{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JEREMIAH   D BYRD","gend":0,"add":"5857 THREE CREEK ROAD","city":"GLADYS","state":"VA","zip":"24554-9998","dob":"2003-03-04","age":"","mstatus":"","insh":"8623953*01","cliId":"","pno":"434\/609-2021","cno":"434\/609-2021","email":"","ename":"","eno":"","pphy":"JONES, WILLIAM G MD","ppno":"434\/376-2325","pcpadd":"104 CAROLINA AVE","pcpcity":"BROOKNEAL","pcpstate":"VA","pcpzip":24528,"pcpcounty":"","pcpid":135921,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/376-4943","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F91.8","F31.75","M25.522","S00.93XA","S00.212A","S80.212A","S60.512A","E78.5","J45.909","K21.9","Z79.1","Z79.51","Z79.899","Z82.49","J30.9","I10.","U07.1","S09.90XA","S59.902A","M22.8X2","M25.561","M25.562","G89.29","L25.9","R03.0","Z04.1","Z48.02","E78.00","R74.9","R79.89"],"date":["2021-05-07","2021-09-03","2020-11-14","2020-11-14","2020-11-14","2020-11-14","2020-11-14","2020-11-14","2020-11-14","2020-11-14","2020-11-14","2020-11-14","2020-11-14","2020-11-14","2020-10-27","2020-11-17","2021-07-14","2020-11-14","2020-11-14","2020-01-29","2020-01-29","2020-01-29","2020-01-29","2020-06-26","2020-06-26","2020-11-17","2020-11-17","2020-10-30","2020-10-30","2020-10-30"],"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":[["","66993058497","FLUTIC\/SALME ","100\/50","60","Select","Select",""],["","61442010305","DICLOFENAC ","75MG DR","60","Select","Select",""],["","59417010410","VYVANSE ","40MG","30","Select","Select",""],["","33342014509","ZIPRASIDONE ","40MG","60","Select","Select",""],["","24979053401","GUANFACINE ","2MG ER","10","Select","Select",""],["","43547028111","ESCITALOPRAM ","10MG","30","Select","Select",""],["","55111015810","OMEPRAZOLE ","20MG","30","Select","Select",""],["","68180031902","BUPROPN ","150MG XL","30","Select","Select",""],["","67877019710","AMLODIPINE ","2.5MG","30","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","59746017509","PREDNISONE ","20MG","10","Select","Select",""],["","10702001110","HYDROXYZ ","25MG","30","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","10","Select","Select",""],["","00173069500","ADVAIR ","100\/50","60","Select","Select",""],["","00904506860","MI-ACID ","80MG","40","Select","Select",""],["","50383070016","FLUTICASONE ","50MCG","16","Select","Select",""],["","16729011917","MONTELUKAST ","10MG","30","Select","Select",""],["","45802091987","CETIRIZINE ","10MG","30","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00406048410","APAP\/CODEINE ","300-30MG","8","Select","Select",""],["","67877057305","BENZONATATE ","100MG","30","Select","Select",""],["","49483060450","IBUPROFEN ","800MG","40","Select","Select",""],["","00781808926","AZITHROMYCIN ","250MG","6","Select","Select",""],["","61442010305","DICLOFENAC","75MG DR","60","Select","Select",""],["","68180031902","BUPROPN","150MG XL","30","Select","Select",""],["","66993058497","FLUTIC\/SALME","100\/50","60","Select","Select",""],["","24979053401","GUANFACINE","2MG ER","10","Select","Select",""],["","59417010710","VYVANSE","70MG","30","Select","Select",""],["","43547028111","ESCITALOPRAM","10MG","30","Select","Select",""],["","55111015810","OMEPRAZOLE","20MG","30","Select","Select",""],["","33342014509","ZIPRASIDONE","40MG","60","Select","Select",""],["","67877019710","AMLODIPINE","2.5MG","30","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","59746017509","PREDNISONE","20MG","10","Select","Select",""],["","10702001110","HYDROXYZ","25MG","30","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","10","Select","Select",""],["","16729011917","MONTELUKAST","10MG","30","Select","Select",""],["","45802091987","CETIRIZINE","10MG","30","Select","Select",""],["","00406048410","APAP\/CODEINE","300-30MG","8","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","49483060450","IBUPROFEN","800MG","40","Select","Select",""],["","67877057305","BENZONATATE","100MG","30","Select","Select",""],["","00173069500","ADVAIR","100\/50","60","Select","Select",""],["","00904506860","MI-ACID","80MG","40","Select","Select",""],["","00781808926","AZITHROMYCIN","250MG","6","Select","Select",""],["","50383070016","FLUTICASONE","50MCG","16","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":""}]}]}