{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JEFFREY DUVALL","gend":0,"add":"13280 MARTINSVILLE HWY LOT 24","city":"DANVILLE","state":"VA","zip":24541,"dob":"1970-10-01","age":"","mstatus":"","insh":"2125704*01","cliId":"","pno":"434\/251-0277","cno":"434\/251-0277","email":"","ename":"","eno":"","pphy":"TRIPATHI, KAVITA MD","ppno":"434\/791-1345","pcpadd":"125 EXECUTIVE DRIVE #H","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"pcpcounty":"","pcpid":175182,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/799-6865","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R07.2","K21.9","F41.9","L08.9","F41.1","Z51.81","Z79.899","R58.","I10.","R19.7","Z47.2","M86.661","M86.669","T84.7XXA","I25.10","R06.02","Z01.810","L02.415","D64.9","T81.49XA","M75.101","M19.011","M75.41","M86.9","T81.40XA","Z79.02","I25.2","Z95.5","F32.9","B95.7","Z20.822","M72.2","Z23.","R07.9","H92.02","H69.80","R07.89","R09.02","G90.01"],"date":["2020-03-23","2020-03-23","2021-01-28","2020-08-26","2021-02-17","2020-09-23","2020-09-23","2020-10-22","2021-08-29","2020-10-22","2021-01-28","2021-01-28","2021-02-01","2021-03-11","2021-02-17","2020-05-14","2020-05-14","2020-10-21","2021-02-17","2021-02-02","2020-09-23","2021-02-17","2020-05-14","2021-02-17","2021-01-28","2021-01-28","2021-09-13","2021-01-29","2021-01-28","2021-01-28","2021-01-25","2020-09-23","2020-09-23","2021-07-07","2021-08-29","2021-08-29","2021-07-07","2021-07-07","2021-09-13"],"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":[["","65862067905","ALPRAZOLAM ","2MG","270","Select","Select",""],["","16729018201","HYDROCHLOROT ","12.5MG","30","Select","Select",""],["","50742061510","METOPROL ","25MG ER","165","Select","Select",""],["","65862086001","FAMOTIDINE ","40MG","30","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","21","Select","Select",""],["","70377000812","ROSUVASTATIN ","20MG","30","Select","Select",""],["","65862020390","LOSARTAN ","100MG","30","Select","Select",""],["","65862035790","CLOPIDOGREL ","75MG","30","Select","Select",""],["","69097094312","GABAPENTIN ","300MG","270","Select","Select",""],["","50111064701","FLUOXETINE ","10MG","90","Select","Select",""],["","57896045501","SENNA ","8.6-50MG","14","Select","Select",""],["","65862001105","SERTRALINE ","25MG","90","Select","Select",""],["","69315090505","LORAZEPAM ","1MG","90","Select","Select",""],["","53489011905","DOXYCYCL ","100MG","14","Select","Select",""],["","00904759180","FERROUS ","325MG","90","Select","Select",""],["","50111033402","METRONIDAZOL ","500MG","114","Select","Select",""],["","57896022201","ACETAMINOPHE ","500MG","60","Select","Select",""],["","10702001801","OXYCODONE ","5MG","42","Select","Select",""],["","70000041503","CLEARLAX ","","510","Select","Select",""],["","00904759180","FEROSUL ","325MG","90","Select","Select",""],["","00378427693","VALACYCLOVIR ","1GM","30","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","59267100003","PFIZER ","COVID-19","0","Select","Select",""],["","16729018201","HYDROCHLOROT","12.5MG","30","Select","Select",""],["","50742061510","METOPROL","25MG ER","165","Select","Select",""],["","65862020390","LOSARTAN","100MG","30","Select","Select",""],["","65862035790","CLOPIDOGREL","75MG","30","Select","Select",""],["","65862086001","FAMOTIDINE","40MG","30","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","21","Select","Select",""],["","70377000812","ROSUVASTATIN","20MG","30","Select","Select",""],["","65862067905","ALPRAZOLAM","2MG","90","Select","Select",""],["","50111064701","FLUOXETINE","10MG","90","Select","Select",""],["","69097094312","GABAPENTIN","300MG","270","Select","Select",""],["","53489011905","DOXYCYCL","100MG","28","Select","Select",""],["","13107008405","LORAZEPAM","1MG","90","Select","Select",""],["","00536100901","FERROUS","325MG","90","Select","Select",""],["","69097083305","SERTRALINE","25MG","90","Select","Select",""],["","10702001801","OXYCODONE","5MG","42","Select","Select",""],["","57896045501","SENNA","8.6-50MG","14","Select","Select",""],["","57896022201","ACETAMINOPHE","500MG","60","Select","Select",""],["","50111033402","METRONIDAZOL","500MG","114","Select","Select",""],["","70000041503","CLEARLAX","","510","Select","Select",""],["","00904759180","FEROSUL","325MG","90","Select","Select",""],["","00378427693","VALACYCLOVIR","1GM","30","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","59267100003","PFIZER","COVID-19","0","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","",""],["N\/A","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":""}]}]}