{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOHN  D WALL","gend":0,"add":"131 CONWAY DR","city":"DANVILLE","state":"VA","zip":"24540-9998","dob":"1966-11-18","age":"","mstatus":"","insh":"2222786*01","cliId":"","pno":4347709480,"cno":4347709480,"email":"","ename":"","eno":"","pphy":"WINFIELD, ALBERT C MD","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":"M4","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":["Z20.828","F33.1","F43.22","I42.9","I25.10","M17.12","S00.03XA","S16.1XXA","V49.40XA","R74.8","I21.4","R03.0","R77.8","R94.31","E66.3","Z91.11","Z20.822","J01.90","R05.9","V58.89","NO DATA","L97.529","H25.013","H52.223","S86.912A","Z88.5","R94.39","R06.02","J40.","I48.91","H25.13","H52.4"],"date":["2021-09-03","2021-07-08","2021-07-08","2023-03-22","2023-03-22","2022-12-20","2021-03-27","2021-03-27","2021-03-27","2021-07-27","2021-08-12","2021-07-29","2021-07-29","2021-07-29","2023-03-22","2021-08-03","2022-10-21","2022-10-21","2022-10-21","2021-02-22","2023-03-22","2021-03-15","2021-08-26","2021-08-26","2021-02-08","2021-07-29","2021-08-12","2021-09-03","2021-09-03","2022-08-23","2023-03-27","2023-03-27"],"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":[["","68382005105","MELOXICAM","15 MG","30","Select","Select",""],["","65162010250","GABAPENTIN","CAP 300MG","60","Select","Select",""],["","65862001205","SERTRALINE","TAB 50MG","30","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","24","Select","Select",""],["","59746012106","MECLIZINE","TAB 25MG","20","Select","Select",""],["","64380080807","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","68462016305","CARVEDILOL","TAB 6.25MG","60","Select","Select",""],["","60219175303","SILDENAFIL","TAB 100MG","30","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","68382091634","METHYLPRED","TAB 4MG","21","Select","Select",""],["","43598043601","NITROGLYCERN","SUB 0.4MG","100","Select","Select",""],["","60432060416","PROMETHAZINE","SYP DM","210","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","55111012405","ATORVASTATIN","TAB 80MG","30","Select","Select",""],["","00280210032","ASPIRIN LOW","TAB 81MG EC","30","Select","Select",""],["","00078077720","ENTRESTO","49 MG-51MG","60","Select","Select",""],["","68462010630","ONDANSETRON","TAB 8MG","10","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","43598081115","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","70069000701","OLOPATADINE HCL","0.1 %","5","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":""}]}]}