{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KEITH   A MABERY","gend":0,"add":"530 HUGHES ST APT 69B","city":"DANVILLE","state":"VA","zip":"24541-9998","dob":"1977-11-29","age":"","mstatus":"","insh":"20031401*01","cliId":"","pno":"434\/429-8291","cno":"434\/429-8291","email":"","ename":"","eno":"","pphy":"HUNDLEY, SUSAN DUPUY MD","ppno":"434\/738-6420","pcpadd":"380 WASHINGTON STREET","pcpcity":"BOYDTON","pcpstate":"VA","pcpzip":23917,"pcpcounty":"","pcpid":125561,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/738-6054","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","F25.0","S00.83XA","S90.02XA","S80.02XA","I10.","M54.5","M25.561","M25.562","M10.9","R52.","M54.89","R53.1","W19.XXXA","R06.00","R07.89","R07.9","M54.2","M79.671","Z87.39","M79.672","L03.115","A41.9","F33.2","Z68.42","B95.61","E78.5","E66.01","Z20.822","Z09.","L97.919","F39.","L97.812","R60.0","F31.9","Z87.891","Z79.52","Z79.82","S81.831A","W26.8XXA"],"date":["2020-11-15","2021-08-12","2020-11-25","2020-12-07","2020-11-25","2021-08-08","2021-08-23","2020-12-07","2020-12-07","2021-08-12","2020-08-06","2020-08-06","2020-08-06","2020-08-06","2020-12-07","2020-12-07","2020-12-07","2020-12-07","2020-09-02","2021-03-08","2021-01-25","2021-08-12","2021-08-10","2021-08-09","2021-08-08","2021-08-08","2021-08-08","2021-08-30","2021-08-08","2021-08-12","2021-08-12","2021-08-12","2021-08-30","2021-08-30","2021-08-30","2021-08-30","2021-08-30","2021-08-30","2021-08-08","2021-08-08"],"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":[["","63481068447","VOLTAREN ","1%","100","Select","Select",""],["","55111016805","OLANZAPINE ","20MG","28","Select","Select",""],["","67877019805","AMLODIPINE ","5MG","28","Select","Select",""],["","55111025960","ZIPRASIDONE ","80MG","56","Select","Select",""],["","57896098110","ASPIRIN ","81MG EC","28","Select","Select",""],["","62756079713","DIVALPROEX ","250MG DR","84","Select","Select",""],["","00536589688","NICOTINE ","21MG\/24H","28","Select","Select",""],["","64380080807","IBUPROFEN ","600MG","120","Select","Select",""],["","55111017915","TIZANIDINE ","2MG","180","Select","Select",""],["","00054252625","LITHIUM ","150MG","28","Select","Select",""],["","00904549213","THERA-M ","","28","Select","Select",""],["","69097052444","DICLOFENAC ","1%","100","Select","Select",""],["","68382008001","HALOPERIDOL ","10MG","84","Select","Select",""],["","00378108601","COLCHICINE ","0.6MG","30","Select","Select",""],["","16729013516","ALLOPURINOL ","300MG","30","Select","Select",""],["","00591544210","PREDNISONE ","10MG","35","Select","Select",""],["","68462019005","NAPROXEN ","500MG","20","Select","Select",""],["","00536466138","THEREMS-M ","","28","Select","Select",""],["","11845012232","FISH ","1000MG","180","Select","Select",""],["","00093031401","KETOROLAC ","10MG","15","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","10","Select","Select",""],["","16729018201","HYDROCHLOROT ","12.5MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPR ","10MG","30","Select","Select",""],["","65162062711","TRAMADOL ","50MG","12","Select","Select",""],["","60505317007","OMEGA-3-ACID ","1GM","60","Select","Select",""],["","69097014260","ALBUTEROL ","HFA","7","Select","Select",""],["","11917014671","OMEGA-3 ","1000MG","60","Select","Select",""],["","40985022368","THERAPEUTIC- ","M\/LUTEIN","28","Select","Select",""],["","00085113204","PROVENTIL ","HFA","7","Select","Select",""],["","00591352530","LIDOCAINE ","5%","30","Select","Select",""],["","65862018501","CLINDAMYCIN ","150MG","21","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","62756079713","DIVALPROEX","250MG DR","84","Select","Select",""],["","57896098110","ASPIRIN","81MG EC","28","Select","Select",""],["","68382008001","HALOPERIDOL","10MG","84","Select","Select",""],["","31722054510","LITHIUM","300MG","28","Select","Select",""],["","43598016605","OLANZAPINE","10MG","28","Select","Select",""],["","67877019805","AMLODIPINE","5MG","28","Select","Select",""],["","55111025960","ZIPRASIDONE","80MG","56","Select","Select",""],["","00904549213","THERA-M","","28","Select","Select",""],["","69097052444","DICLOFENAC","1%","100","Select","Select",""],["","63481068447","VOLTAREN","1%","100","Select","Select",""],["","00536589688","NICOTINE","21MG\/24H","28","Select","Select",""],["","64380080807","IBUPROFEN","600MG","120","Select","Select",""],["","55111017915","TIZANIDINE","2MG","180","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","10","Select","Select",""],["","00591544221","PREDNISONE","10MG","21","Select","Select",""],["","00378108601","COLCHICINE","0.6MG","30","Select","Select",""],["","16729013516","ALLOPURINOL","300MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPR","10MG","30","Select","Select",""],["","65162062711","TRAMADOL","50MG","12","Select","Select",""],["","60505317007","OMEGA-3-ACID","1GM","60","Select","Select",""],["","16729018201","HYDROCHLOROT","12.5MG","30","Select","Select",""],["","68462019005","NAPROXEN","500MG","20","Select","Select",""],["","40985022368","THERAPEUTIC-","M\/LUTEIN","28","Select","Select",""],["","11917014671","OMEGA-3","1000MG","60","Select","Select",""],["","00536466138","THEREMS-M","","28","Select","Select",""],["","11845012232","FISH","1000MG","180","Select","Select",""],["","00085113204","PROVENTIL","HFA","7","Select","Select",""],["","00591352530","LIDOCAINE","5%","30","Select","Select",""],["","00093031401","KETOROLAC","10MG","15","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","65862018501","CLINDAMYCIN","150MG","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","",""],["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":""}]}]}