{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RICHARD PRICE","gend":0,"add":"1325 OLD GARTH HTS","city":"CHARLOTTESVILLE","state":"VA","zip":"22901-9998","dob":"1959-01-02","age":"","mstatus":"","insh":"20033621*01","cliId":"","pno":"434\/466-2471","cno":"434\/466-2471","email":"","ename":"","eno":"","pphy":"KLECAN, ANN M MD","ppno":"434\/977-3140","pcpadd":"315 TENTH STREET NE","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22902,"pcpcounty":"","pcpid":187959,"pcpname":"SMJMG - Sentara Martha Jefferson Family Medicine","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"434\/227-1853","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/977-9808","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.16","G89.4","M47.816","L23.7","M79.89","M79.661","M25.561","M18.0","M18.12","M18.11","Z79.891","E78.00","F17.200","I25.10","R06.02","M70.41","Z23.","M79.645","Z00.00","Z87.09","K21.9","Z86.19","R73.9","Z12.5","M54.5","V58.89","F17.210","M19.90","Z79.52","M25.461","Z01.818","B19.20","J45.909","R05.","J00.","J45.31","G89.18","M79.641","Z47.1","Z96.692","M25.642"],"date":["2021-09-07","2021-08-23","2020-11-30","2020-06-30","2020-08-11","2020-07-28","2020-08-11","2021-01-04","2020-09-08","2020-11-04","2021-08-23","2020-11-16","2020-11-16","2020-11-16","2021-03-09","2020-07-16","2021-04-29","2020-10-01","2020-08-11","2021-03-09","2020-08-11","2020-08-11","2020-08-11","2020-08-11","2021-05-03","2021-01-04","2020-06-30","2020-06-30","2020-06-30","2020-07-15","2020-07-20","2020-08-11","2020-08-11","2021-03-09","2021-03-09","2021-03-09","2020-11-08","2020-11-08","2020-10-01","2020-10-01","2020-10-01"],"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":[["","42858080101","MORPHINE ","15MG ER","90","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","16571020106","DICLOFENAC ","75MG DR","60","Select","Select",""],["","00832105410","BACLOFEN ","10MG","45","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","12","Select","Select",""],["","10702001801","OXYCODONE ","5MG","30","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","1","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","00378064205","PREDNISONE ","20MG","10","Select","Select",""],["","33342032915","TRIAMCINOLON ","0.10%","15","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0","Select","Select",""],["","70377002911","ATORVASTATIN ","40MG","30","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","28","Select","Select",""],["","00069047103","CHANTIX ","0.5& 1MG","53","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","65597030210","MORPHABOND ","30MG ER","60","Select","Select",""],["","42858080101","MORPHINE","15MG ER","90","Select","Select",""],["","00832105410","BACLOFEN","10MG","45","Select","Select",""],["","16571020106","DICLOFENAC","75MG DR","60","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","33342032915","TRIAMCINOLON","0.10%","15","Select","Select",""],["","00378064205","PREDNISONE","20MG","10","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","12","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","28","Select","Select",""],["","10702001801","OXYCODONE","5MG","30","Select","Select",""],["","00069047103","CHANTIX","0.5& 1MG","53","Select","Select",""],["","70377002911","ATORVASTATIN","40MG","30","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","65597030210","MORPHABOND","30MG ER","60","Select","Select",""],["","19515081852","FLULAVAL","2021-22","0","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","Select","Select",""],["","19515081852","FLULAVAL ","INJ 2021-22","0","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","12","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":""}]}]}