{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  AILLEDNAVSNEHCUOH M ","gend":1,"add":"       DR GNIRPS YKCUTNEK 2558                              ","city":"MINERAL                       ","state":"VA","zip":"23117-4654","dob":"1965-07-01","age":"","mstatus":"","insh":"50014032","cliId":"","pno":"0504586980","cno":5402235924,"email":"","ename":"","eno":"","pphy":"HARKRADER, EDWARD R                                         ","ppno":5409672202,"pcpadd":"101 Woolfolk Ave,","pcpcity":"Louisa                        ","pcpstate":"VA","pcpzip":230934264,"pcpcounty":"","pcpid":"","pcpname":"LOUISA FAMILY PRACTICE PLC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"8552 KENTUCKY SPRING RD","madd2":"                                                            ","madd3":"","mcity":"MINERAL                       ","mstate":"VA","mzip":"23117-4654","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","M17.12","M19.071","M79.671","N92.0","Z30.42","N92.1","M19.171","M19.92","S82.391S","Z96.661","Z47.1","M24.571","R06.02","Z23","R03.0","M24.574","M25.771","Z88.5","Z79.899","Z79.02","Z47.89","G89.4","L30.9","R21","L29.9","L01.00","Z20.828","M17.0","N92.6","E66.9","H40.013","H52.03","H52.222","H52.4","H25.13","G47.00","M79.604","M25.571"],"date":["2019-10-15","2021-10-20","2019-11-18","2019-09-16","2019-09-18","2019-09-18","2019-09-18","2019-10-02","2019-10-23","2019-10-02","2019-10-02","2019-10-02","2019-10-31","2019-10-16","2021-10-20","2019-10-16","2019-10-31","2019-10-31","2019-12-29","2019-10-31","2019-10-31","2019-10-31","2019-11-13","2019-12-29","2020-03-19","2019-12-29","2020-03-19","2020-05-27","2020-09-23","2020-09-23","2021-03-31","2021-05-03","2021-05-03","2021-05-03","2021-05-03","2021-05-03","2021-10-20","2021-10-20","2021-10-20"],"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":[["","10702005601","OXYCODONE","TAB 10MG","60","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","00093417773","CEPHALEXIN","SUS 250\/5ML","400","Select","Select",""],["","45802065078","LORATADINE","TAB 10MG","30","Select","Select",""],["","68682010301","DICLOFENAC","TAB 100MG ER","30","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","16","Select","Select",""],["","60432006547","AMOX\/K","SUS 250\/5ML","300","Select","Select",""],["","00003089321","ELIQUIS","TAB 2.5MG","60","Select","Select",""],["","00591544210","PREDNISONE","TAB 10MG","42","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","59779070501","EYE","DRO 0.00025","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":""}]}]}