{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANITA QUINN","gend":1,"add":"2207 THOMPSON STORE ROAD PO BOX 42","city":"VERNON HILL","state":"VA","zip":"24597-9998","dob":"1970-07-06","age":"","mstatus":"","insh":"20033697*01","cliId":"","pno":"434\/476-6281","cno":"","email":"","ename":"","eno":"","pphy":"ROBERTS, MAURICE NP","ppno":"434\/835-4876","pcpadd":"3130 HALIFAX ROAD SUITE C","pcpcity":"SOUTH BOSTON","pcpstate":"VA","pcpzip":24592,"pcpcounty":"","pcpid":"","pcpname":"GODOCS SOUTH BOSTON LLC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/835-4875","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B37.0","I10.","E78.5","M54.5","M47.9","E66.9","J06.9","M54.40","G47.01","R29.898","K59.00","M54.42","M54.41","M62.830","R10.9","N39.0","R19.8","S39.012A","J02.9","Z20.828","K21.9","K44.9","K22.2","R35.0","R35.8"],"date":["2021-07-29","2021-12-28","2021-12-28","2021-09-30","2021-12-28","2021-12-28","2021-10-26","2020-11-19","2020-11-19","2020-11-19","2021-12-28","2020-11-09","2020-11-09","2020-11-09","2021-06-18","2021-06-18","2021-06-18","2021-09-20","2019-03-15","2021-10-29","2020-02-10","2020-02-10","2020-02-10","2021-06-08","2021-06-08"],"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":[["","","AMOXICILLIN"," AMOXICILLIN ","25","Select","Select",""],["","","ATORVASTATIN"," ATORVASTATIN ","30","Select","Select",""],["","","IBUPROFEN"," IBUPROFEN ","30","Select","Select",""],["","","CITALOPRAM"," CITALOPRAM ","30","Select","Select",""],["","","PROAIR"," PROAIR ","8","Select","Select",""],["","","SLEEP-AID"," SLEEP-AID ","30","Select","Select",""],["","","OMEPRAZOLE"," OMEPRAZOLE ","30","Select","Select",""],["","","PREDNISONE"," PREDNISONE ","10","Select","Select",""],["","","ALBUTEROL"," ALBUTEROL ","8","Select","Select",""],["","","FLUTICASONE"," FLUTICASONE ","16","Select","Select",""],["","","BENZONATATE"," BENZONATATE ","30","Select","Select",""],["","","CVS","CAP 1000UNIT","","Select","Select",""],["","","CHLORHEX","SOL 0.0012","","Select","Select",""],["","","TRIAMCINOLON","CRE 0.00025","","Select","Select",""],["","","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","","NABUMETONE","TAB 750MG","","Select","Select",""],["","","BACLOFEN","TAB 10MG","","Select","Select",""],["","","METHOCARBAM","TAB 500MG","","Select","Select",""],["","","FLUZONE","INJ 2020-21","","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":""}]}]}