{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TERESA   W PARRISH","gend":1,"add":"2150 SINAI RD APT 6B","city":"SOUTH BOSTON","state":"VA","zip":"24592-9998","dob":"1970-05-18","age":"","mstatus":"","insh":"7438869*01","cliId":"","pno":"434\/572-8887","cno":"434\/572-8887","email":"","ename":"","eno":"","pphy":"FAJARDO, ARTHUR BERNARD T MD","ppno":"434\/517-3539","pcpadd":"2232 WILBORN AVE","pcpcity":"SOUTH BOSTON","pcpstate":"VA","pcpzip":24592,"pcpcounty":"","pcpid":105512,"pcpname":"","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":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z20.828","I10.","F32.0","J02.9","E03.9","R42.","Q04.6","M54.5","E78.5","E11.9","R05."],"date":["2021-01-26","2021-08-26","2020-10-02","2020-10-02","2021-08-10","2020-11-28","2020-11-28","2021-06-14","2021-08-26","2021-08-26","2021-08-10"],"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":[["","00781518092","LEVOTHYROXIN ","25MCG","30","Select","Select",""],["","68645055854","LISINOP\/HCTZ ","20-25MG","60","Select","Select",""],["","65862019430","FLUOXETINE ","40MG","30","Select","Select",""],["","72305002530","EUTHYROX ","25MCG","30","Select","Select",""],["","50111078751","AZITHROMYCIN ","250MG","6","Select","Select",""],["","00093720210","PRAVASTATIN ","40MG","90","Select","Select",""],["","53885014301","ONETOUCH ","LANCETS","100","Select","Select",""],["","59746012106","MECLIZINE ","25MG","16","Select","Select",""],["","68645051654","AMLODIPINE ","10MG","30","Select","Select",""],["","69584061250","METHOCARBAM ","750MG","30","Select","Select",""],["","68645055554","LISINOPRIL ","40MG","90","Select","Select",""],["","27808006502","PROMETH\/COD ","6.25-10","210","Select","Select",""],["","16729018201","HYDROCHLOROT ","12.5MG","90","Select","Select",""],["","53489047901","SULINDAC ","200MG","30","Select","Select",""],["","68645058459","METFORMIN ","1000MG","90","Select","Select",""],["","53885004401","ONE ","VERIO FL","1","Select","Select",""],["","65862019430","FLUOXETINE","40MG","30","Select","Select",""],["","68645055854","LISINOP\/HCTZ","20-25MG","60","Select","Select",""],["","72305002530","EUTHYROX","25MCG","30","Select","Select",""],["","50111078751","AZITHROMYCIN","250MG","6","Select","Select",""],["","59746012106","MECLIZINE","25MG","16","Select","Select",""],["","47781064090","LEVOTHYROXIN","25MCG","90","Select","Select",""],["","68645051654","AMLODIPINE","10MG","30","Select","Select",""],["","53489047901","SULINDAC","200MG","30","Select","Select",""],["","53885000810","ONETOUCH","PLUS 33G","100","Select","Select",""],["","00093720210","PRAVASTATIN","40MG","90","Select","Select",""],["","27808006502","PROMETH\/COD","6.25-10","240","Select","Select",""],["","16729018201","HYDROCHLOROT","12.5MG","90","Select","Select",""],["","68645058459","METFORMIN","1000MG","90","Select","Select",""],["","53885004401","ONE","VERIO FL","1","Select","Select",""],["","69584061250","METHOCARBAM","750MG","30","Select","Select",""],["","68645055554","LISINOPRIL","40MG","90","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":""}]}]}