{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" R   YRRETNOSRETSEK","gend":0,"add":"C OMLA 654DAOR LEPAH","city":"STEELES TAVERN","state":"VA","zip":"24476-9998","dob":"1958-04-07","age":"","mstatus":"","insh":"12400210*08","cliId":"","pno":"64\/0459250-6","cno":"","email":"","ename":"","eno":"","pphy":"BOULDO, GRIGORII DO","ppno":"540\/234-9241","pcpadd":"1151 KEEZLETOWN RD","pcpcity":"WEYERS CAVE","pcpstate":"VA","pcpzip":24486,"pcpcounty":"","pcpid":"","pcpname":"Carilion Family Medicine Weyers Cave","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":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R00.2","R00.1","K21.9","F17.210","R07.9","Z72.0","Z79.899","F17.200","Z76.89","R29.898","Z71.6","F33.1","K22.70","Z12.11","B18.2","R05.","R06.2","Z20.828","K29.00","K44.9","Z87.19","F43.23","F43.20","R07.89","K29.70","M47.12","M48.02","M50.020","H57.11","V62.84","R13.12","G95.9","Z09.","R13.10","K29.80","Z48.89"],"date":["2020-10-23","2020-10-23","2021-08-18","2020-10-23","2020-10-23","2020-10-23","2020-10-23","2020-10-23","2021-12-21","2021-12-21","2021-12-21","2020-11-25","2021-08-30","2021-08-18","2021-08-18","2020-05-08","2020-05-08","2020-05-08","2021-08-30","2021-08-30","2021-08-30","2019-08-13","2019-08-13","2019-10-07","2019-10-07","2019-02-10","2019-02-10","2019-02-09","2019-02-09","2019-08-12","2019-08-12","2019-02-06","2019-02-06","2019-08-05","2019-10-07","2019-12-18"],"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":[["","59651000305","OMEPRAZOLE","CAP 40MG","60","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","59762040101","SUCRALFATE","TAB 1GM","120","Select","Select",""],["","","PREDNISONE","TAB 50MG","","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","","BENZONATATE","CAP 200MG","","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","40","Select","Select",""],["","00536589453","NICOTINE","DIS 7MG\/24HR","28","Select","Select",""],["","00904645780","DOK","CAP 100MG","15","Select","Select",""],["","50383077504","LIDOCAINE","SOL 2% VISC","100","Select","Select",""],["","68462024805","RANITIDINE","TAB 150MG","60","Select","Select",""],["","43386009019","GAVILYTE-G","SOL ","4000","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":""}]}]}