{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DEBBIE   B POWELL","gend":1,"add":"419 AIRPORT DR LOT 1","city":"DANVILLE","state":"VA","zip":"24540-9998","dob":"1960-06-29","age":"","mstatus":"","insh":"20033555*01","cliId":"","pno":"434\/227-6838","cno":"434\/227-6838","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":"434\/228-8346","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/738-6054","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J44.9","NO DATA","R32.","N39.41","M79.89","D75.89","I10.","E53.8","E66.01","F17.210","G47.33","R26.2","M25.531","H25.811","L20.9","Z72.0","E87.5","H25.813","E11.9","H25.011","H25.812","W19.XXXA","R53.83","R63.5","R06.02","F25.9","Z91.81","E55.9","R22.1","Z68.42","Z79.84","F32.9","G43.009","K59.00","H25.012","G47.34","Z20.828"],"date":["2021-11-20","2020-04-17","2020-07-25","2020-07-25","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-09-16","2021-07-06","2021-11-16","2021-06-03","2021-06-03","2021-06-16","2021-05-03","2021-05-03","2021-05-03","2021-05-11","2021-07-06","2021-06-16","2021-07-07","2021-04-12","2021-04-12","2021-04-19","2021-09-16","2021-11-04","2021-11-04","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2020-07-14","2020-07-14","2020-07-14","2021-07-07","2021-09-16","2021-11-12"],"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":[["","00378623205","CITALOPRAM ","20MG","30","Select","Select",""],["","45802048678","DOCUSATE ","100MG","90","Select","Select",""],["","00536106210","STOOL ","100MG","90","Select","Select",""],["","70377002911","ATORVASTATIN ","40MG","30","Select","Select",""],["","68180098003","LISINOPRIL ","10MG","90","Select","Select",""],["","64380080308","RANITIDINE ","150MG","60","Select","Select",""],["","65862055990","PANTOPRAZOLE ","20MG","30","Select","Select",""],["","23155050110","HYDROXYZ ","25MG","90","Select","Select",""],["","61442012110","FAMOTIDINE ","20MG","180","Select","Select",""],["","62756014202","METFORMIN ","500MG ER","120","Select","Select",""],["","52308014144","","","1","Select","Select",""],["","30768003545","VITAMIN ","1000 TR","60","Select","Select",""],["","60505083001","MOMETASONE ","50MCG","51","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","00186037020","SYMBICORT ","160-4.5","10","Select","Select",""],["","69315011710","FUROSEMIDE ","40MG","7","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","67877031815","TRIAMCINOLON ","0.50%","30","Select","Select",""],["","60505058204","MOXIFLOXACIN ","HCL 0.5%","3","Select","Select",""],["","70000021306","ALLERGY ","10MG","90","Select","Select",""],["","24208091055","ERYTHROMYCIN ","5MG\/GM","4","Select","Select",""],["","00536589688","NICOTINE ","21MG\/24H","28","Select","Select",""],["","61314012605","KETOROLAC ","0.50%","5","Select","Select",""],["","61314063705","PREDNISOLONE ","1% OP","10","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","31722071290","PANTOPRAZOLE","20MG","30","Select","Select",""],["","70377002911","ATORVASTATIN","40MG","34","Select","Select",""],["","68180098003","LISINOPRIL","10MG","90","Select","Select",""],["","13668001005","CITALOPRAM","20MG","10","Select","Select",""],["","64380080307","RANITIDINE","150MG","60","Select","Select",""],["","00536106210","STOOL","100MG","90","Select","Select",""],["","60505083001","MOMETASONE","50MCG","51","Select","Select",""],["","61442012101","FAMOTIDINE","20MG","180","Select","Select",""],["","23155050110","HYDROXYZ","25MG","90","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","30768003545","VITAMIN","1000 TR","180","Select","Select",""],["","67877031815","TRIAMCINOLON","0.50%","30","Select","Select",""],["","60505058204","MOXIFLOXACIN","HCL 0.5%","3","Select","Select",""],["","62756014202","METFORMIN","500MG ER","120","Select","Select",""],["","70000021306","ALLERGY","10MG","90","Select","Select",""],["","61314012605","KETOROLAC","0.50%","5","Select","Select",""],["","69315011710","FUROSEMIDE","40MG","7","Select","Select",""],["","24208091055","ERYTHROMYCIN","5MG\/GM","4","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","00186037020","SYMBICORT","160-4.5","10","Select","Select",""],["","00536589688","NICOTINE","21MG\/24H","28","Select","Select",""],["","61314063705","PREDNISOLONE","1% OP","10","Select","Select",""],["","53191036201","D3-50","50000UNT","28","Select","Select",""],["","00487950160","ALBUTEROL","0.08%","540","Select","Select",""],["","00173088710","TRELEGY","ELLIPTA","60","Select","Select",""],["","00597007541","SPIRIVA","HANDIHLR","30","Select","Select",""],["","45802048678","DOCUSATE","100MG","90","Select","Select",""],["","53191036201","D3-50 ","CAP 50000UNT","28","Select","Select",""],["","00173088710","TRELEGY ","AER ELLIPTA","60","Select","Select",""],["","00597007541","SPIRIVA ","CAP HANDIHLR","30","Select","Select",""],["","00310737020","BUDES\/FORMOT ","AER 160-4.5","10","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":""}]}]}