{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"VICKIE MORTON","gend":1,"add":"504 KING ST","city":"KEYSVILLE","state":"VA","zip":"23947-9998","dob":"1959-02-11","age":"","mstatus":"","insh":"20032485*01","cliId":"","pno":"434\/390-7159","cno":"434\/390-7159","email":"","ename":"","eno":"","pphy":"HAHESY-CALHOUN, MARIAN MD","ppno":"434\/542-5560","pcpadd":"165 LEGRANDE AVENUE","pcpcity":"CHARLOTTE COURT HOUSE","pcpstate":"VA","pcpzip":23923,"pcpcounty":"","pcpid":105455,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"434\/390-7159","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/542-4670","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D50.9","I10.","R07.89","K57.92","K92.1","Z86.79","NO DATA","M85.80","Z71.89","Z71.3","B19.20","Z23.","E05.90","Z12.31","R22.9","I87.2","Z01.419","Z87.42","N90.89","M54.5","G89.29","M05.9","D50.0","K92.2","M05.79","E78.5","D64.9","E66.3","E87.0","Z28.21","Z79.899","I89.0","R26.2","M79.605","M79.604","K62.5","D12.5","K64.1","I42.9","I83.209","E78.9","E66.01","I48.0","L03.115","R60.0","K64.3","K64.4","R19.7","Z71.9","K64.8","K63.5","H25.13","R73.03","R00.1","R53.83"],"date":["2021-09-08","2021-02-11","2020-01-20","2020-02-03","2020-01-20","2020-02-03","2021-09-08","2021-09-16","2021-09-08","2021-09-08","2021-09-08","2020-02-03","2021-09-24","2020-02-03","2020-02-03","2021-08-03","2020-05-22","2020-05-22","2020-05-22","2021-09-16","2020-05-22","2021-09-08","2021-04-13","2021-04-13","2021-09-16","2021-09-16","2020-10-30","2020-10-30","2020-10-30","2020-10-30","2020-10-30","2021-09-08","2021-08-03","2021-08-03","2021-08-03","2020-07-14","2020-06-04","2020-06-04","2021-02-11","2021-02-11","2021-02-11","2021-02-11","2021-02-11","2020-10-09","2020-10-09","2021-01-26","2021-01-26","2021-01-26","2021-01-26","2020-11-10","2020-07-14","2021-09-27","2021-09-24","2021-09-08","2021-09-24"],"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":[["","59746017310","PREDNISONE ","10MG","30","Select","Select",""],["","60505025203","TIZANIDINE ","4MG","90","Select","Select",""],["","00904546052","OYST ","500MG","60","Select","Select",""],["","69315012701","FOLIC ","1000MCG","30","Select","Select",""],["","11917013938","VITAMIN ","500MG","30","Select","Select",""],["","00378668977","PANTOPRAZOLE ","40MG","30","Select","Select",""],["","11917005095","TRIPLE ","","14","Select","Select",""],["","00555057202","METHOTREXATE ","2.5MG","32","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","30","Select","Select",""],["","50111033402","METRONIDAZOL ","500MG","30","Select","Select",""],["","55111012701","CIPROFLOXACN ","500MG","20","Select","Select",""],["","24208078055","NEO\/BAC\/POLY ","OP","4","Select","Select",""],["","00574425035","NEO-POLYCIN ","OP","4","Select","Select",""],["","00363013830","SENNA ","8.6MG","30","Select","Select",""],["","37000074083","METAMUCIL ","58.6%ORG","283","Select","Select",""],["","65862014405","CARVEDILOL ","12.5MG","60","Select","Select",""],["","00054429731","FUROSEMIDE ","20MG","60","Select","Select",""],["","00766165675","OS-CAL ","500-200","180","Select","Select",""],["","67877025520","CEPHALEXIN ","750MG","30","Select","Select",""],["","68462012705","GABAPENTIN ","800MG","90","Select","Select",""],["","68382052942","CHOLESTYRAM ","4GM LITE","231","Select","Select",""],["","65862044890","VALACYCLOVIR ","500MG","6","Select","Select",""],["","10267155107","OSCAL ","200 D-3","180","Select","Select",""],["","10702002903","PHENTERMINE ","37.5MG","90","Select","Select",""],["","31604002517","CALCIUM\/VITD ","500-400","130","Select","Select",""],["","23155007001","METHIMAZOLE ","5MG","60","Select","Select",""],["","62559043130","HYDROCORTISO ","2.50%","30","Select","Select",""],["","00713050324","ANUCORT-HC ","25MG","14","Select","Select",""],["","11917017090","VIT ","500MG","30","Select","Select",""],["","00168009915","KETOCONAZOLE ","2%","15","Select","Select",""],["","00904546052","OYST","500MG","60","Select","Select",""],["","59746017310","PREDNISONE","10MG","30","Select","Select",""],["","00378668977","PANTOPRAZOLE","40MG","30","Select","Select",""],["","55111012701","CIPROFLOXACN","500MG","20","Select","Select",""],["","00363013830","SENNA","8.6MG","30","Select","Select",""],["","50111033402","METRONIDAZOL","500MG","30","Select","Select",""],["","11917005095","TRIPLE","","14","Select","Select",""],["","60505025203","TIZANIDINE","4MG","90","Select","Select",""],["","65862014405","CARVEDILOL","12.5MG","60","Select","Select",""],["","37000074083","METAMUCIL","58.6%ORG","283","Select","Select",""],["","00378001401","METHOTREXATE","2.5MG","32","Select","Select",""],["","00054429731","FUROSEMIDE","20MG","60","Select","Select",""],["","69315012701","FOLIC","1000MCG","30","Select","Select",""],["","68180072003","AMLODIPINE","5MG","30","Select","Select",""],["","68462012705","GABAPENTIN","800MG","90","Select","Select",""],["","00766165675","OS-CAL","500-200","180","Select","Select",""],["","11917013938","VITAMIN","500MG","30","Select","Select",""],["","24208078055","NEO\/BAC\/POLY","OP","4","Select","Select",""],["","00574425035","NEO-POLYCIN","OP","4","Select","Select",""],["","65862044890","VALACYCLOVIR","500MG","6","Select","Select",""],["","10267155107","OSCAL","200 D-3","180","Select","Select",""],["","10702002903","PHENTERMINE","37.5MG","90","Select","Select",""],["","00713050324","ANUCORT-HC","25MG","14","Select","Select",""],["","67877025520","CEPHALEXIN","750MG","30","Select","Select",""],["","11917017090","VIT","500MG","30","Select","Select",""],["","00168009915","KETOCONAZOLE","2%","15","Select","Select",""],["","62559043130","HYDROCORTISO","2.50%","30","Select","Select",""],["","68382052942","CHOLESTYRAM","4GM LITE","231","Select","Select",""],["","31604002517","CALCIUM\/VITD","500-400","130","Select","Select",""],["","23155007001","METHIMAZOLE","5MG","60","Select","Select",""],["","00536781708","OYSCO","","60","Select","Select",""],["","67877056105","METFORMIN","500MG","60","Select","Select",""],["","11917011328","CALCIUM","","180","Select","Select",""],["","11917011328","CALCIUM ","","180","Select","Select",""],["","00536781708","OYSCO ","TAB ","60","Select","Select",""],["","67877056105","METFORMIN ","TAB 500MG","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":[[["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":""}]}]}