{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JESSICA BILLINGSLEA","gend":1,"add":"2222 E HYCO RD LOT 7","city":"SOUTH BOSTON","state":"VA","zip":"24592-9998","dob":"1979-02-24","age":"","mstatus":"","insh":"9635939*01","cliId":"","pno":"434\/476-2009","cno":"434\/476-2009","email":"","ename":"","eno":"","pphy":"PAMBID, LEOVIGIL D MD","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\/579-8258","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.9","M25.571","M25.371","G89.29","M71.371","F43.10","M67.471","M75.41","E03.9","K76.0","I10.","M71.379","Z48.89","M75.52","E78.00","Z01.812","Z01.810","Z01.818","Z11.59","D49.2","L76.34","E66.01","Z68.43","F41.9","Z12.31","Z01.419","J00.","R06.2","J98.01","R09.81","J20.9","Z20.822","M25.471"],"date":["2021-10-25","2021-08-16","2020-06-29","2021-03-10","2020-11-04","2021-01-20","2021-03-15","2021-03-15","2020-09-22","2020-09-22","2020-09-22","2021-08-25","2021-06-02","2020-06-29","2020-06-29","2021-03-11","2021-03-11","2021-03-11","2020-06-26","2020-06-29","2020-09-30","2021-03-15","2021-03-15","2021-03-15","2021-04-06","2021-04-06","2020-01-02","2020-01-02","2020-01-02","2020-01-02","2020-01-02","2021-03-11","2021-05-11"],"priorHcc":[null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","59310057922","PROAIR ","","8","Select","Select",""],["","00093506105","HYDROXYZ ","25MG","90","Select","Select",""],["","00378110101","PRAZOSIN ","1MG","30","Select","Select",""],["","68382013905","TOPIRAMATE ","50MG","60","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","18","Select","Select",""],["","69238152301","TETRACYCLINE ","500MG","28","Select","Select",""],["","53885000810","ONETOUCH ","PLUS 33G","100","Select","Select",""],["","13668044001","FENOFIBRATE ","67MG","30","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","30","Select","Select",""],["","00173069600","ADVAIR ","250\/50","60","Select","Select",""],["","00054032756","FLUTIC\/SALME ","250\/50","60","Select","Select",""],["","65162010150","GABAPENTIN ","100MG","60","Select","Select",""],["","00363007564","BACITRACIN ","500\/GM","28","Select","Select",""],["","65702028810","FASTCLIX ","LANCETS","102","Select","Select",""],["","00378718505","METFORMIN ","500MG","60","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","4","Select","Select",""],["","68180098103","LISINOPRIL ","20MG","30","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","00591544305","PREDNISONE ","20MG","8","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","00591544305","PREDNISONE","20MG","8","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00378110101","PRAZOSIN","1MG","30","Select","Select",""],["","68382013905","TOPIRAMATE","50MG","60","Select","Select",""],["","00093506105","HYDROXYZ","25MG","90","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","18","Select","Select",""],["","64380080707","IBUPROFEN","800MG","30","Select","Select",""],["","65162010150","GABAPENTIN","100MG","60","Select","Select",""],["","65702028810","FASTCLIX","LANCETS","102","Select","Select",""],["","00378718505","METFORMIN","500MG","60","Select","Select",""],["","69452015120","VITAMIN","50000UNT","4","Select","Select",""],["","68180098103","LISINOPRIL","20MG","30","Select","Select",""],["","53885000810","ONETOUCH","PLUS 33G","100","Select","Select",""],["","69238152301","TETRACYCLINE","500MG","28","Select","Select",""],["","13668044001","FENOFIBRATE","67MG","30","Select","Select",""],["","00363007564","BACITRACIN","500\/GM","28","Select","Select",""],["","00173069600","ADVAIR","250\/50","60","Select","Select",""],["","60505014202","GLIPIZIDE","10MG","30","Select","Select",""],["","00054032756","FLUTIC\/SALME","250\/50","60","Select","Select",""],["","60505014202","GLIPIZIDE ","TAB 10MG","30","Select","Select",""],["","68382091634","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","31604002743","MELATONIN ","TAB 5MG","60","Select","Select",""],["","60505265301","TRAZODONE ","TAB 50MG","15","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":""}]}]}