{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HOLLY   K NEWCOMB","gend":1,"add":"3515 SYLVAN HILL RD","city":"SAXE","state":"VA","zip":"23967-9998","dob":"1969-05-01","age":"","mstatus":"","insh":"20032711*01","cliId":"","pno":"434\/454-2231","cno":"434\/568-0337","email":"","ename":"","eno":"","pphy":"HAHESY-CALHOUN, MARIAN MD","ppno":"434\/542-5560","pcpadd":"165 LEGRANDE AVENUE","pcpcity":"CHARLOTTE COURT HOUSE","pcpstate":"VA","pcpzip":23923,"pcpcounty":"","pcpid":"","pcpname":"CENTRAL VIRGINIA HEALTH SERVICES INC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/542-4670","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E03.9","M51.37","Z23.","D50.9","F32.9","J45.909","Z71.89","E55.9","F41.1","Z71.3","M79.7","E53.8","G89.29","H10.32","R60.0","J20.9","R68.89","J01.90","M54.2","R39.89","E78.5","M65.311","G44.209","F51.04","E66.01","R35.8","R53.83","Z79.899","J30.1","T23.231A"],"date":["2021-12-20","2021-12-20","2020-11-30","2021-12-20","2020-08-10","2021-12-20","2021-12-20","2021-12-20","2021-12-20","2021-12-20","2021-12-20","2021-12-20","2021-12-20","2021-03-01","2021-03-01","2021-03-01","2019-02-20","2019-02-20","2020-01-31","2020-01-31","2021-12-20","2019-04-22","2019-07-19","2020-05-05","2020-02-20","2020-02-20","2020-02-20","2020-11-30","2020-11-30","2019-07-19"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","","TIZANIDINE"," TIZANIDINE ","67","Select","Select",""],["","","HYDROCO\/APAP"," HYDROCO\/APAP ","120","Select","Select",""],["","","QUETIAPINE"," QUETIAPINE ","30","Select","Select",""],["","","LEVOTHYROXIN"," LEVOTHYROXIN ","30","Select","Select",""],["","","ALPRAZOLAM"," ALPRAZOLAM ","90","Select","Select",""],["","60758090810","POLYMYXIN","SOL TRIMETHP","10","Select","Select",""],["","","VITAMIN","CAP 50000UNT","","Select","Select",""],["","","HYDROXYZ"," HYDROXYZ ","90","Select","Select",""],["","","ALBUTEROL"," ALBUTEROL ","300","Select","Select",""],["","","SYMBICORT"," SYMBICORT ","10","Select","Select",""],["","","MONTELUKAST","TAB 10MG","","Select","Select",""],["","69315011710","FUROSEMIDE","TAB 40MG","30","Select","Select",""],["","","IPRATROPIUM"," IPRATROPIUM ","312","Select","Select",""],["","","PROAIR"," PROAIR ","8","Select","Select",""],["","","TRAZODONE","TAB 50MG","","Select","Select",""],["","","ATROVENT"," ATROVENT ","13","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","","PAROXETINE","TAB 20MG","","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}