{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WANDA ROSARIO","gend":1,"add":"35 MOREWOOD PL","city":"PALMYRA","state":"VA","zip":"22963-9998","dob":"1971-05-16","age":"","mstatus":"","insh":"20076504*01","cliId":"","pno":6464367669,"cno":6464367669,"email":"","ename":"","eno":"","pphy":"THOMAS, MARIE NP","ppno":4349249333,"pcpadd":"1240 LEE ST","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":"22903-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4349828420,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R06.00","R07.89","R06.02","J90.","R00.0","Z71.89","G89.3","Z51.5","R11.0","M54.6","Z78.9","Z79.891","C80.1","R07.9","G89.29","C79.9","Z20.822","I82.432","K59.03","C34.92","R09.02","E83.52","E87.1","I82.412","E22.2","J96.01","J18.9","C34.91","C79.31","C78.7","C79.51","C79.71","C79.72","J91.0","Z66.","F41.1","K21.9","Z87.891","Z79.01","C34.90","I49.1","K59.00","E87.2","Z51.11","Z51.12","F41.8","R63.0","R07.1","R62.7","R63.4","I82.409","E21.0","Z85.3","Z98.82","Z90.13","Z90.89","Z79.899","Z86.711"],"date":["2021-08-04","2021-08-04","2021-08-04","2021-08-08","2021-08-08","2021-08-11","2021-08-11","2021-08-11","2021-08-11","2021-08-03","2021-08-05","2021-08-03","2021-07-29","2021-07-28","2021-08-03","2021-08-08","2021-07-28","2021-08-01","2021-08-10","2021-08-02","2021-08-02","2021-08-02","2021-08-11","2021-08-02","2021-08-05","2021-08-05","2021-08-08","2021-08-11","2021-08-11","2021-08-11","2021-08-11","2021-08-05","2021-08-05","2021-08-11","2021-08-05","2021-08-05","2021-08-05","2021-08-05","2021-08-05","2021-08-11","2021-07-31","2021-08-02","2021-08-08","2021-07-13","2021-07-13","2021-08-08","2021-08-08","2021-08-04","2021-08-11","2021-08-11","2021-08-11","2021-08-11","2021-08-11","2021-08-11","2021-08-11","2021-08-11","2021-08-11","2021-08-08"],"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":[]},{"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":[["","00003089421","ELIQUIS","TAB 5MG","60","Select","Select",""],["","65162036111","FOLIC ACID","TAB 1MG","30","Select","Select",""],["","00406324401","HYDROMORPHON","TAB 4MG","50","Select","Select",""],["","57896048930","POLYETH GLYC","POW 3350 NF","1020","Select","Select",""],["","00121077001","LORAZEPAM","CON 2MG\/ML","30","Select","Select",""],["","00536126659","SENNA","LIQ 8.8\/5ML","105","Select","Select",""],["","59762134201","PREGABALIN","CAP 25MG","60","Select","Select",""],["","00406575501","METHADONE","TAB 5MG","14","Select","Select",""],["","43598016405","OLANZAPINE","TAB 5MG","30","Select","Select",""],["","69315011710","FUROSEMIDE","TAB 40MG","60","Select","Select",""],["","65862060330","MOXIFLOXACIN","TAB 400MG","2","Select","Select",""],["","55111028130","LEVOFLOXACIN","TAB 750MG","2","Select","Select",""],["","00223176001","SOD CHLORIDE","TAB 1GM","270","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":""}]}]}