{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RONALD F ROSE","gend":0,"add":"1483 BLAIR LOOP ROAD","city":"DANVILLE","state":"VA","zip":"24541-9998","dob":"1971-09-29","age":"","mstatus":"","insh":"20068287*01","cliId":"","pno":4347106840,"cno":4347106840,"email":"","ename":"","eno":"","pphy":"HARRIS, ELIZABETH B NP","ppno":4347914110,"pcpadd":"173 EXECUTIVE DRIVE,","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":"24541-9998","pcpcounty":"","pcpid":"","pcpname":"Providence Family & Sports Medicine, Inc","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4347914003,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J96.01","J44.9","J18.9","F17.210","J18.0","E87.3","A41.9","J18.8","Z20.822","J43.9","J44.1","J44.0","I25.10","I10.","E78.5","F12.90","Z86.73","Z79.02","Z79.82","Z79.899","Z77.098","Z72.0","R93.89","G47.00","Z13.89"],"date":["2022-04-05","2022-04-13","2022-04-05","2022-04-13","2022-04-04","2022-04-05","2022-03-27","2022-03-27","2022-03-27","2022-05-16","2022-03-27","2022-03-27","2022-03-27","2022-04-13","2022-03-27","2022-03-27","2022-03-27","2022-03-27","2022-03-27","2022-03-27","2022-03-27","2022-05-03","2022-05-03","2022-04-13","2022-04-13"],"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":[]},{"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":[["","70000051202","NICOTINE TD","DIS 21MG\/24H","56","Select","Select",""],["","16729021816","CLOPIDOGREL","TAB 75MG","90","Select","Select",""],["","00173088710","TRELEGY","AER ELLIPTA","60","Select","Select",""],["","43547035411","LISINOPRIL","TAB 20MG","30","Select","Select",""],["","69097012705","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","68382056410","METOPROL SUC","TAB 25MG ER","30","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","63824000832","MUCINEX","TAB 600MG ER","20","Select","Select",""],["","00054032756","FLUTIC\/SALME","AER 250\/50","60","Select","Select",""],["","00173069600","ADVAIR DISKU","AER 250\/50","60","Select","Select",""],["","68180063809","ATORVASTATIN","TAB 80MG","30","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","69097012705","AMLODIPINE TAB","5MG","90","Select","Select",""],["","68180063809","ATORVASTATIN TAB","80MG","30","Select","Select",""],["","00173088710","TRELEGY AER ELLIPTA","","60","Select","Select",""],["","43547035411","LISINOPRIL TAB","20MG","30","Select","Select",""],["","68382056410","METOPROL SUC TAB","25MG ER","30","Select","Select",""],["","31722071390","PANTOPRAZOLE TAB","40MG","30","Select","Select",""],["","00173069600","ADVAIR DISKU AER","250\/50","60","Select","Select",""],["","63824000832","MUCINEX TAB","600MG ER","20","Select","Select",""],["","00597007541","SPIRIVA CAP HANDIHLR","","30","Select","Select",""],["","70000051202","NICOTINE TD DIS","21MG\/24H","56","Select","Select",""],["","00054032756","FLUTIC\/SALME AER","250\/50","60","Select","Select",""],["","16729021816","CLOPIDOGREL TAB","75MG","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":""}]}]}