{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   ECINOHSNIGGORB L","gend":1,"add":"RUOC TS DUM 0731945 XOB O P TS T","city":"CONCORD","state":"VA","zip":"24538-9998","dob":"1990-07-12","age":"","mstatus":"","insh":"0296910*88","cliId":"","pno":"12\/4347838-5","cno":"","email":"","ename":"","eno":"","pphy":"MINOTTI, CRISTINA MARIA FNP","ppno":"434\/528-0005","pcpadd":"925 VILLAGE HWY","pcpcity":"RUSTBURG","pcpstate":"VA","pcpzip":24588,"pcpcounty":"","pcpid":"","pcpname":"JOHNSON HEALTH CENTER","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","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":["F33.41","F31.62","R10.32","R07.89","M54.12","N39.0","Z79.01","Z80.3","Z87.891","T67.1XXA","F17.210","R31.9","Z87.440","Z20.822","J06.9","R07.9","E86.0","R55.","R53.1","A08.4","J01.90","B96.89","F17.200","G44.209","R52.","R51.9","R42.","W19.XXXA","R00.2","O34.219","Z33.1","O26.93","Z03.71","O47.1","Z3A.37","O34.211","D57.3","Z30.2","F32.9","O99.344","O75.89","I34.0","Z37.0","O99.013","O99.62","K21.9","Z3A.39","O34.29","I10.","Z32.01","Z36.9","R11.2","D50.9","Z3A.13","Z82.49","O21.0","R40.4"],"date":["2020-08-21","2020-10-01","2021-04-13","2021-10-03","2020-10-12","2020-10-25","2020-10-25","2020-10-12","2020-10-25","2021-07-15","2021-07-15","2020-10-25","2020-10-25","2021-10-08","2021-10-08","2021-10-03","2021-10-03","2021-10-03","2021-10-03","2020-06-11","2021-12-22","2021-12-22","2021-12-22","2021-12-22","2021-07-15","2021-07-15","2021-07-15","2021-07-15","2019-09-12","2019-10-01","2019-08-29","2019-09-18","2019-09-18","2019-09-18","2019-09-18","2019-09-30","2019-09-30","2019-09-30","2019-09-30","2019-09-30","2019-09-30","2019-09-30","2019-09-30","2019-09-30","2019-09-30","2019-09-30","2019-09-30","2019-09-30","2019-02-17","2019-02-17","2019-02-17","2019-02-17","2019-02-17","2019-04-02","2019-08-29","2019-02-20","2019-02-20"],"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":{"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":[["","59267100003","PFIZER","INJ COVID-19","0","Select","Select",""],["","16571040250","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","68180016011","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","50428027137","CVS","TAB ","30","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","","TRAZODONE","TAB 50MG","","Select","Select",""],["","","SMZ\/TMP","TAB 800-160","","Select","Select",""],["","","CEFDINIR","CAP 300MG","","Select","Select",""],["","","TOPIRAMATE","TAB 25MG","","Select","Select",""],["","","BUSPIRONE","TAB 10MG","","Select","Select",""],["","","BUPROPN","TAB 150MG XL","","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","9","Select","Select",""],["","00093117410","PENICILLN","TAB 500MG","28","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","65162052110","PROMETHAZINE","TAB 25MG","56","Select","Select",""],["","00536406301","CL","TAB 28-0.8MG","30","Select","Select",""],["","43386035701","HYDROCO\/APAP","TAB 7.5-325","7","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","30","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","60","Select","Select",""],["","00536100901","FERROUS","TAB 325MG","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":""}]}]}