{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LINDA   M VARNER","gend":1,"add":"10762 WILLS CREEK ROAD","city":"LINVILLE","state":"VA","zip":"22834-9998","dob":"1985-06-24","age":"","mstatus":"","insh":"2222734*01","cliId":"","pno":"540\/271-1229","cno":"540\/271-1229","email":"","ename":"","eno":"","pphy":"HILL, JORDAN L DO","ppno":"540\/564-5622","pcpadd":"13892 TIMBER WAY","pcpcity":"BROADWAY","pcpstate":"VA","pcpzip":22815,"pcpcounty":"","pcpid":188285,"pcpname":"SRMHMG - Sentara Timber Way Health Center","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O24.414","O16.3","Z3A.32","J02.9","R09.81","Z11.52","M54.5","W19.XXXD","S93.401A","M25.571","Z3A.33","V23.9","Z3A.36","Z3A.38","Z30.2","R87.612","Z3A.23","Z3A.34","Z3A.35","G43.901","F32.1","F41.9","Z36.89","O34.211","Z37.0","O24.424","O99.214","E66.01","Z3A.39","Z88.0","Z83.3","Z82.49","Z01.812","Z20.822","M54.40","M54.6","W19.XXXA","Z3A.37","Z68.41","O99.344","F32.9","O26.891","R10.32","Z11.59","O24.410"],"date":["2021-04-29","2021-04-19","2021-03-18","2021-04-20","2021-04-20","2021-04-20","2020-06-17","2020-06-17","2020-07-17","2020-07-17","2021-03-25","2021-04-19","2021-04-15","2021-04-29","2021-05-03","2021-01-12","2021-01-12","2021-04-01","2021-04-08","2020-04-20","2020-04-20","2020-04-20","2021-03-29","2021-05-03","2021-05-03","2021-05-03","2021-05-03","2021-05-03","2021-05-03","2021-05-03","2021-05-03","2021-05-03","2021-05-03","2021-05-03","2020-06-11","2020-06-11","2020-06-11","2021-04-19","2021-05-03","2021-05-03","2021-05-03","2020-09-21","2020-09-21","2020-09-21","2021-03-01"],"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":[["","68180035209","SERTRALINE ","50MG","30","Select","Select",""],["","55111029309","SUMATRIPTAN ","100MG","9","Select","Select",""],["","00591544305","PREDNISONE ","20MG","24","Select","Select",""],["","52817033200","CYCLOBENZAPR ","10MG","30","Select","Select",""],["","68462017901","NAPROXEN ","550MG","60","Select","Select",""],["","00002821501","HUMULIN ","U-100","10","Select","Select",""],["","53885027210","ONETOUCH ","VERIO","100","Select","Select",""],["","90166045635","INSULIN ","0.3\/30G","100","Select","Select",""],["","00406055201","OXYCODONE ","5MG","30","Select","Select",""],["","50111033402","METRONIDAZOL ","500MG","4","Select","Select",""],["","68180035209","SERTRALINE","50MG","30","Select","Select",""],["","55111029309","SUMATRIPTAN","100MG","9","Select","Select",""],["","52817033200","CYCLOBENZAPR","10MG","30","Select","Select",""],["","68462017901","NAPROXEN","550MG","60","Select","Select",""],["","53885027210","ONETOUCH","VERIO","100","Select","Select",""],["","90166045635","INSULIN","0.3\/30G","100","Select","Select",""],["","00002831501","HUMULIN","U-100","10","Select","Select",""],["","00406055201","OXYCODONE","5MG","30","Select","Select",""],["","50111033402","METRONIDAZOL","500MG","4","Select","Select",""],["","00591544305","PREDNISONE","20MG","24","Select","Select",""],["","55111015001","FLUOXETINE ","TAB 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","",""],["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":""}]}]}