{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHARLES   W BROWN","gend":0,"add":"APT B PO BOX 365","city":"LYNDHURST","state":"VA","zip":"22952-9998","dob":"1959-03-10","age":"","mstatus":"","insh":"20041146*01","cliId":"","pno":"540\/836-5273","cno":"540\/836-5273","email":"","ename":"","eno":"","pphy":"YOUNG, SCOTT F MD","ppno":"540\/949-8241","pcpadd":"428 S MAGNOLIA AVE","pcpcity":"WAYNESBORO","pcpstate":"VA","pcpzip":22980,"pcpcounty":"","pcpid":118165,"pcpname":"Carilion Family Medicine Associated Physicians","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/949-5582","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.9","Z91.09","M54.5","F11.90","F41.1","R79.89","I10.","G89.29","G47.33","E11.9","H25.13","H40.013","M54.40","M17.0","J30.89","R09.81","G44.221","J30.1","J45.909"],"date":["2020-03-06","2020-03-06","2020-12-16","2020-12-16","2020-03-06","2020-12-16","2020-03-06","2020-12-16","2020-04-07","2021-04-22","2021-04-22","2021-04-22","2020-02-17","2020-01-06","2020-12-16","2020-07-16","2020-12-16","2020-12-16","2020-12-16"],"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":[["","59779051511","CVS ","FIBER","283","Select","Select",""],["","42858010301","OXYCOD\/APAP ","7.5-325","120","Select","Select",""],["","51672400501","CARBAMAZEPIN ","200MG","150","Select","Select",""],["","00904530660","BANOPHEN ","25MG","30","Select","Select",""],["","45802065087","LORATADINE ","10MG","30","Select","Select",""],["","16729011917","MONTELUKAST ","10MG","30","Select","Select",""],["","62756014202","METFORMIN ","500MG ER","60","Select","Select",""],["","00378668977","PANTOPRAZOLE ","40MG","30","Select","Select",""],["","50428699076","EASY ","","477","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","60","Select","Select",""],["","00093321205","CLONAZEPAM ","1MG","60","Select","Select",""],["","37000096386","","","1","Select","Select",""],["","00574082001","TESTOST ","200MG\/ML","1","Select","Select",""],["","37000011961","METAMUCIL ","58.6% SF","660","Select","Select",""],["","68462039710","OMEPRAZOLE ","40MG","30","Select","Select",""],["","72205000499","ROSUVASTATIN ","20MG","30","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","64380080438","RANITIDINE ","300MG","30","Select","Select",""],["","08290309575","3ML ","21GX1\"","1","Select","Select",""],["","69238183101","LEVOTHYROXIN ","50MCG","30","Select","Select",""],["","45802091987","CETIRIZINE ","10MG","30","Select","Select",""],["","00085461001","DULERA ","200-5MCG","13","Select","Select",""],["","68001033708","LISINOPRIL ","40MG","30","Select","Select",""],["","67877019805","AMLODIPINE ","5MG","30","Select","Select",""],["","27241017101","DOXEPIN ","100MG","60","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","65862086001","FAMOTIDINE ","40MG","90","Select","Select",""],["","00378021810","ATENOLOL ","25MG","15","Select","Select",""],["","66689034599","CHLORTHALID ","25MG","18","Select","Select",""],["","59746021605","SPIRONOLACT ","25MG","18","Select","Select",""],["","00054004641","IPRATROPIUM ","0.06%","15","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","16","Select","Select",""],["","61314054701","LATANOPROST ","0.01%","8","Select","Select",""],["","43598057330","TADALAFIL ","20MG","20","Select","Select",""],["","57237009960","CEFDINIR ","300MG","20","Select","Select",""],["","45802086803","POLYETH ","3350 NF","510","Select","Select",""],["","38485080868","HYDROCIL ","95%","600","Select","Select",""],["","10006070169","FIBER ","","736","Select","Select",""],["","08290309575","3ML","21GX1\"","1","Select","Select",""],["","69238183101","LEVOTHYROXIN","50MCG","30","Select","Select",""],["","68462039710","OMEPRAZOLE","40MG","30","Select","Select",""],["","00093321205","CLONAZEPAM","1MG","60","Select","Select",""],["","72205000499","ROSUVASTATIN","20MG","30","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","00378668977","PANTOPRAZOLE","40MG","30","Select","Select",""],["","64380080438","RANITIDINE","300MG","30","Select","Select",""],["","37000011961","METAMUCIL","58.6% SF","660","Select","Select",""],["","42858010301","OXYCOD\/APAP","7.5-325","120","Select","Select",""],["","00904530660","BANOPHEN","25MG","30","Select","Select",""],["","45802065087","LORATADINE","10MG","30","Select","Select",""],["","16729011917","MONTELUKAST","10MG","30","Select","Select",""],["","50428047931","CVS","FIBER","662","Select","Select",""],["","50428699076","EASY","","477","Select","Select",""],["","00085461001","DULERA","200-5MCG","13","Select","Select",""],["","10006070169","FIBER","","736","Select","Select",""],["","00378641001","DOXEPIN","100MG","60","Select","Select",""],["","51672400501","CARBAMAZEPIN","200MG","150","Select","Select",""],["","62756014202","METFORMIN","500MG ER","60","Select","Select",""],["","38485080868","HYDROCIL","95%","600","Select","Select",""],["","68001033708","LISINOPRIL","40MG","30","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","45802091987","CETIRIZINE","10MG","30","Select","Select",""],["","00574082001","TESTOST","200MG\/ML","1","Select","Select",""],["","64380080707","IBUPROFEN","800MG","60","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","62332000131","FAMOTIDINE","20MG","180","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","16","Select","Select",""],["","00378021810","ATENOLOL","25MG","15","Select","Select",""],["","59746021605","SPIRONOLACT","25MG","18","Select","Select",""],["","66689034599","CHLORTHALID","25MG","18","Select","Select",""],["","43598057330","TADALAFIL","20MG","20","Select","Select",""],["","00054004641","IPRATROPIUM","0.06%","15","Select","Select",""],["","57237009960","CEFDINIR","300MG","20","Select","Select",""],["","61314054701","LATANOPROST","0.01%","2","Select","Select",""],["","45802086803","POLYETH","3350 NF","510","Select","Select",""],["","45802006405","TRIAMCINOLON","0.10%","60","Select","Select",""],["","67877019805","AMLODIPINE","5MG","30","Select","Select",""],["","00781261305","AMOXICILLIN ","CAP 500MG","21","Select","Select",""],["","45802006405","TRIAMCINOLON ","CRE 0.001","60","Select","Select",""],["","10572030201","PEG-3350\/KCL ","SOL \/SODIUM","4000","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":""}]}]}