{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ERIN HARRIS","gend":1,"add":"1136 PUMPING HILL ROAD","city":"NATHALIE","state":"VA","zip":"24577-9998","dob":"2003-04-02","age":"","mstatus":"","insh":"20028716*01","cliId":"","pno":"434\/572-7812","cno":"434\/572-7812","email":"","ename":"","eno":"","pphy":"HAMLOR, GAHEAR F MD","ppno":"434\/349-3113","pcpadd":"15210 L P BAILEY MEMORIAL HIGHWAY","pcpcity":"NATHALIE","pcpstate":"VA","pcpzip":24577,"pcpcounty":"","pcpid":105510,"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":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z30.42","Z23.","G40.909","F84.0","G40.919","T88.7XXA","J18.1","J11.1","Z00.121","M67.01","M67.02","M62.81","R50.9","R05.","Z30.09"],"date":["2020-10-21","2020-07-20","2020-12-09","2020-12-09","2020-12-09","2020-12-09","2020-02-25","2020-02-25","2020-01-16","2020-01-16","2020-01-16","2020-01-24","2020-02-24","2020-02-24","2020-10-21"],"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":[["","69367018408","DM\/GG\/PHENYL ","","240","Select","Select",""],["","68462022901","LAMOTRIGINE ","25MG","120","Select","Select",""],["","70166054905","PREDNISOLONE ","15MG\/5ML","200","Select","Select",""],["","00054318863","DIAZEPAM ","5MG\/5ML","180","Select","Select",""],["","49884048611","LAMOTRIG ","100MG","120","Select","Select",""],["","64980032802","ERY\/BENZOYL ","5-3%","47","Select","Select",""],["","69097012303","TOPIRAMATE ","50MG","90","Select","Select",""],["","47781038426","OSELTAMIVIR ","6MG\/ML","120","Select","Select",""],["","50428033399","DM ","20-400","177","Select","Select",""],["","59762453701","MEDROXYPR ","150MG\/ML","1","Select","Select",""],["","50428041780","CVS ","30MG\/5ML","148","Select","Select",""],["","65862021901","CEFDINIR ","250\/5ML","100","Select","Select",""],["","60432027516","BROM\/PSE\/DM ","","473","Select","Select",""],["","00093321205","CLONAZEPAM ","1MG","20","Select","Select",""],["","00093416178","AMOXICILLIN ","400\/5ML","150","Select","Select",""],["","68462030529","NORETHINDRON ","0.35MG","28","Select","Select",""],["","00093321930","KETOCONAZOLE ","2%","30","Select","Select",""],["","00093321930","KETOCONAZOLE","2%","30","Select","Select",""],["","64980032802","ERY\/BENZOYL","5-3%","47","Select","Select",""],["","00555077902","MEDROXYPR","10MG","30","Select","Select",""],["","69097012303","TOPIRAMATE","50MG","90","Select","Select",""],["","49884048611","LAMOTRIG","100MG","120","Select","Select",""],["","68462022901","LAMOTRIGINE","25MG","120","Select","Select",""],["","00054318863","DIAZEPAM","5MG\/5ML","180","Select","Select",""],["","50428033399","DM","20-400","177","Select","Select",""],["","69367018408","DM\/GG\/PHENYL","","240","Select","Select",""],["","65862021901","CEFDINIR","250\/5ML","100","Select","Select",""],["","60432027516","BROM\/PSE\/DM","","473","Select","Select",""],["","00121075908","PREDNISOLONE","15MG\/5ML","200","Select","Select",""],["","50428041780","CVS","30MG\/5ML","148","Select","Select",""],["","47781038426","OSELTAMIVIR","6MG\/ML","120","Select","Select",""],["","00093321205","CLONAZEPAM","1MG","20","Select","Select",""],["","68462030529","NORETHINDRON","0.35MG","28","Select","Select",""],["","00093416178","AMOXICILLIN","400\/5ML","150","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":""}]}]}