{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RONNIE HOLMAN","gend":0,"add":"PO BOX 913","city":"DILLWYN","state":"VA","zip":"23936-9998","dob":"1979-03-06","age":"","mstatus":"","insh":"9782907*01","cliId":"","pno":"434\/960-5091","cno":"","email":"","ename":"","eno":"","pphy":"BASHORE, RANDALL T MD","ppno":"434\/581-3271","pcpadd":"RT 15 SOUTH","pcpcity":"NEW CANTON","pcpstate":"VA","pcpzip":23123,"pcpcounty":"","pcpid":"","pcpname":"CENTRAL VIRGINIA HEALTH SERVICES INC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/581-1105","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","Z71.89","Z71.3","I10.","E11.40","NO DATA","E11.49","H20.011","M72.2","M76.829","M21.41","M21.42","H25.011","H57.11","Z98.41","S90.31XA","F17.210","Z79.4","H25.11","H25.12","E11.65","H40.013","Z98.49","H43.391","H43.11","E11.3593","Z96.1","H25.012","Z20.822","E11.3499","E78.5","Z53.29","H53.9"],"date":["2020-10-13","2020-01-14","2020-01-14","2022-02-26","2021-01-18","2020-09-07","2020-10-13","2021-10-28","2021-01-18","2021-01-18","2021-01-18","2021-01-18","2021-09-27","2021-10-06","2022-02-26","2020-01-13","2020-01-13","2020-01-13","2021-09-27","2021-08-06","2021-08-06","2021-08-06","2021-10-06","2022-02-26","2022-04-11","2022-05-09","2022-05-09","2022-05-09","2022-04-26","2022-02-26","2022-02-26","2022-02-26","2022-02-26"],"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":[["","00169643810","LEVEMIR","INJ FLEXTOUC","15","Select","Select",""],["","61314063705","PREDNISOLONE","SUS 1% OP","5","Select","Select",""],["","60505058204","MOXIFLOXACIN","SOL HCL 0.5%","3","Select","Select",""],["","24208060203","PROLENSA","SOL 0.0007","3","Select","Select",""],["","24208050707","LOTEMAX","GEL 0.0038","5","Select","Select",""],["","08496080701","EASY","KIT MONITOR","1","Select","Select",""],["","65702071210","ACCU-CHEK","TES GUIDE","100","Select","Select",""],["","67877032101","IBUPROFEN","TAB 800MG","90","Select","Select",""],["","68180098103","LISINOPRIL","TAB 20MG","90","Select","Select",""],["","08214050734","UNIFINE","MIS 31GX3\/16","100","Select","Select",""],["","67877022201","GABAPENTIN","CAP 100MG","30","Select","Select",""],["","60505100301","KETOROLAC","SOL 0.005","5","Select","Select",""],["","65702073110","ACCU-CHECK","KIT GUIDE ME","1","Select","Select",""],["","59762015601","ATORVASTATIN","TAB 20MG","90","Select","Select",""],["","00002143380","TRULICITY","INJ 0.75\/0.5","2","Select","Select",""],["","08489846810","PEN  NEEDLES","MIS 31GX3\/16","100","Select","Select",""],["","00193737701","CONTOUR","KIT NEXT","1","Select","Select",""],["","00904675180","ASPIRIN","TAB 81MG EC","90","Select","Select",""],["","68462019001","NAPROXEN","TAB 500MG","60","Select","Select",""],["","00169266015","TRESIBA","INJ 100UNIT","15","Select","Select",""],["","49483062309","METFORMIN","TAB 500MG ER","120","Select","Select",""],["","56151173301","INSULIN","MIS 1ML\/31G","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}