{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LEW MARFALAERBEGE","gend":0,"add":"LLIH A358EVA EDIS","city":"HARRISONBURG","state":"VA","zip":22802,"dob":"1989-05-01","age":"","mstatus":"","insh":"0130210*20","cliId":"","pno":"03\/0259158-2","cno":"","email":"","ename":"","eno":"","pphy":"Hotchkiss, Jerome","ppno":"540\/433-4913","pcpadd":"1380 Little Sorrell Drive Suite 100","pcpcity":"Harrisonburg","pcpstate":"VA","pcpzip":22802,"pcpcounty":"","pcpid":"","pcpname":"Healthy Community Health Center - Stone Port (HCHC-Stone Port)","plan":"OHP","program":"ACA","lob":"Individual","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G47.33","E11.9","J01.90","R05.","F43.9","I10.","Z23.","R74.01","G40.909","F32.A","R68.2","G47.00","F45.8","M79.642","Z01.812","Z20.828","M25.532","Z03.818","R56.9","R06.09","R09.1","R74.0","R94.01","R06.00","Z86.19","R06.83","U07.1","R07.82","Z99.89","M65.872","M65.9","R41.82"],"date":["2022-02-09","2021-12-15","2021-06-03","2021-06-03","2021-11-05","2021-11-05","2021-11-05","2021-12-15","2021-12-15","2021-12-15","2021-08-26","2021-12-02","2021-12-02","2021-09-25","2021-06-01","2021-09-05","2021-09-26","2021-09-05","2020-11-06","2020-12-27","2019-02-27","2019-02-27","2020-01-16","2020-12-07","2020-12-07","2020-09-06","2020-09-28","2020-07-28","2020-07-28","2020-10-24","2020-10-24","2019-10-16"],"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":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","70010006510","METFORMIN","TAB 1000MG","180","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA","100","Select","Select",""],["","65862024605","LEVETIRACETA","TAB 500MG","360","Select","Select",""],["","65862056099","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","16729000517","SIMVASTATIN","TAB 20MG","90","Select","Select",""],["","50111056102","TRAZODONE","TAB 100MG","180","Select","Select",""],["","13107015405","PAROXETINE","TAB 10MG","90","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","62332038590","MODAFINIL","TAB 100MG","30","Select","Select",""],["","69452014430","BENZONATATE","CAP 200MG","30","Select","Select",""],["","43547028111","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","65162019011","NAPROXEN","TAB 500MG","20","Select","Select",""],["","00603533815","PREDNISONE","PAK 10MG","21","Select","Select",""],["","69238110002","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","70010000201","COLCHICINE","TAB 0.6MG","3","Select","Select",""],["","29300022019","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","50111078751","AZITHROMYCIN","TAB 250MG","6","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":""}]}]}