{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"STEVE SHIFFLETT","gend":0,"add":"262 ROBERSTON RD APT C32","city":"CRAIGSVILLE","state":"VA","zip":"24430-9998","dob":"1968-04-08","age":"","mstatus":"","insh":"20034880*01","cliId":"","pno":"540\/294-4496","cno":"540\/294-4496","email":"","ename":"","eno":"","pphy":"JOYCE, RICHARD A MD","ppno":"434\/286-6434","pcpadd":"295 EAST MAIN STREET","pcpcity":"SCOTTSVILLE","pcpstate":"VA","pcpzip":24590,"pcpcounty":"","pcpid":117378,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"540\/221-5842","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F32.9","R30.9","R10.9","M54.5","Z87.442","F10.10","R23.3","R82.2","R07.9","F41.9","Z45.02","I47.2","R52.","I63.9","R10.30","R00.1","N20.0","I25.10","R11.0","R19.4","K63.5","K57.30","Z86.010","G47.00","I10.","E78.5","Z86.73","R56.9","M70.62","I49.3","F80.1","Z00.00","K21.9","R19.7","N20.1","E78.2","R55.","R25.1","Z01.810","I49.1"],"date":["2021-09-23","2020-04-25","2020-04-25","2021-08-30","2020-07-31","2020-04-25","2020-04-25","2020-04-25","2021-01-19","2021-01-19","2021-08-05","2021-08-17","2021-01-19","2021-01-19","2020-04-25","2021-08-26","2020-04-28","2021-08-30","2021-03-18","2021-03-18","2021-03-18","2021-03-18","2021-03-18","2021-01-21","2021-08-30","2021-08-30","2021-08-30","2021-08-30","2020-08-12","2021-08-26","2020-10-30","2020-11-16","2020-11-16","2020-11-16","2020-09-11","2021-08-17","2020-07-31","2021-01-21","2021-08-26","2021-08-26"],"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":[["","69097094312","GABAPENTIN ","300MG","270","Select","Select",""],["","70377000415","SIMVASTATIN ","40MG","30","Select","Select",""],["","65862035790","CLOPIDOGREL ","75MG","30","Select","Select",""],["","65862024608","LEVETIRACETA ","500MG","60","Select","Select",""],["","50111043301","TRAZODONE ","50MG","30","Select","Select",""],["","13107008501","LORAZEPAM ","2MG","30","Select","Select",""],["","57664050658","METOPROL ","25MG","30","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","5","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","30","Select","Select",""],["","53746010901","HYDROCO\/APAP ","5-325MG","10","Select","Select",""],["","65862007701","CIPROFLOXACN ","500MG","20","Select","Select",""],["","59651000305","OMEPRAZOLE ","40MG","90","Select","Select",""],["","62175061743","PANTOPRAZOLE ","40MG","90","Select","Select",""],["","00054001925","PREDNISONE ","50MG","5","Select","Select",""],["","50111043301","TRAZODONE","50MG","30","Select","Select",""],["","69097094312","GABAPENTIN","300MG","90","Select","Select",""],["","65862035790","CLOPIDOGREL","75MG","30","Select","Select",""],["","70377000415","SIMVASTATIN","40MG","30","Select","Select",""],["","65862024608","LEVETIRACETA","500MG","60","Select","Select",""],["","13107008501","LORAZEPAM","2MG","30","Select","Select",""],["","57664050658","METOPROL","25MG","30","Select","Select",""],["","65862007701","CIPROFLOXACN","500MG","20","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","5","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","30","Select","Select",""],["","53746010901","HYDROCO\/APAP","5-325MG","10","Select","Select",""],["","00054001925","PREDNISONE","50MG","5","Select","Select",""],["","59651000305","OMEPRAZOLE","40MG","90","Select","Select",""],["","62175061743","PANTOPRAZOLE","40MG","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":""}]}]}