{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARK   A GWYNN","gend":0,"add":"312 MELROSE DR","city":"DANVILLE","state":"VA","zip":"24540-9998","dob":"1990-02-02","age":"","mstatus":"","insh":"20028386*01","cliId":"","pno":"434\/347-1357","cno":"434\/347-1357","email":"","ename":"","eno":"","pphy":"BROUGHTON, ROBERT MD","ppno":"434\/791-3630","pcpadd":"705 MAIN STREET","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"pcpcounty":"","pcpid":141141,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F29.","F20.9","F33.2","R94.31","R06.09","E66.9","H40.1134","R74.0","K59.00","K92.2","Z83.71","F79.","F20.0","K80.20","R16.1","Z20.828","F23."],"date":["2021-07-08","2021-07-08","2020-11-18","2021-07-08","2021-07-08","2021-07-08","2021-07-30","2020-01-22","2020-02-18","2020-02-18","2020-01-22","2020-01-22","2020-09-24","2020-01-22","2020-01-22","2020-11-08","2020-11-08"],"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":[["","16729004417","ATORVASTATIN ","10MG","30","Select","Select",""],["","65862056130","OLANZAPINE ","2.5MG","14","Select","Select",""],["","00904604377","MAG ","LEMON","296","Select","Select",""],["","63551590125","","","296","Select","Select",""],["","16729015001","QUETIAPINE ","400MG","30","Select","Select",""],["","00574041207","POLYETH ","3350 NF","56","Select","Select",""],["","43386009019","GAVILYTE-G ","","4000","Select","Select",""],["","00378363701","CETIRIZINE ","10MG","30","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","16","Select","Select",""],["","00065026005","TRAVATAN ","0.00%","5","Select","Select",""],["","14539067505","HYDROXYZ ","50MG","30","Select","Select",""],["","65862069790","VENLAFAXINE ","150MG ER","30","Select","Select",""],["","50111043303","TRAZODONE ","50MG","30","Select","Select",""],["","61314054701","LATANOPROST ","0.01%","8","Select","Select",""],["","69315090405","LORAZEPAM ","0.5MG","30","Select","Select",""],["","00781618575","TRAVOPROST ","0.00%","5","Select","Select",""],["","00904642285","PEG ","","14","Select","Select",""],["","65862056130","OLANZAPINE","2.5MG","14","Select","Select",""],["","16729004417","ATORVASTATIN","10MG","30","Select","Select",""],["","00904604377","MAG","LEMON","296","Select","Select",""],["","00574041207","POLYETH","3350 NF","56","Select","Select",""],["","43386009019","GAVILYTE-G","","4000","Select","Select",""],["","00065026005","TRAVATAN","0.00%","5","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","16","Select","Select",""],["","67877024801","QUETIAPINE","400MG","30","Select","Select",""],["","00378363701","CETIRIZINE","10MG","30","Select","Select",""],["","14539067505","HYDROXYZ","50MG","30","Select","Select",""],["","69315090405","LORAZEPAM","0.5MG","10","Select","Select",""],["","50111043302","TRAZODONE","50MG","30","Select","Select",""],["","65862069790","VENLAFAXINE","150MG ER","30","Select","Select",""],["","00781618575","TRAVOPROST","0.00%","5","Select","Select",""],["","00904642285","PEG","","14","Select","Select",""],["","61314054701","LATANOPROST","0.01%","8","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":""}]}]}