{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PENNY  C BOLIN","gend":1,"add":"2068 OLD MILL ROAD","city":"HALIFAX","state":"VA","zip":"24558-9998","dob":"1976-10-31","age":"","mstatus":"","insh":"8285020*01","cliId":"","pno":4342226624,"cno":4342226624,"email":"","ename":"","eno":"","pphy":"GAJADEERA, DEVMITH MD","ppno":4345173879,"pcpadd":"101 AUBREYS LOOP","pcpcity":"SOUTH BOSTON","pcpstate":"VA","pcpzip":"24592-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4345173989,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E10.9","M31.0","Z48.02","G56.01","G56.03","R51.9","J00.","Z20.822","Z20.828","S82.64XA","R50.9","R21.","A77.0","S93.401A","I10.","E11.59","E78.2","K76.0","D50.9","S20.20XA","E11.65","Z79.4","Z47.89","M79.641","M79.642","H52.4"],"date":["2023-02-16","2023-02-13","2023-02-13","2021-02-16","2021-03-02","2021-03-25","2021-03-25","2021-03-25","2021-03-25","2021-11-09","2022-09-08","2023-01-31","2023-01-31","2021-11-12","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2022-04-03","2021-10-13","2021-01-15","2021-03-02","2021-01-19","2021-01-19","2021-10-13"],"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":[["","00088221905","LANTUS SOLOS","INJ 100\/ML","30","Select","Select",""],["","00024576105","SOLIQUA","INJ 100\/33","15","Select","Select",""],["","57599080000","FREESTY LIBR","KIT 2 SENSOR","2","Select","Select",""],["","65862019499","FLUOXETINE","CAP 40MG","30","Select","Select",""],["","75834050005","METFORMIN","TAB 500MG ER","120","Select","Select",""],["","00597015390","JARDIANCE","25 MG","30","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","20","Select","Select",""],["","98302000198","COMFORT EZ","MIS 31GX8MM","100","Select","Select",""],["","58604021430","ADDYI","TAB 100MG","30","Select","Select",""],["","49502019675","SEMGLEE","INJ 100U\/ML","30","Select","Select",""],["","00002879959","HUMALOG KWIK","INJ 100\/ML","15","Select","Select",""],["","00173068220","VENTOLIN HFA","AER ","18","Select","Select",""],["","31722057310","ESOMEPRA MAG","CAP 40MG DR","90","Select","Select",""],["","60432060416","PROMETHAZINE","SYP DM","180","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","59267102504","PFIZER VACC","INJ ADLT RTU","0","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","16714004301","VENLAFAXINE","CAP 37.5 ER","30","Select","Select",""],["","11877001140","BINAXNOW COV","KIT HOME TES","8","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","65862050301","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","00054982831","PREDNISONE","5 MG","30","Select","Select",""],["","27808023302","DOXYCYCL HYC","CAP 100MG","14","Select","Select",""],["","67877025145","TRIAMCINOLONE ACETONIDE","0.1 %","45","Select","Select",""],["","42806031205","DOXYCYCLINE HYCLATE","100 MG","20","Select","Select",""],["","65862019499","FLUOXETINE HCL","40 MG","30","Select","Select",""],["","75834050005","METFORMIN HCL ER","500 MG","120","Select","Select",""],["","21922002505","KETOCONAZOLE","2 %","30","Select","Select",""],["","63304069205","CLINDAMYCIN HCL","150 MG","80","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":""}]}]}