{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TINA TUCKER","gend":1,"add":"133 BAUGH ST","city":"DANVILLE","state":"VA","zip":"24540-9998","dob":"1973-06-03","age":"","mstatus":"","insh":"20036462*01","cliId":"","pno":"434\/429-3011","cno":"434\/429-3011","email":"","ename":"","eno":"","pphy":"SEEPE, CAROLYN S MD","ppno":"434\/799-4444","pcpadd":"SUITE 3200 201 SOUTH MAIN STREET","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"pcpcounty":"","pcpid":170836,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"434\/228-3871","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"000\/000-0000","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E66.01","F40.01","M54.5","Z68.43","Z71.3","F32.9","F41.1","E05.90","E78.5","K66.0","N18.9","Z88.1","Z88.2","Z88.5","Z88.0","Z87.891","Z80.3","N83.292","R30.0","Z98.84","Z80.49","Z68.41","R10.10","G89.18","J01.90","S60.559A","Z68.44","M47.896","M53.3","M25.551","Z72.0","H35.3131","N83.202","N83.209","S05.01XA","F41.9","E03.9","Z68.42","X58.XXXA","Y92.89","N83.291"],"date":["2021-08-19","2020-08-06","2020-08-06","2021-03-22","2021-02-09","2021-08-19","2020-11-12","2021-03-22","2021-03-29","2021-03-22","2021-08-19","2021-03-22","2021-08-19","2021-03-22","2021-03-22","2021-08-19","2021-07-19","2021-07-19","2021-08-19","2021-07-19","2021-07-19","2021-02-09","2021-03-29","2021-03-29","2020-04-02","2020-04-30","2020-08-10","2020-08-10","2020-08-10","2020-08-10","2021-03-04","2021-05-06","2021-08-06","2021-08-19","2021-08-19","2021-08-19","2021-08-19","2021-08-19","2021-08-19","2021-08-19","2021-08-19"],"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":[["","49884080502","QUETIAPINE ","50MG ER","60","Select","Select",""],["","00169280015","SAXENDA ","18MG\/3ML","15","Select","Select",""],["","16729004617","ATORVASTATIN ","40MG","30","Select","Select",""],["","00781552910","BUPROPN ","300MG XL","30","Select","Select",""],["","65862070060","CEFUROXIME ","500MG","20","Select","Select",""],["","16729030017","TRAZODONE ","100MG","60","Select","Select",""],["","00456114030","VIIBRYD ","40MG","30","Select","Select",""],["","59762372103","ALPRAZOLAM ","1MG","90","Select","Select",""],["","00527134901","LEVOTHYROXIN ","150MCG","30","Select","Select",""],["","00085134107","ASMANEX ","220MCG","1","Select","Select",""],["","63304069301","CLINDAMYCIN ","300MG","28","Select","Select",""],["","00093716956","AZITHROMYCIN ","500MG","3","Select","Select",""],["","57664037713","TRAMADOL ","50MG","30","Select","Select",""],["","69315011610","FUROSEMIDE ","20MG","7","Select","Select",""],["","00378064210","PREDNISONE ","20MG","6","Select","Select",""],["","00781223401","OMEPRAZOLE ","40MG","30","Select","Select",""],["","68462015713","ONDANSETRON ","4MG ODT","20","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","47781026305","OXYCODONE ","5MG","12","Select","Select",""],["","55111025660","ZIPRASIDONE ","20MG","30","Select","Select",""],["","61874011530","VRAYLAR ","1.5MG","30","Select","Select",""],["","00378647099","SCOPOLAMINE ","1MG\/3DAY","1","Select","Select",""],["","60505015701","BUPROPION ","100MG","90","Select","Select",""],["","65862085901","FAMOTIDINE ","20MG","60","Select","Select",""],["","53746010905","HYDROCO\/APAP ","5-325MG","10","Select","Select",""],["","00536106210","STOOL ","100MG","60","Select","Select",""],["","16571041250","CIPROFLOXACN ","500MG","10","Select","Select",""],["","24208091055","ERYTHROMYCIN ","5MG\/GM","4","Select","Select",""],["","59310057922","PROAIR ","","8","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":""}]}]}