{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"FRANKLIN   G MCILVAIN","gend":0,"add":"4701 DARLINGTON HEIGHTS ROAD","city":"FARMVILLE","state":"VA","zip":23901,"dob":"1956-04-01","age":"","mstatus":"","insh":"20031857*01","cliId":"","pno":"434\/568-7644","cno":"434\/568-7644","email":"","ename":"","eno":"","pphy":"PRUITT, DAVID E MD","ppno":"434\/315-5340","pcpadd":"935 SOUTH MAIN STREET","pcpcity":"FARMVILLE","pcpstate":"VA","pcpzip":23901,"pcpcounty":"","pcpid":182209,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/315-2059","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z95.810","I25.10","I42.9","E78.5","I10.","I49.3","Z45.02","E78.2","I25.2","Z79.82","J44.9","K29.70","E11.9","F17.210","I50.23","J96.01","Z72.0","R73.03","N17.9","Z20.828","I13.0","N18.2","Z86.010","Z79.899","R44.1","I50.22","G47.33","I50.9","F19.11","R09.02","R10.84","S86.019A","G47.00","R60.9","R74.01","I11.0","NO DATA","Z87.891","I42.8","R07.9","Z88.0","R06.9","R00.0","E44.0","J18.9","I95.9","E11.22","K76.1","I25.5","I45.9","R10.11","J98.11","F19.10","I47.2","E87.6","E87.1","Z86.73","I49.01","R10.9","M79.609","D64.9","R57.0","R94.5","R65.10","R11.10","R94.31","D68.9","Z91.19","Z82.49","N18.9","D63.1","K80.20","R16.0","U07.1","J96.00","Z83.3","J96.21","N17.0","K72.00","D69.6","Z51.5","J96.22","E87.2","J12.89","R57.8","R13.13","E86.0","Z71.89"],"date":["2021-08-20","2021-08-20","2021-08-25","2021-07-09","2021-08-27","2020-12-27","2020-11-19","2021-07-21","2021-07-15","2021-07-15","2020-12-27","2020-11-09","2021-08-27","2020-11-15","2021-08-20","2021-08-25","2021-07-20","2021-07-21","2021-08-23","2020-12-27","2021-08-20","2020-12-27","2020-12-27","2021-07-15","2021-04-21","2021-08-27","2021-07-19","2021-07-17","2021-07-20","2020-11-15","2020-11-09","2020-12-09","2021-04-20","2021-04-20","2021-04-22","2021-08-20","2021-08-27","2021-07-15","2021-07-09","2020-11-15","2020-12-26","2020-12-26","2020-12-26","2021-04-20","2021-04-20","2021-04-20","2021-08-21","2021-04-20","2021-07-09","2021-04-20","2021-04-20","2021-07-15","2021-08-27","2021-08-23","2021-07-12","2021-08-20","2020-11-15","2020-11-19","2021-08-20","2021-07-09","2021-07-09","2021-08-20","2021-08-20","2021-08-20","2021-08-20","2021-08-20","2021-08-20","2021-07-09","2021-07-09","2021-08-27","2021-07-09","2021-08-20","2021-08-20","2021-08-27","2021-08-23","2021-07-15","2021-08-27","2021-08-27","2021-08-21","2021-08-21","2021-08-27","2021-08-21","2021-08-21","2021-08-27","2021-08-27","2021-08-27","2021-08-27","2021-08-27"],"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":[["","65862014305","CARVEDILOL ","6.25MG","60","Select","Select",""],["","68645056854","ATORVASTATIN ","40MG","30","Select","Select",""],["","31722070290","LOSARTAN ","100MG","30","Select","Select",""],["","43598043611","NITROGLYCERN ","0.4MG","25","Select","Select",""],["","65862085901","FAMOTIDINE ","20MG","30","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","68382022714","AMIODARONE ","200MG","90","Select","Select",""],["","00067611730","ALLERGY ","10MG","30","Select","Select",""],["","16714089803","LORATADINE ","10MG","30","Select","Select",""],["","00173088710","TRELEGY ","ELLIPTA","60","Select","Select",""],["","00186037020","SYMBICORT ","160-4.5","10","Select","Select",""],["","00093873901","MEXILETINE ","150MG","90","Select","Select",""],["","50742061510","METOPROL ","25MG ER","15","Select","Select",""],["","68180016013","AZITHROMYCIN ","250MG","4","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","00378064205","PREDNISONE ","20MG","24","Select","Select",""],["","69097014260","ALBUTEROL ","HFA","7","Select","Select",""],["","00378020810","FUROSEMIDE ","20MG","30","Select","Select",""],["","31722053101","TORSEMIDE ","20MG","60","Select","Select",""],["","65862057490","MONTELUKAST ","10MG","30","Select","Select",""],["","00597007541","SPIRIVA ","HANDIHLR","30","Select","Select",""],["","24658031205","DOXYCYCL ","100MG","20","Select","Select",""],["","00603020922","MAG ","400MG","30","Select","Select",""],["","53746051101","SPIRONOLACT ","25MG","30","Select","Select",""],["","00245531911","KLOR-CON ","20MEQ ER","30","Select","Select",""],["","70436015301","POT  CHLORIDE","20MEQ ER","30","Select","Select",""],["","65862014305","CARVEDILOL","6.25MG","60","Select","Select",""],["","68645056854","ATORVASTATIN","40MG","30","Select","Select",""],["","31722070290","LOSARTAN","100MG","30","Select","Select",""],["","43598043611","NITROGLYCERN","0.4MG","25","Select","Select",""],["","00591049101","MEXILETINE","150MG","90","Select","Select",""],["","68382022714","AMIODARONE","200MG","90","Select","Select",""],["","45802065078","LORATADINE","10MG","30","Select","Select",""],["","00378064205","PREDNISONE","20MG","24","Select","Select",""],["","65862085901","FAMOTIDINE","20MG","30","Select","Select",""],["","69097014260","ALBUTEROL","HFA","7","Select","Select",""],["","00378020810","FUROSEMIDE","20MG","30","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","4","Select","Select",""],["","59779061288","ALLERGY","10MG","30","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","31722053101","TORSEMIDE","20MG","60","Select","Select",""],["","65862057490","MONTELUKAST","10MG","30","Select","Select",""],["","00173088710","TRELEGY","ELLIPTA","60","Select","Select",""],["","00597007541","SPIRIVA","HANDIHLR","30","Select","Select",""],["","00186037020","SYMBICORT","160-4.5","10","Select","Select",""],["","50742061510","METOPROL","25MG ER","15","Select","Select",""],["","24658031205","DOXYCYCL","100MG","20","Select","Select",""],["","70436015301","POT CHLORIDE","20MEQ ER","30","Select","Select",""],["","10006073038","MAG","400MG","30","Select","Select",""],["","00245531911","KLOR-CON","20MEQ ER","30","Select","Select",""],["","53746051101","SPIRONOLACT","25MG","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":""}]}]}