{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALICIA ORTIZ","gend":1,"add":"2131 OAK RIDGE DR 1087 MASSANETTA SPRINGS ROAD","city":"HARRISONBURG","state":"VA","zip":"22801-9998","dob":"2002-09-06","age":"","mstatus":"","insh":"8191204*01","cliId":"","pno":"540\/241-8707","cno":"540\/241-8707","email":"","ename":"","eno":"","pphy":"PERKINS, JASON F DO","ppno":"540\/298-1200","pcpadd":"13737 SPOTSWOOD TRAIL","pcpcity":"ELKTON","pcpstate":"VA","pcpzip":22827,"pcpcounty":"","pcpid":188285,"pcpname":"SRMHMG - East Rockingham Health Center","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"540\/574-5195","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z34.02","Z3A.24","O99.89","J06.9","Z3A.26","Z34.03","Z3A.30","O36.8130","Z3A.35","O47.1","Z3A.37","Z34.90","O42.12","Z3A.38","Z37.0","O62.0","Z87.440","Z91.040","Z82.49","Z81.8","Z88.8","O42.92","Z30.017","O21.9","Z3A.11","Z3A.32","O21.0","O62.2","R07.81","R06.02","Z20.828","N92.1","Z97.5","J01.00","M25.561","M25.562","R10.30","Z3A.10","O62.1","B34.9","J45.909","R10.84","R52.","J02.9","J30.2","Z20.822"],"date":["2020-04-23","2020-04-23","2020-04-29","2020-04-29","2020-04-29","2020-06-04","2020-06-04","2020-07-08","2020-07-08","2020-07-08","2020-07-08","2020-08-04","2020-07-28","2020-07-29","2020-07-29","2020-07-28","2020-07-28","2020-07-28","2020-07-28","2020-07-28","2020-07-28","2020-07-28","2021-03-25","2020-01-20","2020-01-20","2020-06-18","2020-03-09","2020-07-29","2021-01-23","2021-01-23","2021-01-23","2021-06-08","2021-06-08","2020-03-02","2020-04-21","2020-04-21","2020-04-21","2020-01-16","2020-07-29","2021-01-23","2021-11-05","2020-04-21","2020-04-21","2021-11-05","2021-11-05","2021-11-05"],"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":[["","00378647097","SCOPOLAMINE ","1MG\/3DAY","3","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","40","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","55111015330","ONDANSETRON ","4MG","60","Select","Select",""],["","00378803093","LANSOPRAZOLE ","30MG DR","30","Select","Select",""],["","68382004001","PROMETHAZINE ","12.5MG","20","Select","Select",""],["","49035091530","OMEPRAZOLE ","20MG","30","Select","Select",""],["","37000045504","PRILOSEC ","20MG","30","Select","Select",""],["","00143928501","AMOXICILLIN ","875MG","20","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","30","Select","Select",""],["","68645056354","IBUPROFEN ","800MG","30","Select","Select",""],["","59746017509","PREDNISONE ","20MG","15","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","16714043901","NITROFURANTN ","100MG","14","Select","Select",""],["","16714043901","NITROFURANTN","100MG","14","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","40","Select","Select",""],["","68382004001","PROMETHAZINE","12.5MG","20","Select","Select",""],["","55111015330","ONDANSETRON","4MG","60","Select","Select",""],["","00378647097","SCOPOLAMINE","1MG\/3DAY","5","Select","Select",""],["","37000035905","PRILOSEC","20MG","28","Select","Select",""],["","00143928501","AMOXICILLIN","875MG","20","Select","Select",""],["","49035091530","OMEPRAZOLE","20MG","30","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","00378803093","LANSOPRAZOLE","30MG DR","30","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","30","Select","Select",""],["","68645056354","IBUPROFEN","800MG","30","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","59746017509","PREDNISONE","20MG","15","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","49035061246","ALLERGY ","TAB 10MG","30","Select","Select",""],["","45802065078","LORATADINE ","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","",""],["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":""}]}]}