{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HAYWOOD   A ROSE","gend":0,"add":"2145 UNION HILL DR","city":"WINGINA","state":"VA","zip":"24599-9998","dob":"1957-10-20","age":"","mstatus":"","insh":"20034309*01","cliId":"","pno":4342634386,"cno":4342634386,"email":"","ename":"","eno":"","pphy":"RICHMOND, MICHAEL DO","ppno":"540\/967-9401","pcpadd":"SUITE 9 115 JEFFERSON HWY","pcpcity":"LOUISA","pcpstate":"VA","pcpzip":23093,"pcpcounty":"","pcpid":126591,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/967-9405","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S52.501A","F29.","V62.85","F15.10","I10.","E78.00","F17.210","Z91.19","Z79.899","I21.4","F32.3","F15.259","NO DATA","Z03.818","K21.9","R91.8","G89.29","M25.532","R73.03","E78.5","Z79.82","Z87.11","Z82.49","R07.9","R06.9","R20.0","Z13.6","Z51.81","F33.3","I20.1","E78.2","J43.9","Z72.0","M25.539","V54.12","F19.10","F15.950","S69.91XA","V48.0XXA","F22.","I25.10"],"date":["2020-01-20","2020-10-19","2020-08-19","2020-08-19","2020-10-23","2020-08-19","2020-10-13","2020-08-19","2020-10-13","2020-11-18","2020-10-13","2020-10-13","2020-11-18","2020-10-13","2020-10-13","2020-10-13","2020-10-13","2020-10-13","2020-10-13","2020-10-23","2020-10-13","2020-10-13","2020-10-13","2020-10-13","2020-10-13","2020-10-13","2020-10-18","2020-10-18","2020-10-15","2020-11-18","2020-11-18","2020-11-18","2020-11-18","2020-01-08","2020-02-17","2020-10-16","2020-10-23","2020-01-09","2020-01-09","2020-08-18","2020-10-19"],"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":[["","67877024910","QUETIAPINE ","50MG","60","Select","Select",""],["","00536100836","ASPIRIN ","81MG","90","Select","Select",""],["","00378363205","CARVEDILOL ","6.25MG","90","Select","Select",""],["","43547035210","LISINOPRIL ","5MG","90","Select","Select",""],["","43547034150","RISPERIDONE ","1MG","90","Select","Select",""],["","00378395305","ATORVASTATIN ","80MG","90","Select","Select",""],["","55111019605","CLOPIDOGREL ","75MG","90","Select","Select",""],["","00093013505","CARVEDILOL","6.25MG","180","Select","Select",""],["","68382011405","RISPERIDONE","1MG","60","Select","Select",""],["","67877024910","QUETIAPINE","50MG","60","Select","Select",""],["","00378395305","ATORVASTATIN","80MG","90","Select","Select",""],["","00904679489","ASPIRIN","81MG","90","Select","Select",""],["","68180051303","LISINOPRIL","5MG","90","Select","Select",""],["","55111019605","CLOPIDOGREL","75MG","90","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":""}]}]}