{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AG D   AIRAMARYEIV AICR","gend":1,"add":"S1 543EVA T","city":"TIMBERVILLE","state":"VA","zip":"22853-9998","dob":"1980-08-15","age":"","mstatus":"","insh":"0792210*05","cliId":"","pno":"12\/0450498-4","cno":"540\/214-8940","email":"","ename":"","eno":"","pphy":"DERBY, JENNIFER R DO","ppno":"540\/901-0800","pcpadd":"13892 TIMBER WAY","pcpcity":"BROADWAY","pcpstate":"VA","pcpzip":22815,"pcpcounty":"","pcpid":"","pcpname":"SRMHMG - Sentara Timber Way Health Center","plan":"OHP","program":"MEDICAID","lob":"M4","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":["O15.1","D62.","R57.8","D65.","R68.0","E87.2","E87.5","N17.9","Z99.11","M79.81","O35.8XX0","O28.3","Z3A.26","Z3A.28","Z36.83","Z34.81","Z3A.11","O26.851","Z11.59","O36.5920","O09.522","O34.219","B37.3","R35.0","Z3A.32","K75.9","O15.9","R74.8","D68.9","O26.613","K76.0","O14.25","O15.2","O99.13","Z45.2","O14.20","R10.13","F43.10","I10.","F41.1","O90.89","N90.89","F41.9","N94.6","Z00.00","Z87.59","D64.9","I42.8","K82.9","R18.8","O36.5930","R56.9","O76.","O14.23","Z3A.34","Z37.0","N99.840","K66.1","I60.9","Z87.19","R07.9","R12."],"date":["2020-10-19","2020-10-21","2020-10-21","2020-10-31","2020-10-19","2020-10-19","2020-10-19","2021-09-22","2020-10-19","2020-10-21","2020-09-10","2020-08-27","2020-08-27","2020-09-10","2020-09-10","2020-05-14","2020-05-14","2020-05-14","2020-05-14","2020-08-27","2020-08-27","2020-10-19","2020-10-05","2020-10-05","2020-10-05","2020-10-21","2020-10-21","2020-10-21","2020-10-21","2020-10-21","2020-10-21","2020-10-31","2020-10-31","2020-10-31","2020-10-28","2020-10-28","2021-10-22","2021-07-02","2021-12-14","2021-06-29","2020-10-31","2020-10-31","2021-12-14","2021-08-27","2021-12-14","2021-12-14","2021-12-14","2020-10-19","2020-10-19","2020-10-19","2020-10-19","2020-10-19","2020-10-19","2020-10-19","2020-10-19","2020-10-19","2020-10-21","2020-10-21","2021-06-11","2021-06-11","2020-10-28","2021-03-03"],"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":[["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","00228202710","ALPRAZOLAM","TAB 0.25MG","15","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","49884012201","LABETALOL","TAB 100MG","60","Select","Select",""],["","68180071909","AMLODIPINE","TAB 2.5MG","30","Select","Select",""],["","65862077685","MILI","TAB 0.25\/35","28","Select","Select",""],["","68180035103","SERTRALINE","TAB 25MG","90","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","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":""}]}]}