{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CECELI   M EDMONDS","gend":1,"add":"2150 SINAI RD APT 6C","city":"SOUTH BOSTON","state":"VA","zip":"24592-9998","dob":"1989-08-11","age":"","mstatus":"","insh":"8160090*01","cliId":"","pno":"434\/228-6888","cno":"434\/228-6888","email":"","ename":"","eno":"","pphy":"PATEL, BEENA N DO","ppno":"434\/517-3879","pcpadd":"101 AUBREYS LOOP","pcpcity":"SOUTH BOSTON","pcpstate":"VA","pcpzip":24592,"pcpcounty":"","pcpid":144661,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"434\/517-0629","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/572-4549","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L02.411","K29.70","K21.9","R14.0","B96.81","R14.2","R11.0","Z86.19","K82.4","M54.9","R63.1","R53.1","R53.83","R82.4","R82.2","F41.1","K30.","K29.50","R10.9","M79.605","F17.200","M13.0","M79.641","M79.642","M70.71","M70.72","M54.5","M25.472","M25.471","R10.31","L02.412","E78.00","F41.9","R10.13","R23.8","M25.551","M54.6","S33.4XXS","S32.434S","S32.811S","E66.09","F17.210","G89.29","Z68.35","M25.562","Z79.899","L98.8","M79.662","Z86.718","E66.9"],"date":["2020-02-18","2021-02-09","2021-06-16","2021-06-16","2021-02-09","2021-06-16","2021-06-16","2021-06-16","2021-06-16","2020-04-29","2020-04-29","2020-04-29","2020-04-29","2020-04-29","2020-04-29","2020-10-22","2020-11-06","2020-11-06","2021-01-12","2021-03-30","2021-06-16","2021-07-27","2021-07-07","2021-07-07","2021-07-07","2021-07-07","2021-07-27","2021-07-07","2021-07-27","2020-01-29","2020-02-04","2020-05-04","2020-05-04","2021-01-10","2021-01-10","2020-11-27","2020-11-27","2020-11-27","2020-11-27","2020-11-27","2020-11-27","2021-01-10","2020-11-27","2020-11-27","2021-01-10","2021-01-10","2021-01-10","2021-03-30","2021-03-30","2021-07-27"],"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":[["","57237023305","SMZ-TMP ","800-160","20","Select","Select",""],["","68180016013","AZITHROMYCIN ","250MG","6","Select","Select",""],["","16729020001","BUSPIRONE ","5MG","30","Select","Select",""],["","69315090510","LORAZEPAM ","1MG","60","Select","Select",""],["","70461032003","FLUCLVX ","2020-21","0","Select","Select",""],["","62175018046","PANTOPRAZOLE ","20MG","30","Select","Select",""],["","31722057330","ESOMEPRA ","40MG DR","30","Select","Select",""],["","58914060120","PYLERA ","","168","Select","Select",""],["","00527128210","DICYCLOMINE ","20MG","60","Select","Select",""],["","68382004001","PROMETHAZINE ","12.5MG","20","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","20","Select","Select",""],["","59651000305","OMEPRAZOLE ","40MG","30","Select","Select",""],["","69097015915","MELOXICAM ","15MG","90","Select","Select",""],["","00591079510","DICYCLOMINE","20MG","18","Select","Select",""],["","57237023305","SMZ-TMP","800-160","20","Select","Select",""],["","62175018046","PANTOPRAZOLE","20MG","30","Select","Select",""],["","69315090510","LORAZEPAM","1MG","60","Select","Select",""],["","70461032003","FLUCLVX","2020-21","0","Select","Select",""],["","58914060120","PYLERA","","168","Select","Select",""],["","31722057330","ESOMEPRA","40MG DR","30","Select","Select",""],["","00781223410","OMEPRAZOLE","40MG","30","Select","Select",""],["","69452015120","VITAMIN","50000UNT","20","Select","Select",""],["","68382004001","PROMETHAZINE","12.5MG","20","Select","Select",""],["","69097015915","MELOXICAM","15MG","90","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","Select","Select",""],["","16729020001","BUSPIRONE","5MG","30","Select","Select",""],["","57237001899","DULOXETINE ","CAP 30MG","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":""}]}]}