{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DEBBIE   A GALIMORE","gend":1,"add":"31765 ZOAR ROAD","city":"LOCUST GROVE","state":"VA","zip":"22508-9998","dob":"1973-10-07","age":"","mstatus":"","insh":"7370008*01","cliId":"","pno":"540\/222-4619","cno":"540\/222-4619","email":"","ename":"","eno":"","pphy":"BABAR, AHMAD MD","ppno":"540\/972-7798","pcpadd":"4376 GERMANNA HWY","pcpcity":"LOCUST GROVE","pcpstate":"VA","pcpzip":22508,"pcpcounty":"","pcpid":100582,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"540\/497-2001","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/972-7798","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01.810","I10.","I50.32","N93.9","M25.511","N92.0","N80.0","N73.6","K91.72","M65.4","R76.0","R07.2","E78.5","Z87.891","R07.9","R79.1","I34.2","I35.1","M15.9","Z20.828","J06.9","I16.9","Z71.3","T78.40XA","Z01.818","G47.33","E78.2","Z98.890","Z99.89","I11.0","I50.30","I34.0","V58.89","R29.818","E11.9","J45.909","I50.9","E78.00","D64.9","Z79.84","Z79.899","T81.41XA","K65.9","N73.9","Z90.710","D50.9","R10.9","M79.641","M25.542","M25.532","M25.531","Z09.","R70.0","M25.552","J45.40","E11.69","Z00.00","I50.42","J45.30","R21.","Z23.","Z74.3","M79.662","N73.5","Z88.8","Z82.49","M54.6","R07.89","D50.8","M54.12","M54.2","R12.","I50.23"],"date":["2020-02-10","2021-08-17","2020-08-04","2020-02-10","2021-11-04","2020-04-29","2020-04-29","2020-04-29","2020-04-29","2021-03-15","2020-12-10","2021-05-20","2021-05-20","2021-05-20","2021-05-22","2021-05-22","2020-03-18","2020-03-18","2020-08-04","2020-12-02","2020-12-02","2021-06-03","2021-06-02","2021-06-02","2020-02-05","2021-07-29","2021-04-26","2020-06-26","2020-11-13","2021-05-22","2021-05-22","2021-05-22","2021-06-10","2020-04-21","2021-07-29","2020-05-04","2021-01-06","2020-04-21","2020-04-21","2020-05-04","2020-04-21","2020-05-04","2020-05-04","2020-05-04","2020-05-04","2020-05-04","2020-05-05","2020-09-15","2020-09-15","2020-09-15","2021-01-06","2020-06-26","2020-10-30","2021-11-04","2021-04-30","2021-07-29","2020-05-15","2020-05-15","2020-05-15","2020-06-18","2021-04-09","2020-05-04","2021-07-01","2020-05-05","2021-01-06","2021-01-06","2021-05-20","2021-05-20","2021-07-13","2021-08-06","2021-11-04","2021-07-29","2021-07-29"],"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":[["","10370074501","GLIPIZIDE ","5MG","60","Select","Select",""],["","00555087302","MEDROXYPR ","5MG","30","Select","Select",""],["","76385011250","CARVEDILOL ","12.5MG","60","Select","Select",""],["","00904671980","ACETAMINOPHE ","325MG","90","Select","Select",""],["","53885000810","ONETOUCH ","PLUS 33G","100","Select","Select",""],["","00378021610","FUROSEMIDE ","40MG","180","Select","Select",""],["","50111033401","METRONIDAZOL ","500MG","20","Select","Select",""],["","70377000712","ROSUVASTATIN ","10MG","90","Select","Select",""],["","67877032005","IBUPROFEN ","600MG","60","Select","Select",""],["","10702001801","OXYCODONE ","5MG","15","Select","Select",""],["","65162019050","NAPROXEN ","500MG","14","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","20","Select","Select",""],["","68180051703","LISINOPRIL ","40MG","30","Select","Select",""],["","50742062101","NIFEDIPINE ","60MG ER","90","Select","Select",""],["","00378064110","PREDNISONE ","10MG","21","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","180","Select","Select",""],["","23155000201","HYDRALAZINE ","25MG","90","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","00591565810","CYCLOBENZAPR ","10MG","30","Select","Select",""],["","53746051101","SPIRONOLACT ","25MG","90","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","62175061743","PANTOPRAZOLE ","40MG","30","Select","Select",""],["","10370074501","GLIPIZIDE","5MG","60","Select","Select",""],["","53885000810","ONETOUCH","PLUS 33G","100","Select","Select",""],["","00555087302","MEDROXYPR","5MG","90","Select","Select",""],["","76385011250","CARVEDILOL","12.5MG","60","Select","Select",""],["","00378021610","FUROSEMIDE","40MG","180","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","00904671980","ACETAMINOPHE","325MG","90","Select","Select",""],["","00406055201","OXYCODONE","5MG","15","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","20","Select","Select",""],["","67877032005","IBUPROFEN","600MG","60","Select","Select",""],["","00378064110","PREDNISONE","10MG","21","Select","Select",""],["","65162019050","NAPROXEN","500MG","14","Select","Select",""],["","68180051703","LISINOPRIL","40MG","30","Select","Select",""],["","68180072103","AMLODIPINE","10MG","90","Select","Select",""],["","50742062101","NIFEDIPINE","60MG ER","90","Select","Select",""],["","53746051101","SPIRONOLACT","25MG","90","Select","Select",""],["","23155000201","HYDRALAZINE","25MG","270","Select","Select",""],["","00591565810","CYCLOBENZAPR","10MG","30","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","62175061743","PANTOPRAZOLE","40MG","30","Select","Select",""],["","70377000712","ROSUVASTATIN","10MG","90","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","64380071307","BENZONATATE ","CAP 200MG","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":[[["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":""}]}]}