{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CAROLYN   A CREWS","gend":1,"add":"APT B6 PO BOX 1252","city":"GRETNA","state":"VA","zip":"24557-9998","dob":"1969-12-27","age":"","mstatus":"","insh":"20025955*01","cliId":"","pno":"434\/656-1724","cno":"434\/656-1724","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":"CHARLOTTESVILLE WESTERN","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":["H40.1131","H25.13","N92.6","E11.9","F17.210","D51.0"],"date":["2021-06-11","2021-06-11","2020-07-18","2020-07-18","2020-07-18","2020-12-10"],"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":[["","00904421813","VITAMIN ","250MCG","30","Select","Select",""],["","55111015810","OMEPRAZOLE ","20MG","30","Select","Select",""],["","00904759060","FEROSUL ","325MG","60","Select","Select",""],["","00065026005","TRAVATAN ","0.00%","5","Select","Select",""],["","64980043901","ATENOLOL ","100MG","60","Select","Select",""],["","62175089241","ATORVASTATIN ","40MG","30","Select","Select",""],["","33342006207","VALSARTAN ","40MG","30","Select","Select",""],["","00597015330","JARDIANCE ","25MG","30","Select","Select",""],["","67877056310","METFORMIN ","1000MG","180","Select","Select",""],["","53885024450","ONETOUCH ","ULTRA","50","Select","Select",""],["","56151146304","TRUE ","GLUCOSE","50","Select","Select",""],["","00781618575","TRAVOPROST ","0.00%","5","Select","Select",""],["","51672130200","TERCONAZOLE ","0.80%","20","Select","Select",""],["","74312017621","D3 ","50MCG","30","Select","Select",""],["","52937000120","VASCEPA ","1GM","180","Select","Select",""],["","60505317007","OMEGA-3-ACID ","1GM","120","Select","Select",""],["","59762033302","LATANOPROST ","0.01%","2","Select","Select",""],["","45802065087","LORATADINE ","10MG","90","Select","Select",""],["","80777027310","MODERNA ","COVID-19","0","Select","Select",""],["","00597015330","JARDIANCE","25MG","30","Select","Select",""],["","33342006207","VALSARTAN","40MG","30","Select","Select",""],["","00904759060","FEROSUL","325MG","60","Select","Select",""],["","69452015120","VITAMIN","50000UNT","4","Select","Select",""],["","00065026005","TRAVATAN","0.00%","5","Select","Select",""],["","64980043901","ATENOLOL","100MG","60","Select","Select",""],["","62175089241","ATORVASTATIN","40MG","30","Select","Select",""],["","67877056310","METFORMIN","1000MG","60","Select","Select",""],["","55111015810","OMEPRAZOLE","20MG","30","Select","Select",""],["","53885027150","ONETOUCH","VERIO","50","Select","Select",""],["","56151146304","TRUE","GLUCOSE","50","Select","Select",""],["","00781618575","TRAVOPROST","0.00%","5","Select","Select",""],["","51672130200","TERCONAZOLE","0.80%","20","Select","Select",""],["","74312017621","D3","50MCG","30","Select","Select",""],["","52937000120","VASCEPA","1GM","180","Select","Select",""],["","45802065087","LORATADINE","10MG","90","Select","Select",""],["","60505317007","OMEGA-3-ACID","1GM","120","Select","Select",""],["","59762033302","LATANOPROST","0.01%","2","Select","Select",""],["","80777027310","MODERNA","COVID-19","0","Select","Select",""],["","16729044717","LEVOTHYROXIN ","TAB 25MCG","30","Select","Select",""],["","31604001269","MAGNESIUM ","TAB 250MG","60","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":""}]}]}