{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOHN GOSNELL","gend":0,"add":"111 DEVON RD APT 1","city":"STAUNTON","state":"VA","zip":"24401-9998","dob":"1971-02-03","age":"","mstatus":"","insh":"2064276*01","cliId":"","pno":"443\/904-8911","cno":"","email":"","ename":"","eno":"","pphy":"CHERNOFF, DAVID B MD","ppno":"540\/885-3525","pcpadd":"STAUNTON MED CTR 40 LAMBERT ST STE5","pcpcity":"STAUNTON","pcpstate":"VA","pcpzip":24401,"pcpcounty":"","pcpid":"","pcpname":"Carilion Family Medicine Staunton","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/886-5935","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E03.9","K04.7","I10.","R74.01","Z12.11","R10.13","L72.3","Z01.818","Z23.","F10.10","R74.8","Z11.4","N64.4","S69.92XA","X50.0XXA","J02.9","Z03.818","Z48.02","K08.9","M79.645","M65.842","W22.8XXA","R05.","S61.431A","J44.9","N52.9","S69.91XA","F41.1","R06.09","K21.9","F41.9","J06.9","J44.1"],"date":["2021-03-15","2021-03-15","2021-07-21","2021-03-15","2021-03-15","2021-03-15","2020-12-04","2021-05-20","2020-10-19","2021-07-21","2021-07-21","2021-07-21","2021-07-21","2020-07-12","2020-07-12","2020-09-21","2020-09-21","2020-12-14","2020-12-14","2021-04-29","2020-05-21","2020-05-21","2019-04-18","2019-03-18","2019-04-18","2019-03-18","2019-03-18","2019-02-21","2019-04-18","2019-08-09","2019-08-09","2019-08-22","2019-08-22"],"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":[["","57664050658","METOPROL","TAB 25MG","30","Select","Select",""],["","55111011230","MOXIFLOXACIN","TAB 400MG","10","Select","Select",""],["","","CHLORHEX","SOL 0.0012","","Select","Select",""],["","","FAMOTIDINE","TAB 20MG","","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","65862001305","SERTRALINE","TAB 100MG","30","Select","Select",""],["","","PROAIR","AER ","","Select","Select",""],["","68001018000","QUETIAPINE","TAB 50MG","60","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","","IBUPROFEN","TAB 800MG","","Select","Select",""],["","69238183001","LEVOTHYROXIN","TAB 25MCG","30","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","63304069201","CLINDAMYCIN","CAP 150MG","42","Select","Select",""],["","","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","","PREDNISONE","TAB 20MG","","Select","Select",""],["","","CIMETIDINE","TAB 400MG","","Select","Select",""],["","","SILDENAFIL","TAB 100MG","","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","","NIZATIDINE","CAP 150MG","","Select","Select",""],["","","VENTOLIN","AER ","","Select","Select",""],["","54838055080","RANITIDINE","SYP 75MG\/5ML","340","Select","Select",""],["","00228300350","CLONAZEPAM","TAB 0.5MG","30","Select","Select",""],["","13668015510","ESOMEPRA","CAP 40MG DR","44","Select","Select",""],["","00186198904","PULMICORT","SUS 0.5MG\/2","120","Select","Select",""],["","69097031987","BUDESONIDE","SUS 0.5MG\/2","120","Select","Select",""],["","68001000501","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00093300993","LANSOPRAZOLE","TAB 30MG","30","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":""}]}]}