{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RITA SUMMERS","gend":1,"add":"1809 SHENANDOAH AVE APT 12","city":"WAYNESBORO","state":"VA","zip":"22980-9998","dob":"1981-02-26","age":"","mstatus":"","insh":"20035804*01","cliId":"","pno":"540\/836-4257","cno":"540\/836-4257","email":"","ename":"","eno":"","pphy":"PITSILOS, STEPHANIE MD","ppno":"540\/886-6259","pcpadd":"42 LAMBERT ST STE 511","pcpcity":"STAUNTON","pcpstate":"VA","pcpzip":24401,"pcpcounty":"","pcpid":190956,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/885-1696","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","F32.9","F15.10","N39.0","F19.129","S00.81XA","M79.672","M79.671","R20.2","F17.210","F22.","R40.0","R23.4","S91.332A","Z79.899","Z88.5","Z88.8","R41.82","F11.23","F33.1","F41.1","G56.03","M25.511","K21.9","Z00.00","M06.9","M25.512","I73.00","M35.01","B18.2","R40.4","S01.01XA","M06.00","E66.01","G47.33","Z68.39","R10.30","R10.13","NO DATA","M25.519","Z11.59","F11.159","F33.3","F15.159","F41.9","Z72.0","Z20.822","Z87.01","F42.9","G62.9","F19.21","M05.9","Z76.89","Z20.828","F13.19","R07.9","R11.0","F15.20","U07.1","F11.21","R53.83","R60.0","R07.81","Z86.718","Z79.01"],"date":["2021-11-19","2021-09-12","2021-01-14","2021-01-09","2021-01-22","2021-01-22","2021-01-22","2021-01-22","2021-01-22","2021-01-22","2021-01-22","2021-01-22","2021-01-22","2021-01-22","2021-09-12","2021-09-12","2021-09-12","2021-01-22","2021-07-19","2021-11-17","2021-11-17","2020-01-20","2020-02-14","2020-01-20","2020-01-20","2021-05-07","2020-02-14","2021-03-17","2020-02-14","2021-03-17","2021-01-22","2021-01-22","2021-03-17","2020-04-08","2020-04-08","2020-04-08","2020-04-22","2020-04-22","2020-04-22","2020-03-03","2021-01-07","2021-01-07","2021-01-09","2021-01-09","2021-01-09","2021-09-12","2021-09-12","2021-01-09","2021-01-09","2021-05-07","2020-04-02","2020-04-20","2020-04-20","2020-10-13","2021-01-07","2021-09-12","2021-08-14","2021-11-17","2021-09-12","2021-09-12","2021-09-12","2021-09-12","2021-09-12","2021-09-12","2021-09-12"],"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":[["","68462015713","ONDANSETRON ","4MG ODT","20","Select","Select",""],["","00054018913","BUPREN\/NALOX ","8-2MG","56","Select","Select",""],["","65162036111","FOLIC ","1MG","30","Select","Select",""],["","00378064110","PREDNISONE ","10MG","60","Select","Select",""],["","59651000305","OMEPRAZOLE ","40MG","30","Select","Select",""],["","67877022405","GABAPENTIN ","400MG","84","Select","Select",""],["","43598063230","FLUOXETINE ","60MG","28","Select","Select",""],["","12496120803","SUBOXONE ","8-2MG","18","Select","Select",""],["","00378001401","METHOTREXATE ","2.5MG","16","Select","Select",""],["","65628020510","FIRVANQ ","25MG\/ML","300","Select","Select",""],["","27808003501","HYDROCO\/APAP ","5-325MG","10","Select","Select",""],["","00536589688","NICOTINE ","21MG\/24H","28","Select","Select",""],["","00054017713","BUPRENORPHIN ","8MG","84","Select","Select",""],["","23155050110","HYDROXYZ ","25MG","15","Select","Select",""],["","49483060350","IBUPROFEN ","600MG","20","Select","Select",""],["","00093310905","AMOXICILLIN ","500MG","21","Select","Select",""],["","43598016430","OLANZAPINE ","5MG","30","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","65162019050","NAPROXEN ","500MG","60","Select","Select",""],["","00054018913","BUPREN\/NALOX","8-2MG","14","Select","Select",""],["","67877022405","GABAPENTIN","400MG","84","Select","Select",""],["","43598063230","FLUOXETINE","60MG","28","Select","Select",""],["","68462015713","ONDANSETRON","4MG ODT","20","Select","Select",""],["","65162019050","NAPROXEN","500MG","60","Select","Select",""],["","59651000305","OMEPRAZOLE","40MG","30","Select","Select",""],["","00378064110","PREDNISONE","10MG","60","Select","Select",""],["","00378001401","METHOTREXATE","2.5MG","16","Select","Select",""],["","65162036111","FOLIC","1MG","30","Select","Select",""],["","65628020510","FIRVANQ","25MG\/ML","300","Select","Select",""],["","27808003501","HYDROCO\/APAP","5-325MG","10","Select","Select",""],["","12496120803","SUBOXONE","8-2MG","18","Select","Select",""],["","00067512628","NICOTINE","21MG\/24H","28","Select","Select",""],["","49483060350","IBUPROFEN","600MG","20","Select","Select",""],["","00093310905","AMOXICILLIN","500MG","21","Select","Select",""],["","43598016430","OLANZAPINE","5MG","30","Select","Select",""],["","00054017713","BUPRENORPHIN","8MG","84","Select","Select",""],["","23155050110","HYDROXYZ","25MG","30","Select","Select",""],["","69547035302","NARCAN","","2","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","",""],["No","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":""}]}]}