{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JESSICA   J WAGSTAFF","gend":1,"add":"212 BRADLEY ROAD","city":"DANVILLE","state":"VA","zip":"24540-9998","dob":"1976-11-25","age":"","mstatus":"","insh":"20042491*01","cliId":"","pno":"434\/713-9410","cno":"434\/713-9410","email":"","ename":"","eno":"","pphy":"WATERS, MICHAEL MD","ppno":"434\/797-2828","pcpadd":"125 EXECUTIVE DRIVE","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"pcpcounty":"","pcpid":133812,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"434\/429-4697","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/773-6833","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","O09.521","Z83.2","V23.89","Z81.8","Z81.0","Z3A.13","E53.8","M54.89","R06.09","G47.33","Z79.899","I10.","O13.9","O09.523","O10.013","Z11.59","O77.0","O99.824","O48.0","O42.02","O99.334","O10.02","Z37.0","Z3A.41","F17.210","Z30.2","E66.01","O35.9XX0","O35.1XX0","O28.3","F32.9","G43.111","G25.81","F41.1","Z39.1","Z34.82","Z34.83","Z3A.38","O99.212","E66.9","Z3A.19","O47.9","R52.","O98.82","O16.4","B95.1","F31.9","O99.344","O09.513","Z85.850","Z88.6","Z88.0","O80.","Z31.5","Z3A.22","Z34.90","R32.","Z32.01","N92.6","R93.89","K21.9","R19.7","Z86.010","Z33.1","Z87.09","J02.9","J32.9"],"date":["2021-07-09","2020-03-23","2020-02-10","2020-03-23","2020-02-10","2020-02-10","2020-02-10","2021-10-28","2020-02-21","2020-07-21","2020-07-21","2020-08-24","2020-08-24","2020-03-24","2020-08-13","2020-08-13","2020-08-13","2020-08-24","2020-08-24","2020-08-24","2020-08-24","2020-08-24","2020-08-24","2020-08-24","2020-08-24","2020-08-25","2020-08-25","2020-08-25","2020-05-06","2020-05-06","2020-05-06","2020-10-05","2020-04-21","2020-04-21","2020-04-21","2020-06-26","2020-06-26","2020-06-26","2020-08-03","2020-03-23","2020-03-23","2020-03-23","2020-08-24","2020-05-14","2020-08-24","2020-08-24","2020-08-24","2020-08-24","2020-08-24","2020-08-24","2020-08-24","2020-08-24","2020-08-24","2020-08-24","2020-04-17","2020-04-17","2020-07-21","2020-10-09","2020-01-21","2020-01-21","2020-05-06","2020-06-30","2020-06-30","2020-06-30","2020-06-30","2021-07-27","2021-07-27","2021-07-27"],"priorHcc":["","","","","","","",null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","50111043303","TRAZODONE ","50MG","60","Select","Select",""],["","60505083001","MOMETASONE ","50MCG","17","Select","Select",""],["","62175013637","OMEPRAZOLE ","40MG","30","Select","Select",""],["","16571040210","CETIRIZINE ","10MG","30","Select","Select",""],["","43547027210","ROPINIROLE ","3MG","30","Select","Select",""],["","65162089609","ARIPIPRAZOLE ","2MG","30","Select","Select",""],["","57237001830","DULOXETINE ","30MG","60","Select","Select",""],["","66993058597","FLUTIC\/SALME ","250\/50","60","Select","Select",""],["","65862052301","GABAPENTIN ","600MG","90","Select","Select",""],["","43547040611","CLONAZEPAM ","0.5MG","60","Select","Select",""],["","55111072530","MONTELUKAST ","10MG","30","Select","Select",""],["","43598044674","NICOTINE ","7MG\/24HR","28","Select","Select",""],["","13107000334","MIRTAZAPINE ","30MG","30","Select","Select",""],["","00487950103","ALBUTEROL ","0.08%","90","Select","Select",""],["","00185067401","HYDROXYZ ","25MG","180","Select","Select",""],["","23155048601","VERAPAMIL ","120MG","90","Select","Select",""],["","69315021101","NIFEDIPINE ","10MG","90","Select","Select",""],["","75834002012","VITAMIN ","50000UNT","4","Select","Select",""],["","00904759161","FERROUS ","325MG","60","Select","Select",""],["","00904759080","FEROSUL ","325MG","60","Select","Select",""],["","13811071910","NITROFURANTN ","100MG","14","Select","Select",""],["","68462010530","ONDANSETRON ","4MG","90","Select","Select",""],["","69315013710","BENZTROPINE ","1MG","60","Select","Select",""],["","50111078710","AZITHROMYCIN ","250MG","6","Select","Select",""],["","00603533821","PREDNISONE ","10MG","10","Select","Select",""],["","66993058597","FLUTIC\/SALME","250\/50","60","Select","Select",""],["","65862052301","GABAPENTIN","600MG","90","Select","Select",""],["","43547040611","CLONAZEPAM","0.5MG","60","Select","Select",""],["","55111072530","MONTELUKAST","10MG","30","Select","Select",""],["","23155048601","VERAPAMIL","120MG","90","Select","Select",""],["","43547027010","ROPINIROLE","1MG","30","Select","Select",""],["","43598044674","NICOTINE","7MG\/24HR","28","Select","Select",""],["","60505083001","MOMETASONE","50MCG","17","Select","Select",""],["","65162089609","ARIPIPRAZOLE","2MG","30","Select","Select",""],["","57237001830","DULOXETINE","30MG","60","Select","Select",""],["","62175013637","OMEPRAZOLE","40MG","30","Select","Select",""],["","16571040210","CETIRIZINE","10MG","30","Select","Select",""],["","00185067401","HYDROXYZ","25MG","180","Select","Select",""],["","00487950103","ALBUTEROL","0.08%","90","Select","Select",""],["","75834002012","VITAMIN","50000UNT","4","Select","Select",""],["","50111043303","TRAZODONE","50MG","60","Select","Select",""],["","69315021101","NIFEDIPINE","10MG","90","Select","Select",""],["","00904759080","FEROSUL","325MG","60","Select","Select",""],["","00904759161","FERROUS","325MG","60","Select","Select",""],["","13811071910","NITROFURANTN","100MG","14","Select","Select",""],["","13107000334","MIRTAZAPINE","30MG","45","Select","Select",""],["","69315013710","BENZTROPINE","1MG","60","Select","Select",""],["","00781808926","AZITHROMYCIN","250MG","6","Select","Select",""],["","00603533821","PREDNISONE","10MG","10","Select","Select",""],["","68462010530","ONDANSETRON","4MG","90","Select","Select",""],["","42806040021","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","59310057922","PROAIR ","AER ","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":""}]}]}