{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LEYHA   R TREMOR","gend":1,"add":"387 GILBERT ROAD","city":"RUCKERSVILLE","state":"VA","zip":"22968-9998","dob":"1983-10-22","age":"","mstatus":"","insh":"2222689*01","cliId":"","pno":"434\/987-8283","cno":"434\/987-8283","email":"","ename":"","eno":"","pphy":"RICE, HANNAH R MD","ppno":"434\/654-1800","pcpadd":"435 MERCHANT WALK SQUARE SUITE 400","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22902,"pcpcounty":"","pcpid":192714,"pcpname":"SMJMG - Sentara Family Medicine at 5th Street Station","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"844\/883-6065","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F32.9","F41.9","R41.840","NO DATA","B19.20","R21.","L29.9","F11.20","F33.1","F41.1","F12.10","Z72.0","Z01.818","G56.01","R39.9","R10.9","R13.10","K21.9","G89.29","J06.9","B18.2","R11.2","Z86.19","R53.81","K29.70","R10.13","G56.03","S81.831A","M25.541","M25.542","S29.011A"],"date":["2020-12-14","2020-03-18","2020-02-18","2021-07-27","2020-03-18","2020-02-18","2020-02-18","2021-09-21","2021-09-21","2021-09-21","2021-09-21","2021-08-24","2021-01-18","2021-02-02","2020-03-18","2020-11-24","2021-01-27","2020-11-24","2020-11-24","2021-09-13","2020-02-21","2020-07-09","2020-07-09","2020-07-09","2021-01-27","2021-01-27","2021-01-06","2021-07-15","2020-12-14","2020-12-14","2021-09-17"],"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":[["","00093005301","BUSPIRONE ","5MG","90","Select","Select",""],["","43598065530","BUPROPN ","150MG XL","30","Select","Select",""],["","61958220101","EPCLUSA ","400-100","28","Select","Select",""],["","16714008210","HYDROXYZ ","25MG","90","Select","Select",""],["","72626270101","SOFOS\/VELPAT ","400-100","28","Select","Select",""],["","55111015430","ONDANSETRON ","8MG","20","Select","Select",""],["","62756097083","BUPREN\/NALOX ","8-2MG","14","Select","Select",""],["","12496130602","SUBOXONE ","8-2MG","14","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","55111064530","OMEPRAZOLE ","40MG","90","Select","Select",""],["","68382005105","MELOXICAM ","15MG","30","Select","Select",""],["","49281072010","FLUBLOK ","2020-21","0","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","00143924920","AMOX\/K ","875-125","20","Select","Select",""],["","31722094101","HYDROCO\/APAP ","5-325MG","15","Select","Select",""],["","67877021905","CEPHALEXIN ","500MG","21","Select","Select",""],["","43598065530","BUPROPN","150MG XL","30","Select","Select",""],["","00093005301","BUSPIRONE","5MG","90","Select","Select",""],["","16714008210","HYDROXYZ","25MG","90","Select","Select",""],["","61958220101","EPCLUSA","400-100","28","Select","Select",""],["","72626270101","SOFOS\/VELPAT","400-100","28","Select","Select",""],["","55111015330","ONDANSETRON","4MG","20","Select","Select",""],["","62756097083","BUPREN\/NALOX","8-2MG","14","Select","Select",""],["","12496130602","SUBOXONE","8-2MG","14","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","49281072010","FLUBLOK","2020-21","0","Select","Select",""],["","31722094101","HYDROCO\/APAP","5-325MG","15","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","00143924920","AMOX\/K","875-125","20","Select","Select",""],["","55111064530","OMEPRAZOLE","40MG","90","Select","Select",""],["","67877021905","CEPHALEXIN","500MG","21","Select","Select",""],["","65162027250","SMZ\/TMP","800-160","14","Select","Select",""],["","49281042150","FLUZONE","2021-22","0","Select","Select",""],["","68382005105","MELOXICAM","15MG","30","Select","Select",""],["","65862042001","SMZ\/TMP ","TAB 800-160","14","Select","Select",""],["","49281042150","FLUZONE ","INJ 2021-22","0","Select","Select",""],["","62332002231","FLUOXETINE ","CAP 10MG","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":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","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":""}]}]}