{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CONNIE   S LOGAN","gend":1,"add":"462 COPPER HEAD RD APT B","city":"DANVILLE","state":"VA","zip":"24540-9998","dob":"1965-11-14","age":"","mstatus":"","insh":"20031226*01","cliId":"","pno":"434\/203-3829","cno":"434\/203-3829","email":"","ename":"","eno":"","pphy":"WINFIELD, ALBERT C MD","ppno":"434\/791-4110","pcpadd":"173 EXECUTIVE DRIVE","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"pcpcounty":"","pcpid":134296,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"434\/203-3829","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/791-4003","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S29.011A","K04.7","J44.9","I10.","E78.5","K08.89","R22.0"],"date":["2020-08-06","2020-03-17","2020-03-17","2020-03-17","2020-03-17","2020-03-17","2020-03-17"],"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":[["","43547026910","ROPINIROLE ","0.5MG","30","Select","Select",""],["","70377000315","SIMVASTATIN ","20MG","30","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","30","Select","Select",""],["","00173086910","ANORO ","62.5-25","60","Select","Select",""],["","70710122901","AMITRIPTYLIN ","100MG","30","Select","Select",""],["","00597002402","COMBIVENT ","20-100","4","Select","Select",""],["","67877032105","IBUPROFEN ","800MG","30","Select","Select",""],["","63304069301","CLINDAMYCIN ","300MG","40","Select","Select",""],["","10702000650","CYCLOBENZAPR ","5MG","21","Select","Select",""],["","00378180010","LEVOTHYROXIN ","25MCG","30","Select","Select",""],["","50090294500","CONTRAVE ","8-90MG","120","Select","Select",""],["","68382075810","METFORMIN ","500MG","60","Select","Select",""],["","70710122901","AMITRIPTYLIN","100MG","30","Select","Select",""],["","70377000315","SIMVASTATIN","20MG","30","Select","Select",""],["","00173086910","ANORO","62.5-25","60","Select","Select",""],["","43547026910","ROPINIROLE","0.5MG","30","Select","Select",""],["","68180072003","AMLODIPINE","5MG","30","Select","Select",""],["","00597002402","COMBIVENT","20-100","4","Select","Select",""],["","67877032105","IBUPROFEN","800MG","30","Select","Select",""],["","63304069301","CLINDAMYCIN","300MG","40","Select","Select",""],["","10702000650","CYCLOBENZAPR","5MG","21","Select","Select",""],["","00378180010","LEVOTHYROXIN","25MCG","30","Select","Select",""],["","50090294500","CONTRAVE","8-90MG","120","Select","Select",""],["","68382075810","METFORMIN","500MG","60","Select","Select",""],["","00603533715","PREDNISONE","5MG","21","Select","Select",""],["","00781808931","AZITHROMYCIN","250MG","6","Select","Select",""],["","00781808931","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","00603533715","PREDNISONE ","PAK 5MG","21","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","",""],["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":""}]}]}