{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"IONA   L COFFEY","gend":1,"add":"2134 LAKESIDE DR LOT 104","city":"LYNCHBURG","state":"VA","zip":"24501-9998","dob":"1954-08-21","age":"","mstatus":"","insh":"20025543*01","cliId":"","pno":"434\/229-4153","cno":"434\/229-4153","email":"","ename":"","eno":"","pphy":"BLACKWOOD, GEORGE DO","ppno":"434\/947-5967","pcpadd":"320 FEDERAL ST","pcpcity":"LYNCHBURG","pcpstate":"VA","pcpzip":24504,"pcpcounty":"","pcpid":972504,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/947-5971","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.65","Z79.4","E78.5","R07.89","R07.9","R09.02","R06.89","R50.9","M19.012","E11.9","E78.00","Z87.891","S81.009S","N39.0","I10.","U07.1","J18.9","F41.9","J96.01","R79.89","R21.","Z88.0","Z88.6","E11.42","F32.9","F43.21","M17.12","Z82.49","K21.9","Z09.","Z86.19","R87.612","R87.810","Z20.9","R53.1","R05.","K21.0","K59.00","Z91.14","J12.89","D64.9","V58.69","M62.9","N81.10","S52.614A"],"date":["2021-06-24","2020-10-31","2020-09-23","2020-09-23","2020-09-23","2020-09-27","2020-09-23","2020-09-27","2020-03-20","2020-10-31","2020-10-01","2020-10-31","2020-05-07","2020-05-07","2021-06-24","2020-10-01","2020-09-27","2020-10-01","2020-10-01","2020-09-27","2020-10-31","2020-10-31","2020-10-31","2021-06-24","2021-06-24","2021-06-24","2020-04-26","2020-09-27","2020-10-01","2020-10-15","2020-10-15","2020-06-02","2020-06-02","2020-10-31","2020-09-27","2020-09-27","2020-05-20","2020-05-20","2020-09-23","2020-09-27","2020-09-27","2020-09-27","2021-07-19","2021-07-19","2021-10-21"],"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":[["","31722070210","LOSARTAN ","100MG","30","Select","Select",""],["","62175013643","OMEPRAZOLE ","40MG","30","Select","Select",""],["","00169643810","LEVEMIR ","FLEXTOUC","30","Select","Select",""],["","59746017710","CYCLOBENZAPR ","10MG","30","Select","Select",""],["","16714050301","GABAPENTIN ","100MG","90","Select","Select",""],["","13668011105","DULOXETINE ","60MG","60","Select","Select",""],["","65862005299","SIMVASTATIN ","20MG","30","Select","Select",""],["","69097082112","GEMFIBROZIL ","600MG","60","Select","Select",""],["","00006057762","JANUMET ","50-1000","60","Select","Select",""],["","00143314250","DOXYCYCL ","100MG","14","Select","Select",""],["","00093101042","MUPIROCIN ","2%","22","Select","Select",""],["","00904645780","DOK ","100MG","90","Select","Select",""],["","16714043901","NITROFURANTN ","100MG","14","Select","Select",""],["","56151210301","PEN  NEEDLES  ","31GX5\/16","100","Select","Select",""],["","00054001825","PREDNISONE ","20MG","2","Select","Select",""],["","00904699880","DOCUSATE ","100MG","180","Select","Select",""],["","13668011105","DULOXETINE","60MG","60","Select","Select",""],["","59746017710","CYCLOBENZAPR","10MG","30","Select","Select",""],["","62175013643","OMEPRAZOLE","40MG","30","Select","Select",""],["","16714050301","GABAPENTIN","100MG","90","Select","Select",""],["","65862005299","SIMVASTATIN","20MG","30","Select","Select",""],["","00006057762","JANUMET","50-1000","60","Select","Select",""],["","31722070210","LOSARTAN","100MG","30","Select","Select",""],["","00169643810","LEVEMIR","FLEXTOUC","30","Select","Select",""],["","16714043901","NITROFURANTN","100MG","14","Select","Select",""],["","69097082112","GEMFIBROZIL","600MG","60","Select","Select",""],["","00093101042","MUPIROCIN","2%","22","Select","Select",""],["","00904645780","DOK","100MG","90","Select","Select",""],["","56151210301","PEN NEEDLES","31GX5\/16","100","Select","Select",""],["","00143314250","DOXYCYCL","100MG","14","Select","Select",""],["","00904699880","DOCUSATE","100MG","180","Select","Select",""],["","00169633910","NOVOLOG","FLEXPEN","15","Select","Select",""],["","00054001825","PREDNISONE","20MG","2","Select","Select",""],["","00169633910","NOVOLOG ","INJ FLEXPEN","15","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}