{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"N   TREBORII SSALG ","gend":0,"add":"DANNLLOC 34202 TPA RD E","city":"CHARLOTTESVILLE","state":"VA","zip":"22903-9998","dob":"1993-12-10","age":"","mstatus":"","insh":"0384710*51","cliId":"","pno":"52\/0455212-6","cno":"540\/256-2125","email":"","ename":"","eno":"","pphy":"LAMORE, CHRISTOPHER A PA","ppno":"434\/975-7700","pcpadd":"2335 SEMINOLE LN STE 200","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22901,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"","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":["F90.9","F41.1","I10.","R07.89","K64.9","F31.77","F31.9","E03.2","R60.0","J02.9","Z86.59","E06.3","K02.9","K21.9","R53.83","E03.8","F51.01","E03.9","F41.9","F39.","L29.9","R09.82","R21.","N50.812"],"date":["2020-11-03","2020-06-08","2021-12-17","2021-12-17","2020-01-22","2020-11-03","2020-11-03","2021-03-29","2021-12-17","2022-04-13","2020-08-04","2020-08-04","2020-08-04","2022-07-21","2020-08-04","2021-02-15","2021-02-15","2021-12-17","2021-12-17","2021-12-17","2021-12-17","2021-12-17","2022-08-08","2022-05-03"],"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":[["","00781518210","LEVOTHYROXIN","TAB 75MCG","90","Select","Select",""],["","55111015810","OMEPRAZOLE","CAP 20MG","90","Select","Select",""],["","50111056002","TRAZODONE","TAB 50MG","30","Select","Select",""],["","10702001050","HYDROXYZ","TAB 10MG","30","Select","Select",""],["","00378022210","CHLORTHALID","TAB 25MG","30","Select","Select",""],["","62332000191","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","67877025130","TRIAMCINOLON","CRE 0.001","30","Select","Select",""],["","16571040250","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","43547028111","ESCITALOPRAM","TAB 10MG","90","Select","Select",""],["","54766071604","PRAMOSONE","CRE 1-1%","57","Select","Select",""],["","45802012416","HC","CRE 2.5-1%","57","Select","Select",""],["","00904578051","HEARTBURN","TAB 20MG","60","Select","Select",""],["","59746024501","LAMOTRIGINE","TAB 25MG","120","Select","Select",""],["","60793085501","LEVOXYL","TAB 112MCG","90","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":""}]}]}