{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" IROLKISAW","gend":1,"add":"REHS 016EVA DOOW","city":"WAYNESBORO","state":"VA","zip":"22980-9998","dob":"1990-01-19","age":"","mstatus":"","insh":"0441110*34","cliId":"","pno":"52\/0455842-6","cno":"","email":"","ename":"","eno":"","pphy":"BLOSSER, JENNIFER NP","ppno":"540\/942-1200","pcpadd":"1850 ROSSER AVE","pcpcity":"WAYNESBORO","pcpstate":"VA","pcpzip":22980,"pcpcounty":"","pcpid":"","pcpname":"UNIVERSITY OF VIRGINIA PHYSICIANS GROUP","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":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J02.9","R68.89","Z47.89","M25.562","T84.84XA","S93.401A","F41.1","F33.0","S61.402A","X58.XXXA","S29.012A","A08.4","A54.02","S93.431A","S91.332A","W25.XXXA","S83.522A","M25.362","F32.9","F41.9","F12.90","M25.371","M23.8X2","V58.89","G89.29","R05.9","R51.9","R68.83","Z20.822","S06.0X0A","G89.18","H66.91","J02.0","Z01.419","NO DATA","Z30.46","S09.90XA","Z20.2"],"date":["2021-04-13","2020-01-31","2021-07-27","2020-11-27","2021-07-27","2019-03-07","2019-12-12","2019-12-12","2019-11-10","2019-11-29","2019-11-29","2020-02-19","2021-06-29","2019-04-19","2019-08-23","2019-08-23","2020-11-12","2020-11-12","2021-01-12","2021-01-12","2021-01-12","2019-04-19","2020-10-13","2020-10-13","2020-10-13","2021-12-31","2021-12-31","2021-12-31","2021-12-31","2020-12-04","2020-11-12","2019-03-06","2019-03-06","2019-08-08","2019-08-08","2019-08-28","2020-12-04","2021-06-18"],"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":[["","","VENLAFAXINE"," VENLAFAXINE ","30","Select","Select",""],["","","TAMIFLU"," TAMIFLU ","10","Select","Select",""],["","","OSELTAMIVIR"," OSELTAMIVIR ","10","Select","Select",""],["","","AZITHROMYCIN"," AZITHROMYCIN ","6","Select","Select",""],["","","PREDNISONE"," PREDNISONE ","5","Select","Select",""],["","","BUPROPN"," BUPROPN ","30","Select","Select",""],["","","MUPIROCIN"," MUPIROCIN ","22","Select","Select",""],["","","METHOCARBAM"," METHOCARBAM ","60","Select","Select",""],["","","ONDANSETRON","TAB 8MG ODT","","Select","Select",""],["","","BUSPIRONE","TAB 30MG","","Select","Select",""],["","","OXYCODONE","TAB 5MG","","Select","Select",""],["","","ARIPIPRAZOLE","TAB 2MG","","Select","Select",""],["","","TRAZODONE","TAB 50MG","","Select","Select",""],["","","ASPIRIN","CHW 81MG","","Select","Select",""],["","","TRAMADOL","TAB 50MG","","Select","Select",""],["","","KETOROLAC","TAB 10MG","","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":""}]}]}