{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" A  NYLEVESELAROM ED","gend":1,"add":"OW LERUAL 396 TPA RD DO","city":"WAYNESBORO","state":"VA","zip":22980,"dob":"1977-11-05","age":"","mstatus":"","insh":"0123210*74","cliId":"","pno":"04\/4341311-9","cno":"","email":"","ename":"","eno":"","pphy":"Aguero, Lindsay","ppno":"434\/654-4550","pcpadd":"310 Old Ivy Road Suite 201","pcpcity":"Charlottesville","pcpstate":"VA","pcpzip":22980,"pcpcounty":"","pcpid":"","pcpname":"SMJMG - Sentara Blue Ridge Internal Medicine","plan":"OHP","program":"Medicaid","lob":"M4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M47.816","R43.9","R10.31","K31.89","NO DATA","K44.9","Z71.89","R10.13","F43.10","G47.33","Z23.","Q63.2","Z00.00","R43.2","L72.9","E66.01","F41.9","M54.5","R73.02","D50.9","Z68.42","F32.9","G89.29","N10.","R93.3","K51.40","K21.9","R11.2","F34.1","F41.1","F41.0","Z65.9","F42.2","Z62.819","Z99.89","R10.11","G47.00","I10."],"date":["2020-09-14","2020-10-14","2020-10-30","2020-11-03","2020-11-03","2020-11-03","2021-02-23","2021-05-07","2021-10-26","2021-12-03","2021-03-31","2021-05-07","2020-09-03","2020-09-03","2020-09-03","2020-09-03","2021-08-04","2020-09-03","2020-09-03","2020-09-03","2020-09-03","2020-09-03","2020-09-03","2020-10-19","2021-01-22","2021-01-22","2020-09-17","2020-09-17","2021-08-31","2021-08-31","2021-08-31","2021-08-31","2021-08-31","2021-08-31","2021-12-03","2021-01-01","2021-08-04","2021-08-04"],"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":[["","","ONDANSETRON","TAB 4MG ODT","","Select","Select",""],["","","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","","LISINOPRIL","TAB 5MG","","Select","Select",""],["","00536100901","FERROUS","TAB 325MG","90","Select","Select",""],["","","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","","OXYCOD\/APAP","TAB 5-325MG","","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","","DICYCLOMINE","TAB 20MG","","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","90","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","10","Select","Select",""],["","69097083412","SERTRALINE","TAB 50MG","90","Select","Select",""],["","00228202950","ALPRAZOLAM","TAB 0.5MG","15","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","90","Select","Select",""],["","50111064801","FLUOXETINE","CAP 20MG","90","Select","Select",""],["","65162006205","SUCRALFATE","SUS 1GM\/10ML","420","Select","Select",""],["","","TIZANIDINE","TAB 4MG","","Select","Select",""],["","","NYSTATIN","SUS 100000","","Select","Select",""],["","","DICLOFENAC","GEL 0.01","","Select","Select",""],["","","METFORMIN","TAB 500MG","","Select","Select",""],["","","CIPROFLOXACN","TAB 500MG","","Select","Select",""],["","","VITAMIN","TAB COMPLEX","","Select","Select",""],["","","AMOX\/K","TAB 875-125","","Select","Select",""],["","","SUPREP","SOL PREP KIT","","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}