{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"REHPOTSIRHCDLAREGZTIF ","gend":0,"add":"      ENAL WOLLOH RETNUG   935                              ","city":"ROSELAND                      ","state":"VA","zip":"22967-2822","dob":"1971-08-10","age":"","mstatus":"","insh":"50010212","cliId":"","pno":"0943432997","cno":"","email":"","ename":"","eno":"","pphy":"BROWN, BENJAMIN T                                           ","ppno":4342634000,"pcpadd":"4038 Thomas Nelson Hwy,","pcpcity":"Arrington                     ","pcpstate":"VA","pcpzip":229222302,"pcpcounty":"","pcpid":"","pcpname":"BLUE RIDGE MEDICAL CENTER","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"539 GUNTER HOLLOW LANE","madd2":"                                                            ","madd3":"","mcity":"ROSELAND                      ","mstate":"VA","mzip":"22967-2822","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z93.3","R06.02","R40.4","J11.1","L03.90","R05","F17.210","R53.1","R58","R52","M25.519","I95.9","I10","S09.90XA","M25.511","V86.55XA","S52.501A","S20.211A","S00.81XA","S01.312A","S01.01XA","L73.2","S21.211A","S52.301A","S39.93XA","S39.91XA","S00.03XA","S29.9XXA","S19.9XXA","S59.901A","S49.91XA","M25.531","S52.571A","R50.9","Y65.8","T81.49XA","L03.317","R59.0","K83.8","R10.9","M79.9","R07.9","R10.84","R60.9","R11.0","L02.31","Z79.899","M79.18","K52.9","D72.829","D47.3","D64.9","R59.9","K59.00","R79.89","K63.5","R23.4","R19.00","R93.3","R10.30","R19.7","K92.1","D12.3","D12.6","Z09","Z87.891","Z93.9","Z72.0","Z43.3","I83.811","K94.09","Z23","Z11.59","Z13.220","Z00.00","Z13.1","U07.1","R91.8","Z20.822","Z20.9","L08.9","D63.8","E87.1"],"date":["2021-11-16","2019-02-19","2019-02-19","2019-02-19","2019-02-20","2019-02-20","2021-11-17","2019-02-20","2019-06-09","2020-04-22","2019-06-09","2021-11-16","2019-06-09","2019-06-09","2019-06-09","2019-06-09","2019-06-10","2019-06-09","2019-06-09","2019-06-09","2019-06-09","2021-12-19","2019-06-09","2019-06-09","2019-06-09","2019-06-09","2019-06-09","2019-06-09","2019-06-09","2019-06-09","2019-06-09","2019-06-21","2019-06-21","2019-12-22","2019-12-22","2019-12-22","2021-01-07","2021-02-26","2019-12-23","2021-02-26","2021-02-26","2020-04-22","2020-04-22","2020-04-22","2020-04-22","2021-11-16","2020-04-22","2021-01-07","2021-02-26","2021-02-25","2021-03-30","2021-11-17","2021-02-25","2021-02-26","2021-03-30","2021-02-26","2021-02-26","2021-02-26","2021-02-26","2021-02-26","2021-02-28","2021-02-28","2021-02-28","2021-02-28","2021-03-30","2021-03-30","2021-03-30","2021-11-17","2021-12-19","2021-09-27","2021-09-27","2021-09-27","2021-09-27","2021-09-27","2021-09-27","2021-09-27","2021-11-17","2021-11-16","2021-11-16","2021-11-16","2021-11-16","2021-11-17","2021-11-17"],"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":[["","16571020106","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","15","Select","Select",""],["","00536589588","NICOTINE","DIS 14MG\/24H","28","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","30","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","72205001390","PREGABALIN","CAP 75MG","60","Select","Select",""],["","50228043605","NAPROXEN","TAB 500MG","180","Select","Select",""],["","24658031205","DOXYCYCL","TAB 100MG","14","Select","Select",""],["","65862007701","CIPROFLOXACN","TAB 500MG","20","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","20","Select","Select",""],["","00093005805","TRAMADOL","TAB 50MG","20","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","10","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":""}]}]}