{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KAYLIE CLIFTON","gend":1,"add":"316 AUGUSTA SPRINGS ROAD","city":"CRAIGSVILLE","state":"VA","zip":"24430-9998","dob":"2002-04-25","age":"","mstatus":"","insh":"8828741*01","cliId":"","pno":"540\/849-5929","cno":"540\/849-5929","email":"","ename":"","eno":"","pphy":"FISHER, JOSEPH D MD","ppno":"540\/932-0980","pcpadd":"57 BEAM LANE SUITE 202","pcpcity":"FISHERSVILLE","pcpstate":"VA","pcpzip":22939,"pcpcounty":"","pcpid":100684,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/932-0979","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F32.3","R50.9","Z03.818","R10.31","N83.201","N10.","R10.9","R11.2","K92.0","F41.9","N76.0","R30.0","T43.205A","R10.12","M54.9","E86.0","N93.8","N39.0"],"date":["2020-02-25","2020-05-14","2020-05-14","2021-07-11","2021-07-11","2020-01-17","2020-05-26","2020-01-17","2020-01-17","2020-12-11","2020-12-25","2020-05-26","2020-07-23","2020-07-23","2020-01-17","2020-01-17","2021-01-03","2020-11-24"],"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":[["","49884033611","FLUOXETINE ","20MG","30","Select","Select",""],["","42806031205","DOXYCYCL ","100MG","20","Select","Select",""],["","65162047810","NITROFURANTN ","100MG","14","Select","Select",""],["","68382004101","PROMETHAZINE ","25MG","12","Select","Select",""],["","00527058601","DICYCLOMINE ","10MG","20","Select","Select",""],["","69238111501","BUSPIRONE ","5MG","60","Select","Select",""],["","13668021630","ARIPIPRAZOLE ","2MG","15","Select","Select",""],["","00116200116","CHLORHEX ","0.12%","473","Select","Select",""],["","27808003602","HYDROCO\/APAP ","7.5-325","16","Select","Select",""],["","57237004105","PENICILLN ","500MG","28","Select","Select",""],["","57237000511","FLUCONAZOLE ","150MG","2","Select","Select",""],["","50111033402","METRONIDAZOL ","500MG","13","Select","Select",""],["","65862052790","VENLAFAXINE ","37.5 ER","7","Select","Select",""],["","51293081001","PHENAZOPYRID ","100MG","6","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","10","Select","Select",""],["","65862007601","CIPROFLOXACN ","250MG","6","Select","Select",""],["","65862050320","AMOX\/K ","875-125","10","Select","Select",""],["","00093314705","CEPHALEXIN ","500MG","13","Select","Select",""],["","49884033601","FLUOXETINE","20MG","30","Select","Select",""],["","00527058601","DICYCLOMINE","10MG","20","Select","Select",""],["","65162047810","NITROFURANTN","100MG","14","Select","Select",""],["","68382004101","PROMETHAZINE","25MG","12","Select","Select",""],["","42806031205","DOXYCYCL","100MG","20","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","27808003602","HYDROCO\/APAP","7.5-325","16","Select","Select",""],["","57237004105","PENICILLN","500MG","28","Select","Select",""],["","69238111501","BUSPIRONE","5MG","60","Select","Select",""],["","65862052890","VENLAFAXINE","75MG ER","23","Select","Select",""],["","13668021630","ARIPIPRAZOLE","2MG","15","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","10","Select","Select",""],["","57237000511","FLUCONAZOLE","150MG","2","Select","Select",""],["","50111033402","METRONIDAZOL","500MG","13","Select","Select",""],["","65862007601","CIPROFLOXACN","250MG","6","Select","Select",""],["","51293081001","PHENAZOPYRID","100MG","6","Select","Select",""],["","65862050320","AMOX\/K","875-125","10","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","13","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":""}]}]}