{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   AYAIMRETRAC L","gend":1,"add":"L TSEROF 441B TPA RD NWA","city":"DANVILLE","state":"VA","zip":"24540-9998","dob":"1994-01-08","age":"","mstatus":"","insh":"05200210*39","cliId":"","pno":"97\/4349942-1","cno":"","email":"","ename":"","eno":"","pphy":"STEPHENS, AMBER L DO","ppno":"434\/799-4488","pcpadd":"SUITE 201 109 BRIDGE STREET","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"pcpcounty":"","pcpid":"","pcpname":"DANVILLE PHYSICIAN PRACTICES LLC","plan":"OHP","program":"MEDICAID","lob":"OHCC","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":["F33.9","V02.51","Z30.2","K43.9","R00.0","D56.3","F79.","D64.9","F41.9","Z98.51","S80.262A","D50.8","K59.00","N76.2","F99.","N76.0","K46.9","L98.7","J98.11","R50.82","O80.","Z3A.40","Z37.0","O99.824","O99.02","K91.840","J30.9","S80.862A","L29.9","R60.9","M62.81","R11.0","R53.1","R07.0","J03.00"],"date":["2019-01-20","2019-05-30","2019-05-30","2019-12-23","2021-08-20","2019-12-23","2019-12-23","2019-12-23","2019-12-23","2019-12-23","2020-08-21","2019-04-29","2019-11-13","2019-04-29","2019-04-29","2019-11-13","2019-11-13","2019-12-23","2019-12-26","2019-12-26","2019-05-29","2019-05-29","2019-05-29","2019-05-29","2019-05-29","2019-12-31","2019-02-15","2020-08-21","2020-08-21","2019-06-17","2021-08-20","2021-08-20","2021-08-20","2021-08-20","2021-08-20"],"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":[["","","ONDANSETRON"," ONDANSETRON ","120","Select","Select",""],["","","CVS"," CVS ","60","Select","Select",""],["","","BUDESONIDE"," BUDESONIDE ","8","Select","Select",""],["","","FERROUS"," FERROUS ","473","Select","Select",""],["","","METRONIDAZOL"," METRONIDAZOL ","70","Select","Select",""],["","","ALLERGY"," ALLERGY ","30","Select","Select",""],["","","FOLIC"," FOLIC ","30","Select","Select",""],["","","BISACODYL"," BISACODYL ","30","Select","Select",""],["","","TERCONAZOLE"," TERCONAZOLE ","45","Select","Select",""],["","","HYDROCO\/APAP"," HYDROCO\/APAP ","60","Select","Select",""],["","","DOCUSATE"," DOCUSATE ","90","Select","Select",""],["","","MEDICATED"," MEDICATED ","50","Select","Select",""],["","","A.E.R."," A.E.R. ","5","Select","Select",""],["","","DOCU"," DOCU ","600","Select","Select",""],["","","IBUPROFEN"," IBUPROFEN ","600","Select","Select",""],["","","TUCKS"," TUCKS ","40","Select","Select",""],["","","FAMOTIDINE","TAB 20MG","","Select","Select",""],["","","HYDROCORT","CRE 0.01","","Select","Select",""],["","","DIPHENHYDRAM","ELX 12.5\/5ML","","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":""}]}]}