MG","60","Select","Select",""],["","61314003002","DORZOL\/TIMOL ","22.3-6.8","10","Select","Select",""],["","00054429731","FUROSEMIDE ","20MG","12","Select","Select",""],["","16571040110","CETIRIZINE ","5MG","30","Select","Select",""],["","40985027292","VITAMIN ","1000UNIT","60","Select","Select",""],["","24208046325","LATANOPROST ","0.01%","2","Select","Select",""],["","00904646420","ROBAFEN ","10-100\/5","240","Select","Select",""],["","69097012815","AMLODIPINE ","10MG","30","Select","Select",""],["","00832121300","JANTOVEN ","2.5MG","30","Select","Select",""],["","68180016106","AZITHROMYCIN ","500MG","3","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","61314065605","CIPROFLOXACN ","0.3% OP","5","Select","Select",""],["","60505058204","MOXIFLOXACIN ","HCL 0.5%","3","Select","Select",""],["","17478060510","COSOPT ","22.3-6.8","10","Select","Select",""],["","00003089421","ELIQUIS ","5MG","60","Select","Select",""],["","60758011915","PREDNISOLONE ","1% OP","15","Select","Select",""],["","17478021515","ATROPINE ","1% OP","15","Select","Select",""],["","31604002793","D3 ","1000UNIT","60","Select","Select",""],["","55111046605","METOPROL ","25MG ER","45","Select","Select",""],["","54022108402","CALCIUM ","1040MG","90","Select","Select",""],["","43292055606","CA ","250MG","120","Select","Select",""],["","45802095301","DICLOFENAC ","1%","100","Select","Select",""],["","00904679489","ASPIRIN","81MG","30","Select","Select",""],["","00904188372","OYSTER","500MG","60","Select","Select",""],["","65862020299","LOSARTAN","50MG","30","Select","Select",""],["","24208048610","DORZOL\/TIMOL","22.3-6.8","10","Select","Select",""],["","68180072103","AMLODIPINE","10MG","30","Select","Select",""],["","60505257808","ATORVASTATIN","10MG","30","Select","Select",""],["","24208046325","LATANOPROST","0.01%","2","Select","Select",""],["","16571040110","CETIRIZINE","5MG","30","Select","Select",""],["","00832121300","JANTOVEN","2.5MG","30","Select","Select",""],["","51672405506","AMIODARONE","100MG","30","Select","Select",""],["","00904646420","ROBAFEN","10-100\/5","236","Select","Select",""],["","00054429731","FUROSEMIDE","20MG","12","Select","Select",""],["","00023932110","ALPHAGAN","0.10%","10","Select","Select",""],["","00536118497","COUGH\/CHEST","DM","236","Select","Select",""],["","40985027292","VITAMIN","1000UNIT","60","Select","Select",""],["","55111015810","OMEPRAZOLE","20MG","30","Select","Select",""],["","68180035106","SERTRALINE","25MG","30","Select","Select",""],["","68180016106","AZITHROMYCIN","500MG","3","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","17478060510","COSOPT","22.3-6.8","10","Select","Select",""],["","00003089421","ELIQUIS","5MG","60","Select","Select",""],["","61314065605","CIPROFLOXACN","0.3% OP","5","Select","Select",""],["","60505058204","MOXIFLOXACIN","HCL 0.5%","3","Select","Select",""],["","60758011915","PREDNISOLONE","1% OP","15","Select","Select",""],["","17478021515","ATROPINE","1% OP","15","Select","Select",""],["","31604002793","D3","1000UNIT","60","Select","Select",""],["","54022108402","CALCIUM","1040MG","90","Select","Select",""],["","43292055606","CA","250MG","120","Select","Select",""],["","45802095301","DICLOFENAC","1%","100","Select","Select",""],["","55111046605","METOPROL","25MG ER","45","Select","Select",""],["","63824000815","MUCINEX ","TAB 600MG ER","100","Select","Select",""],["","17856049801","GUAIFENESIN ","TAB 600MG ER","120","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","",""],["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":""}]}]}