{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DIANNE   M LITTLE","gend":1,"add":"4865 ROARK MILL ROAD","city":"HURT","state":"VA","zip":"24563-9998","dob":"1964-01-07","age":"","mstatus":"","insh":"20031179*01","cliId":"","pno":"434\/324-6077","cno":"434\/324-6077","email":"","ename":"","eno":"","pphy":"SCANLON ROWLETT, NICOLE MD","ppno":"434\/309-1165","pcpadd":"STE A 1280 MAIN STREET","pcpcity":"ALTAVISTA","pcpstate":"VA","pcpzip":24517,"pcpcounty":"","pcpid":135924,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/369-9130","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","E11.59","E11.29","E11.69","D50.9","E78.5","J45.909","B35.3","M21.42","R20.2","Z68.43","E66.01"],"date":["2021-02-10","2021-02-10","2021-02-10","2021-02-10","2021-02-10","2021-02-10","2021-02-10","2021-02-10","2021-02-10","2021-02-10","2021-02-10","2021-02-10"],"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":[["","00378020810","FUROSEMIDE ","20MG","30","Select","Select",""],["","00228212910","CLONIDINE ","0.3MG","60","Select","Select",""],["","10370074601","GLIPIZIDE ","10MG","60","Select","Select",""],["","68382076010","METFORMIN ","1000MG","60","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","68180051703","LISINOPRIL ","40MG","30","Select","Select",""],["","68180046807","LOVASTATIN ","20MG","30","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","90","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","59779046768","ASPIRIN ","81MG","36","Select","Select",""],["","59310030480","QVAR ","80MCG","32","Select","Select",""],["","00597015230","JARDIANCE ","10MG","90","Select","Select",""],["","00169430313","RYBELSUS ","3MG","90","Select","Select",""],["","00169406013","VICTOZA ","18MG\/3ML","6","Select","Select",""],["","53885059501","ONETOUCH ","30G","100","Select","Select",""],["","68462018135","CLOTRIMAZOLE ","1%","60","Select","Select",""],["","12843013105","BAYER ","81MG","90","Select","Select",""],["","00169185189","NOVOFINE ","32GX6MM","100","Select","Select",""],["","08271036100","LANCETS ","THIN","100","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","68180046807","LOVASTATIN","20MG","30","Select","Select",""],["","00378020810","FUROSEMIDE","20MG","30","Select","Select",""],["","00228212910","CLONIDINE","0.3MG","60","Select","Select",""],["","68180051703","LISINOPRIL","40MG","30","Select","Select",""],["","23155010410","METFORMIN","1000MG","60","Select","Select",""],["","10370074601","GLIPIZIDE","10MG","60","Select","Select",""],["","68180072003","AMLODIPINE","5MG","90","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","59310030480","QVAR","80MCG","32","Select","Select",""],["","00169430313","RYBELSUS","3MG","90","Select","Select",""],["","59779046768","ASPIRIN","81MG","36","Select","Select",""],["","00169406013","VICTOZA","18MG\/3ML","6","Select","Select",""],["","53885024510","ONETOUCH","ULTRA","100","Select","Select",""],["","00597015230","JARDIANCE","10MG","90","Select","Select",""],["","00169185189","NOVOFINE","32GX6MM","100","Select","Select",""],["","08271036100","LANCETS","THIN","100","Select","Select",""],["","12843013105","BAYER","81MG","90","Select","Select",""],["","68462018135","CLOTRIMAZOLE","1%","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":""}]}]}