{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DENISE   S COPELAND","gend":1,"add":"317 SHILOH AVE","city":"WAYNESBORO","state":"VA","zip":"22980-9998","dob":"1973-12-19","age":"","mstatus":"","insh":"20025784*01","cliId":"","pno":"301\/800-3296","cno":"301\/800-3296","email":"","ename":"","eno":"","pphy":"JAFFE, KATHERINE GEER MD","ppno":"434\/924-2472","pcpadd":"415 RAY C HUNT DRIVE STE 2100","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22908,"pcpcounty":"","pcpid":100619,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"540\/836-9615","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R53.83","R51.9","R05.","Z20.828","R52.","F31.32","K21.9","F31.9","J45.40","G43.009","Z91.19","C53.9","R39.81","G35.","Z08.","Z85.41","R11.0","F31.63","S29.9XXA","W10.8XXA"],"date":["2021-02-19","2021-02-19","2021-02-19","2021-02-19","2020-12-31","2021-01-15","2020-07-24","2020-07-24","2020-07-24","2020-07-24","2020-07-24","2020-07-24","2020-01-12","2020-01-24","2020-01-24","2020-02-14","2020-02-14","2021-02-11","2021-01-26","2021-01-26"],"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":[["","58468021004","AUBAGIO ","14MG","30","Select","Select",""],["","69097094312","GABAPENTIN ","300MG","90","Select","Select",""],["","00832105410","BACLOFEN ","10MG","45","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","30","Select","Select",""],["","81131000720","D3 ","2000UNIT","50","Select","Select",""],["","31722071390","PANTOPRAZOLE ","40MG","60","Select","Select",""],["","68180096301","ALBUTEROL ","HFA","8","Select","Select",""],["","51645094101","VITAMIN ","100MG","50","Select","Select",""],["","65862014836","SUMATRIPTAN ","100MG","9","Select","Select",""],["","00085113204","PROVENTIL ","HFA","7","Select","Select",""],["","68180061207","QUETIAPINE ","50MG ER","6","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","65162019011","NAPROXEN ","500MG","28","Select","Select",""],["","42806016005","HYDROXYZ ","25MG","90","Select","Select",""],["","43547028111","ESCITALOPRAM ","10MG","30","Select","Select",""],["","58468021004","AUBAGIO","14MG","30","Select","Select",""],["","69097094312","GABAPENTIN","300MG","90","Select","Select",""],["","00832105410","BACLOFEN","10MG","45","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","30","Select","Select",""],["","65862056099","PANTOPRAZOLE","40MG","60","Select","Select",""],["","45802008801","ALBUTEROL","HFA","17","Select","Select",""],["","81131000720","D3","2000UNIT","50","Select","Select",""],["","51645094101","VITAMIN","100MG","50","Select","Select",""],["","65862014836","SUMATRIPTAN","100MG","9","Select","Select",""],["","00085113204","PROVENTIL","HFA","7","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","68180061207","QUETIAPINE","50MG ER","60","Select","Select",""],["","65162019011","NAPROXEN","500MG","28","Select","Select",""],["","42806016005","HYDROXYZ","25MG","90","Select","Select",""],["","43547028111","ESCITALOPRAM","10MG","30","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":""}]}]}