{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"VIRGINIA MATOS FLORES","gend":1,"add":"263 VINE ST APT 102","city":"HARRISONBURG","state":"VA","zip":"22802-9998","dob":"1953-11-14","age":"","mstatus":"","insh":"20040306*01","cliId":"","pno":"540\/435-6895","cno":"540\/435-6895","email":"","ename":"","eno":"","pphy":"MAHMOODIAN, MARYAM MD","ppno":"540\/209-0287","pcpadd":"STE 203 2015 RESERVOIR STREET","pcpcity":"HARRISONBURG","pcpstate":"VA","pcpzip":22801,"pcpcounty":"","pcpid":187977,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z95.810","I42.8","I63.412","U07.1","I50.22","G81.01","I44.2","R47.01","R29.810","I48.0","I11.0","R29.717","R47.1","R91.8","V58.69","R50.81","Z91.128","E11.9","I63.9","E16.1","E16.2","E11.65","R40.4","E78.2","I10.","Z91.89","E03.9","L40.9","Z86.73","Z79.4","E03.8","E78.5","Z72.89","I69.351","I69.320","I69.391","R13.10","I13.0","E11.22","N18.1","F10.10","Z79.01","Z91.81","Z09.","R53.1","I50.20"],"date":["2021-09-23","2021-09-23","2020-06-01","2020-07-06","2021-05-26","2020-06-01","2021-07-16","2020-06-01","2020-06-01","2021-07-16","2020-06-01","2020-06-01","2020-06-01","2020-06-01","2020-06-01","2020-06-01","2020-06-01","2021-07-16","2020-07-15","2020-06-01","2020-06-01","2020-06-18","2020-06-01","2021-05-26","2021-07-16","2020-09-02","2021-05-26","2021-05-26","2021-05-26","2021-05-26","2020-03-17","2021-07-16","2020-06-02","2020-07-06","2020-07-06","2020-07-06","2020-07-06","2020-07-06","2020-07-06","2020-07-06","2020-07-06","2020-07-06","2020-07-06","2020-06-18","2020-06-18","2021-07-16"],"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":[["","70377002911","ATORVASTATIN ","40MG","30","Select","Select",""],["","68382076010","METFORMIN ","1000MG","60","Select","Select",""],["","00378020810","FUROSEMIDE ","20MG","90","Select","Select",""],["","76385011250","CARVEDILOL ","12.5MG","60","Select","Select",""],["","68180036209","FENOFIBRATE ","54MG","30","Select","Select",""],["","53885027210","ONETOUCH ","VERIO","100","Select","Select",""],["","65862020390","LOSARTAN ","100MG","15","Select","Select",""],["","33342032815","TRIAMCINOLON ","0.50%","60","Select","Select",""],["","00003089421","ELIQUIS ","5MG","60","Select","Select",""],["","00378180510","LEVOTHYROXIN ","75MCG","90","Select","Select",""],["","08290320109","BD  PEN NEEDL","31GX8MM","30","Select","Select",""],["","00088221905","LANTUS ","100\/ML","30","Select","Select",""],["","70377002911","ATORVASTATIN","40MG","30","Select","Select",""],["","68382076010","METFORMIN","1000MG","60","Select","Select",""],["","68180036209","FENOFIBRATE","54MG","30","Select","Select",""],["","76385011250","CARVEDILOL","12.5MG","60","Select","Select",""],["","65862020390","LOSARTAN","100MG","15","Select","Select",""],["","53885065701","ONETOUCH","VERIO","1","Select","Select",""],["","00378020810","FUROSEMIDE","20MG","90","Select","Select",""],["","00003089421","ELIQUIS","5MG","60","Select","Select",""],["","00378180510","LEVOTHYROXIN","75MCG","90","Select","Select",""],["","33342032815","TRIAMCINOLON","0.50%","60","Select","Select",""],["","08290320109","BD PEN NEEDL","31GX8MM","30","Select","Select",""],["","00088221905","LANTUS","100\/ML","30","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}