{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PATRICIA   B ROBERTSON","gend":1,"add":"PO BOX 13","city":"PITTSVILLE","state":"VA","zip":"24139-9998","dob":"1965-06-16","age":"","mstatus":"","insh":"20034141*01","cliId":"","pno":"434\/656-2980","cno":"434\/656-2980","email":"","ename":"","eno":"","pphy":"COGGIN, CHARLES H MD","ppno":"434\/200-3656","pcpadd":"3300 RIVERMONT AVE","pcpcity":"LYNCHBURG","pcpstate":"VA","pcpzip":24503,"pcpcounty":"","pcpid":182209,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"540\/491-3654","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J34.89","H53.8","J32.8","Z79.84","J32.9","J31.0","G40.909","R00.2","I10.","J45.909","H05.011","J45.20","J11.1","Z87.891","Z79.899","Z20.828","E11.9","Z20.822","K21.9","E66.01","Z23.","S93.401A","E78.5","E66.9","Z68.42","Z88.8","Z79.51","W01.0XXA","Y92.89","F32.9","M25.562","R00.0","Z71.89","Z88.6","R56.9","M20.42","M20.41","L60.0","B35.1","M79.674","M79.675","H25.13","H10.45","H31.093","H52.4","Z91.81","M25.551","J18.9","F22.","M65.871","J09.X2","R41.82","J34.1","J34.2","D33.2","M25.561"],"date":["2021-03-10","2020-12-02","2020-12-02","2021-03-10","2021-03-10","2021-03-10","2021-03-30","2020-02-12","2021-06-05","2021-06-05","2020-02-20","2020-02-21","2020-02-21","2021-06-05","2020-11-05","2020-11-05","2021-06-05","2021-03-05","2021-03-05","2021-03-05","2021-11-10","2021-06-05","2021-06-05","2021-06-05","2021-08-27","2021-06-05","2021-06-05","2021-06-05","2021-06-05","2020-04-23","2021-01-12","2020-02-19","2020-09-09","2020-09-09","2020-02-19","2021-06-16","2021-06-16","2021-06-16","2021-06-16","2020-08-14","2021-06-16","2020-10-21","2020-10-21","2020-10-21","2020-10-21","2021-05-24","2021-05-24","2020-02-19","2020-02-19","2021-06-16","2020-02-19","2020-02-19","2020-06-09","2020-06-09","2020-06-09","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":[["","55111015905","OMEPRAZOLE ","40MG","30","Select","Select",""],["","31722053960","LEVETIRACETA ","1000MG","90","Select","Select",""],["","00904759060","FEROSUL ","325MG","30","Select","Select",""],["","16729029917","TRAZODONE ","50MG","30","Select","Select",""],["","65862001305","SERTRALINE ","100MG","30","Select","Select",""],["","16729011917","MONTELUKAST ","10MG","30","Select","Select",""],["","68462047201","POT  CL MICRO","20MEQ ER","60","Select","Select",""],["","68462013701","OXCARBAZEPIN ","150MG","60","Select","Select",""],["","67877019910","AMLODIPINE ","10MG","30","Select","Select",""],["","69230020201","ALLERGY ","180MG","30","Select","Select",""],["","62175089143","ATORVASTATIN ","20MG","30","Select","Select",""],["","64380079901","OSELTAMIVIR ","75MG","7","Select","Select",""],["","69238110005","DOXYCYCL ","100MG","25","Select","Select",""],["","23155010210","METFORMIN ","500MG","60","Select","Select",""],["","29300012501","MELOXICAM ","15MG","30","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","45802008801","ALBUTEROL ","HFA","8","Select","Select",""],["","68462015713","ONDANSETRON ","4MG ODT","6","Select","Select",""],["","68180098430","BUDESONIDE ","0.5MG\/2","120","Select","Select",""],["","45802086802","POLYETH ","3350 NF","238","Select","Select",""],["","00406055201","OXYCODONE ","5MG","18","Select","Select",""],["","45802065087","LORATADINE ","10MG","30","Select","Select",""],["","00904676130","12HOUR ","0.05%","30","Select","Select",""],["","66993058597","FLUTIC\/SALME ","250\/50","60","Select","Select",""],["","45802011222","MUPIROCIN ","2%","22","Select","Select",""],["","55111012705","CIPROFLOXACN ","500MG","28","Select","Select",""],["","80777027310","MODERNA ","COVID-19","0","Select","Select",""],["","67877021901","CEPHALEXIN ","500MG","28","Select","Select",""],["","74312017621","D3 ","50MCG","90","Select","Select",""],["","57237023305","SMZ-TMP ","800-160","14","Select","Select",""],["","31722053960","LEVETIRACETA","1000MG","90","Select","Select",""],["","00832532511","POT CL MICRO","20MEQ ER","60","Select","Select",""],["","16729029917","TRAZODONE","50MG","30","Select","Select",""],["","71093013205","METFORMIN","500MG","60","Select","Select",""],["","55111015905","OMEPRAZOLE","40MG","30","Select","Select",""],["","62175089143","ATORVASTATIN","20MG","30","Select","Select",""],["","00904759060","FEROSUL","325MG","30","Select","Select",""],["","16729011917","MONTELUKAST","10MG","30","Select","Select",""],["","68462013701","OXCARBAZEPIN","150MG","60","Select","Select",""],["","67877019910","AMLODIPINE","10MG","30","Select","Select",""],["","65862001305","SERTRALINE","100MG","30","Select","Select",""],["","69238110005","DOXYCYCL","100MG","25","Select","Select",""],["","29300012501","MELOXICAM","15MG","30","Select","Select",""],["","64380079901","OSELTAMIVIR","75MG","7","Select","Select",""],["","69230020201","ALLERGY","180MG","30","Select","Select",""],["","00406055201","OXYCODONE","5MG","18","Select","Select",""],["","45802086802","POLYETH","3350 NF","238","Select","Select",""],["","00904676130","12HOUR","0.05%","30","Select","Select",""],["","45802065087","LORATADINE","10MG","30","Select","Select",""],["","66993058597","FLUTIC\/SALME","250\/50","60","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","45802008801","ALBUTEROL","HFA","8","Select","Select",""],["","68180098430","BUDESONIDE","0.5MG\/2","120","Select","Select",""],["","45802011222","MUPIROCIN","2%","22","Select","Select",""],["","55111012705","CIPROFLOXACN","500MG","28","Select","Select",""],["","74312017621","D3","50MCG","90","Select","Select",""],["","57237023305","SMZ-TMP","800-160","14","Select","Select",""],["","68462015713","ONDANSETRON","4MG ODT","6","Select","Select",""],["","80777027310","MODERNA","COVID-19","0","Select","Select",""],["","67877021901","CEPHALEXIN","500MG","28","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":""}]}]}