{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"FAYE   Y PAIGE","gend":1,"add":"112 HARRISON ST APT 4","city":"LYNCHBURG","state":"VA","zip":"24504-9998","dob":"1957-05-24","age":"","mstatus":"","insh":"20033032*01","cliId":"","pno":"434\/444-8535","cno":"434\/444-8535","email":"","ename":"","eno":"","pphy":"COHEN, LEONARD J MD","ppno":"540\/425-7910","pcpadd":"582 BLUE RIDGE AVE","pcpcity":"BEDFORD","pcpstate":"VA","pcpzip":24523,"pcpcounty":"","pcpid":972504,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/583-5149","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M79.7","M17.0","M47.22","G89.4","M16.0","M25.511","M54.17","M47.26","M54.2","J22.","Z20.828","R05.","J01.90","Z79.899","I10.","Z72.0","E66.01","M25.512","J30.9","K21.9","M17.11","M25.561","S89.91XA","S70.01XA","M54.12"],"date":["2021-05-27","2021-08-26","2021-06-24","2021-08-26","2021-08-26","2021-05-27","2021-06-24","2021-07-26","2021-08-26","2020-07-10","2020-07-10","2020-09-04","2020-09-04","2021-06-24","2020-05-19","2020-05-19","2020-02-10","2021-05-27","2020-05-19","2020-05-19","2021-02-24","2021-02-24","2020-12-11","2020-12-11","2021-07-26"],"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":[["","76385011150","CARVEDILOL ","6.25MG","60","Select","Select",""],["","70377002911","ATORVASTATIN ","40MG","30","Select","Select",""],["","43598075201","BUPROPION ","150MG SR","60","Select","Select",""],["","68180037803","LOSARTAN ","100MG","30","Select","Select",""],["","73796027104","BLOOD ","3 SERIES","1","Select","Select",""],["","50428246106","CVS ","2MG ORIG","170","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","30","Select","Select",""],["","55111015810","OMEPRAZOLE ","20MG","90","Select","Select",""],["","59779054309","SEV ","SINUS","20","Select","Select",""],["","60432027516","BROM\/PSE\/DM ","","120","Select","Select",""],["","69842090001","FLUTICASONE ","50MCG","16","Select","Select",""],["","68180071160","CEFDINIR ","300MG","20","Select","Select",""],["","10702000801","OXYCODONE ","15MG","21","Select","Select",""],["","69097014260","ALBUTEROL ","HFA","7","Select","Select",""],["","00054001925","PREDNISONE ","50MG","4","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","30","Select","Select",""],["","69097052444","DICLOFENAC ","1%","100","Select","Select",""],["","63304069301","CLINDAMYCIN ","300MG","28","Select","Select",""],["","00069046856","CHANTIX ","0.5MG","30","Select","Select",""],["","50428053560","SERIES ","BLOOD PR","1","Select","Select",""],["","50428016183","CVS","2000UNIT","30","Select","Select",""],["","65862020190","LOSARTAN","25MG","60","Select","Select",""],["","43598075201","BUPROPION","150MG SR","60","Select","Select",""],["","70377002911","ATORVASTATIN","40MG","30","Select","Select",""],["","50428053560","SERIES","BLOOD PR","1","Select","Select",""],["","68180072003","AMLODIPINE","5MG","30","Select","Select",""],["","76385011150","CARVEDILOL","6.25MG","60","Select","Select",""],["","55111015810","OMEPRAZOLE","20MG","90","Select","Select",""],["","59779054309","SEV","SINUS","20","Select","Select",""],["","10702000801","OXYCODONE","15MG","28","Select","Select",""],["","69097014260","ALBUTEROL","HFA","7","Select","Select",""],["","00054001925","PREDNISONE","50MG","4","Select","Select",""],["","60432027516","BROM\/PSE\/DM","","120","Select","Select",""],["","68180071160","CEFDINIR","300MG","20","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","30","Select","Select",""],["","69097052444","DICLOFENAC","1%","100","Select","Select",""],["","00069046856","CHANTIX","0.5MG","30","Select","Select",""],["","63304069301","CLINDAMYCIN","300MG","28","Select","Select",""],["","73796027104","BLOOD","3 SERIES","1","Select","Select",""],["","69842090001","FLUTICASONE","50MCG","16","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","00904674880","BISACODYL ","TAB 5MG EC","30","Select","Select",""],["","80681000900","VITAMIN ","CAP 50MCG","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":[[["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":""}]}]}