{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PATSY   D LAM","gend":1,"add":"649 OAK HILL CT","city":"CHARLOTTESVILLE","state":"VA","zip":"22902-9998","dob":"1960-05-24","age":"","mstatus":"","insh":"20030835*01","cliId":"","pno":"434\/293-2265","cno":"434\/293-2265","email":"","ename":"","eno":"","pphy":"SCOTT, EVELYN S MD","ppno":"434\/924-1931","pcpadd":"1222 JEFFERSON PARK AVE 3RD FLOOR","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22903,"pcpcounty":"","pcpid":110470,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"434\/202-9093","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/924-1138","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.65","R07.89","E78.5","R53.83","R53.1","Z79.4","Z87.891","Z86.010","H40.051","M65.311","G56.01","M65.319","R73.09","R07.9","R29.898","E11.9","G60.9","F32.9","K21.9","E66.9","H52.03","H52.203","H52.4","Z79.84","R05.","I10.","K62.5","Z23.","N39.0","B37.3","R13.10","E11.29","R80.9","R09.89","R10.819","R10.33","F41.0","R35.0","F17.200","NO DATA","K31.7","R31.29","N30.00","R10.9","K44.9"],"date":["2021-11-17","2020-04-12","2020-04-12","2020-04-12","2020-04-12","2021-05-19","2021-05-19","2020-02-05","2021-02-10","2021-02-22","2021-02-22","2021-02-22","2021-02-22","2021-05-01","2020-06-30","2021-05-19","2020-06-30","2020-06-30","2020-06-30","2020-06-30","2021-01-07","2021-01-07","2021-01-07","2021-01-11","2020-01-29","2020-01-29","2020-01-29","2021-09-30","2021-11-23","2021-02-17","2021-10-20","2021-05-19","2021-05-19","2021-09-14","2021-09-28","2021-09-30","2021-10-05","2021-11-23","2021-11-17","2021-10-20","2021-10-20","2021-11-23","2021-09-28","2021-09-28","2021-10-20"],"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":[["","60505014201","GLIPIZIDE ","10MG","60","Select","Select",""],["","13668001005","CITALOPRAM ","20MG","30","Select","Select",""],["","55111015810","OMEPRAZOLE ","20MG","30","Select","Select",""],["","50458014030","INVOKANA ","100MG","30","Select","Select",""],["","70377000415","SIMVASTATIN ","40MG","30","Select","Select",""],["","68180098003","LISINOPRIL ","10MG","30","Select","Select",""],["","08290320550","BD  PEN NEEDL","32GX5\/32","100","Select","Select",""],["","63824000832","MUCINEX ","600MG ER","40","Select","Select",""],["","50428887849","CVS ","600MG","40","Select","Select",""],["","67877057305","BENZONATATE ","100MG","20","Select","Select",""],["","53885027210","ONETOUCH ","VERIO","100","Select","Select",""],["","53885004401","ONE ","VERIO FL","1","Select","Select",""],["","00088221905","LANTUS ","100\/ML","3","Select","Select",""],["","65702043810","ACCU-CHEK ","AVIVA PL","100","Select","Select",""],["","58657045001","PHENAZOPYRID ","100MG","6","Select","Select",""],["","65862007601","CIPROFLOXACN ","250MG","14","Select","Select",""],["","68462010530","ONDANSETRON ","4MG","30","Select","Select",""],["","00002771559","BASAGLAR ","100UNIT","3","Select","Select",""],["","65162044110","MECLIZINE ","12.5MG","30","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","28","Select","Select",""],["","70710113908","FLUCONAZOLE ","150MG","1","Select","Select",""],["","59267100003","PFIZER ","COVID-19","0","Select","Select",""],["","70377000415","SIMVASTATIN","40MG","30","Select","Select",""],["","68180098003","LISINOPRIL","10MG","30","Select","Select",""],["","60505014201","GLIPIZIDE","10MG","60","Select","Select",""],["","13668001005","CITALOPRAM","20MG","30","Select","Select",""],["","50458014030","INVOKANA","100MG","30","Select","Select",""],["","50428887849","CVS","600MG","40","Select","Select",""],["","63824000832","MUCINEX","600MG ER","40","Select","Select",""],["","67877057305","BENZONATATE","100MG","20","Select","Select",""],["","53885027210","ONETOUCH","VERIO","100","Select","Select",""],["","65702043810","ACCU-CHEK","AVIVA PL","100","Select","Select",""],["","08290320550","BD PEN NEEDL","32GX5\/32","100","Select","Select",""],["","00088221905","LANTUS","100\/ML","3","Select","Select",""],["","58657045001","PHENAZOPYRID","100MG","6","Select","Select",""],["","00002771559","BASAGLAR","100UNIT","3","Select","Select",""],["","68462010530","ONDANSETRON","4MG","30","Select","Select",""],["","65862007601","CIPROFLOXACN","250MG","14","Select","Select",""],["","65162044110","MECLIZINE","12.5MG","30","Select","Select",""],["","55111015810","OMEPRAZOLE","20MG","90","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","28","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","1","Select","Select",""],["","59267100003","PFIZER","COVID-19","0","Select","Select",""],["","42806016005","HYDROXYZ","25MG","30","Select","Select",""],["","43199001301","HYOSCYAMINE","0.125MG","30","Select","Select",""],["","53885004401","ONE","VERIO FL","1","Select","Select",""],["","42806016005","HYDROXYZ ","TAB 25MG","30","Select","Select",""],["","43199001301","HYOSCYAMINE ","TAB 0.125MG","30","Select","Select",""],["","51672128902","NYSTATIN ","CRE 100000","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":[[["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":""}]}]}