{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ENRIQUE ROJAS FERNANDEZ","gend":0,"add":"4181 HUDSON CIR","city":"HARRISONBURG","state":"VA","zip":"22801-9998","dob":"1951-08-15","age":"","mstatus":"","insh":"20034268*01","cliId":"","pno":"540\/478-4961","cno":"540\/478-4961","email":"","ename":"","eno":"","pphy":"ALLEYNE, LISA ANTHONY MD","ppno":"540\/248-3413","pcpadd":"1371 LEE HIGHWAY","pcpcity":"VERONA","pcpstate":"VA","pcpzip":24482,"pcpcounty":"","pcpid":147705,"pcpname":"Carilion Family Medicine - Dayton","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/248-8413","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F32.1","C61.","R97.20","F41.9","E78.5","F41.1","R41.3","I10.","N52.9","Z51.81","R73.01","Z79.899","F33.41","N40.0","N41.9","Z20.822"],"date":["2021-06-11","2021-10-20","2021-02-16","2021-02-16","2021-04-16","2021-04-16","2021-04-16","2021-04-16","2021-04-16","2021-04-16","2020-05-21","2021-07-09","2021-07-09","2021-09-10","2021-09-10","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":[["","64679092402","ENALAPRIL ","5MG","60","Select","Select",""],["","50111064701","FLUOXETINE ","10MG","30","Select","Select",""],["","60219175203","SILDENAFIL ","50MG","30","Select","Select",""],["","00093083205","CLONAZEPAM ","0.5MG","60","Select","Select",""],["","16729016901","ESCITALOPRAM ","10MG","30","Select","Select",""],["","70377002811","ATORVASTATIN ","20MG","90","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","6","Select","Select",""],["","50111064701","FLUOXETINE","10MG","30","Select","Select",""],["","64679092402","ENALAPRIL","5MG","60","Select","Select",""],["","60219175203","SILDENAFIL","50MG","30","Select","Select",""],["","16729013600","CLONAZEPAM","0.5MG","60","Select","Select",""],["","70377002811","ATORVASTATIN","20MG","90","Select","Select",""],["","16729016901","ESCITALOPRAM","10MG","30","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","6","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":""}]}]}