{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MEREDITH   R DRISKILL","gend":1,"add":"410 HANBACK ROAD","city":"GORDONSVILLE","state":"VA","zip":"22942-9998","dob":"1985-08-12","age":"","mstatus":"","insh":"2190399*01","cliId":"","pno":"434\/607-7572","cno":"434\/607-7572","email":"","ename":"","eno":"","pphy":"COX, DAVID B MD","ppno":"540\/832-2211","pcpadd":"501 N MAIN STREET","pcpcity":"GORDONSVILLE","pcpstate":"VA","pcpzip":22942,"pcpcounty":"","pcpid":107976,"pcpname":"Gordonsville Area Medical Center","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/832-2293","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K29.00","R11.2","G89.29","R10.12","N17.9","E87.5","E86.0","Z86.19","N30.00","Q61.5","Z87.440","F43.10","F11.20","T39.1X4A","R94.5","V62.84","R10.31","G89.4","R10.84","N10.","R53.83","R10.9","R39.9","R19.7","NO DATA","R57.9","E87.2","E27.40","E87.8","E03.8","F41.8","Z72.0","I10.","Z76.5","R00.0","Z85.51","Z92.21","A49.8","R11.0","N20.0","R74.8","K72.00","F17.210","K72.01","D68.9","B17.9","I47.1","F68.10","F33.2","Z68.41","E83.42","R79.89","D53.9","E66.9","T39.1X1A","G93.41","E87.4","F39.","E66.01","F32.5","G47.00","R10.11","F32.4","K85.90","F41.9","N32.89","F32.9","G62.9","E78.1","F17.290","K21.9","I95.89","R41.82","V58.89","D64.9","F51.01","F41.1","N39.0","G89.18","T50.901A","R94.7","R42.","K76.9","F11.10","N17.0","R10.13","M79.7","Z87.442","E83.39","R31.1","Z09.","R74.0","N30.90","R31.9","R40.4","R40.20","R41.0","R45.6","R82.5","R11.10","R26.9","S40.011A","S80.812A","R30.1","R58.","R14.0","R52.","R09.02","K71.9","T50.905A","Z90.49","E11.9","T50.904A","F43.0","A41.9","R65.21","R10.32","E86.1","M54.89","R11.11","T40.604A","N83.201","Z68.38","T40.2X1A","Z79.899","Z79.84"],"date":["2020-01-02","2020-05-25","2020-07-07","2020-06-16","2020-06-08","2020-02-28","2020-04-07","2020-06-16","2020-05-11","2020-10-05","2020-06-07","2021-01-08","2021-01-04","2020-04-27","2020-04-22","2020-04-27","2020-07-23","2020-07-16","2020-06-22","2020-07-02","2020-07-07","2021-01-04","2020-07-07","2020-05-24","2020-06-10","2020-06-10","2020-06-08","2020-06-07","2020-06-07","2020-06-07","2020-06-07","2020-06-07","2020-06-07","2020-06-07","2020-06-07","2020-10-05","2020-06-07","2020-06-09","2020-07-16","2020-10-05","2020-02-22","2020-04-18","2020-10-05","2020-03-02","2020-03-02","2020-04-19","2020-03-12","2020-03-12","2020-02-04","2020-04-17","2020-02-04","2020-02-04","2020-02-04","2020-02-04","2020-04-22","2020-06-07","2020-02-27","2020-04-17","2020-05-25","2020-02-27","2020-03-06","2020-03-31","2020-03-04","2020-03-30","2020-05-25","2020-03-12","2020-04-24","2020-05-25","2020-03-12","2020-03-12","2020-03-12","2020-06-09","2021-01-05","2021-01-05","2021-01-05","2021-01-08","2021-01-08","2020-07-23","2020-03-02","2020-03-20","2020-06-09","2020-02-27","2020-03-02","2020-04-21","2020-06-07","2020-06-16","2020-10-05","2020-10-05","2020-01-20","2020-02-26","2020-03-09","2020-03-09","2020-03-12","2020-07-23","2020-03-20","2021-01-04","2020-03-20","2020-03-20","2021-01-04","2020-01-21","2020-02-16","2020-02-20","2020-02-20","2020-02-20","2020-01-29","2020-01-29","2020-02-27","2020-02-27","2020-04-17","2020-04-17","2020-05-25","2020-04-24","2020-04-24","2020-04-24","2020-06-07","2020-06-07","2020-07-15","2020-01-29","2020-02-04","2020-02-04","2020-04-20","2020-04-20","2020-05-25","2020-05-25","2020-05-25","2020-05-25"],"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":[["","65628020110","FIRST-VANC ","50MG\/ML","400","Select","Select",""],["","00093321205","CLONAZEPAM ","1MG","60","Select","Select",""],["","43547040011","CYCLOBENZAPR ","10MG","90","Select","Select",""],["","68001018400","QUETIAPINE ","100MG","90","Select","Select",""],["","68001000703","GABAPENTIN ","800MG","90","Select","Select",""],["","65628020605","FIRVANQ ","50MG\/ML","150","Select","Select",""],["","10702001850","OXYCODONE ","5MG","4","Select","Select",""],["","68001039708","FAMOTIDINE ","20MG","30","Select","Select",""],["","68001024604","ONDANSETRON ","4MG ODT","20","Select","Select",""],["","00049234045","RELPAX ","40MG","6","Select","Select",""],["","62559083080","VANCOMYCIN ","250\/5ML","400","Select","Select",""],["","13668000810","ZOLPIDEM ","10MG","30","Select","Select",""],["","50228010510","METFORMIN ","500MG","60","Select","Select",""],["","68001035703","METOPROL ","50MG ER","30","Select","Select",""],["","00228203196","ALPRAZOLAM ","1MG","60","Select","Select",""],["","00054023525","MORPHINE ","15MG","12","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","20","Select","Select",""],["","00591299239","PHENADOZ ","25MG","6","Select","Select",""],["","65162027250","SMZ\/TMP ","800-160","14","Select","Select",""],["","0","","","40","Select","Select",""],["","55111014512","FLUCONAZOLE ","150MG","1","Select","Select",""],["","16729017501","AMITRIPTYLIN ","100MG","60","Select","Select",""],["","16714073902","FENOFIBRATE ","67MG","30","Select","Select",""],["","60505025202","TIZANIDINE ","4MG","60","Select","Select",""],["","42571016242","AMOX\/K ","875-125","20","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","12","Select","Select",""],["","65162047810","NITROFURANTN ","100MG","20","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","6","Select","Select",""],["","68001016100","PROMETHAZINE ","12.5MG","20","Select","Select",""],["","27241004011","ELETRIPTAN ","40MG","6","Select","Select",""],["","51293081101","PHENAZOPYRID ","200MG","6","Select","Select",""],["","68001018400","QUETIAPINE","100MG","90","Select","Select",""],["","00049234045","RELPAX","40MG","6","Select","Select",""],["","50228010510","METFORMIN","500MG","60","Select","Select",""],["","00093321205","CLONAZEPAM","1MG","60","Select","Select",""],["","68001024604","ONDANSETRON","4MG ODT","20","Select","Select",""],["","10702001850","OXYCODONE","5MG","4","Select","Select",""],["","16729017501","AMITRIPTYLIN","100MG","60","Select","Select",""],["","13668000810","ZOLPIDEM","10MG","30","Select","Select",""],["","65628020810","FIRVANQ","50MG\/ML","300","Select","Select",""],["","68001041200","GABAPENTIN","800MG","90","Select","Select",""],["","62559083080","VANCOMYCIN","250\/5ML","400","Select","Select",""],["","65628020110","FIRST-VANC","50MG\/ML","400","Select","Select",""],["","68001039708","FAMOTIDINE","20MG","30","Select","Select",""],["","43547040011","CYCLOBENZAPR","10MG","90","Select","Select",""],["","00591299239","PHENADOZ","25MG","6","Select","Select",""],["","68001035703","METOPROL","50MG ER","30","Select","Select",""],["","55111014512","FLUCONAZOLE","150MG","1","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","20","Select","Select",""],["","65162027250","SMZ\/TMP","800-160","14","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","12","Select","Select",""],["","00054023525","MORPHINE","15MG","12","Select","Select",""],["","16714073902","FENOFIBRATE","67MG","30","Select","Select",""],["","00228203196","ALPRAZOLAM","1MG","60","Select","Select",""],["","65162047810","NITROFURANTN","100MG","20","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","6","Select","Select",""],["","42571016242","AMOX\/K","875-125","14","Select","Select",""],["","60505025202","TIZANIDINE","4MG","60","Select","Select",""],["","68001016100","PROMETHAZINE","12.5MG","20","Select","Select",""],["","27241004011","ELETRIPTAN","40MG","6","Select","Select",""],["","51293081101","PHENAZOPYRID","200MG","6","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","",""],["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":""}]}]}