{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  SEMAJDROW E ","gend":0,"add":"                   TS ENIP 001                              ","city":"CHATHAM                       ","state":"VA","zip":"24531-4670","dob":"1962-09-21","age":"","mstatus":"","insh":"50018943","cliId":"","pno":"0743437339","cno":"","email":"","ename":"","eno":"","pphy":"TRENT, STEPHEN                                              ","ppno":4347994488,"pcpadd":"201 S Main St Ste 3200,","pcpcity":"Danville                      ","pcpstate":"VA","pcpzip":245412932,"pcpcounty":"","pcpid":"","pcpname":"DRMC FAMILY MEDICINE RESIDENCY CLINIC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"100 PINE ST","madd2":"                                                            ","madd3":"","mcity":"CHATHAM                       ","mstate":"VA","mzip":"24531-4670","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G40.909","R90.89","F81.89","Q85.1","L82.1","L72.0","D22.39","L70.0","L21.8","L72.8","L57.0","B07.8","R23.8","L53.8","R20.8","R58","Z78.9","L29.8"],"date":["2021-09-15","2020-09-15","2021-09-15","2021-09-15","2021-03-23","2021-03-23","2021-03-23","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-12-14"],"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":[["","65862069201","PHENYTOIN","CAP 100MG","90","Select","Select",""],["","51672136606","CLINDAMY\/BEN","GEL 1.2-5%","45","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0.5","Select","Select",""],["","53746054501","PRIMIDONE","TAB 250MG","60","Select","Select",""],["","45802046564","KETOCONAZOLE","SHA 0.02","120","Select","Select",""],["","00574222545","TRETINOIN","CRE 0.00025","45","Select","Select",""],["","45802002146","BETAMETH","LOT 0.0005","60","Select","Select",""],["","45802011846","MOMETASONE","SOL 0.001","60","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":""}]}]}