{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ANUAHSTRAWETS","gend":1,"add":"DNIL 9742DAOR YAS","city":"GORDONSVILLE","state":"VA","zip":"22942-9998","dob":"1993-11-23","age":"","mstatus":"","insh":"1482210*77","cliId":"","pno":"72\/0453524-7","cno":"","email":"","ename":"","eno":"","pphy":"CORBETT, SUSAN CNM","ppno":"434\/924-2500","pcpadd":"1204 W MAIN STREET FL 3","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22903,"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":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R93.0","O28.3","O99.345","F32.9","Z39.2","Z30.013","Z36.3","Z13.79","Z34.00","O21.9","Z34.01","Z3A.29","O26.13","O26.843","O99.343","Z3A.33","O42.013","O9A.213","V47.5XXA","Z3A.36","V87.7XXA","U07.1","O60.14X0","O35.0XX0","O36.5930","Z37.0","R11.2","Z33.1","O99.89","R87.613","Z3A.23","O26.892","Z3A.25","N20.0","Z3A.31","O99.340","O47.9","Z3A.08","O47.03","N92.6","N89.8","Z30.42","R10.84","K92.0","R52.","R11.0","R11.11","Z3A.13","O99.344","O76.","O99.62","O69.81X0","D06.0","K21.9","Z34.03","Z39.1","N93.9","O26.899","O60.03","O36.8130","Z88.0","Z87.891","O80.","T14.90XA","R10.9","R06.9","O99.612","K59.00","O22.42","Z3A.27","O35.8XX0","D27.0"],"date":["2020-09-09","2020-09-24","2020-09-29","2020-09-29","2020-11-10","2020-11-10","2020-04-15","2020-04-15","2020-04-15","2020-08-12","2020-04-15","2020-08-12","2020-08-26","2020-08-26","2020-09-08","2020-09-08","2020-09-27","2020-09-27","2020-09-26","2020-09-27","2020-09-27","2021-10-03","2020-09-27","2020-09-27","2020-09-27","2020-09-27","2020-03-21","2020-03-21","2020-09-26","2021-01-29","2020-06-26","2020-07-15","2020-07-15","2020-09-05","2020-08-26","2020-09-08","2020-09-08","2020-03-18","2020-09-05","2021-01-29","2021-01-29","2021-01-29","2021-08-22","2021-08-22","2021-08-22","2021-08-22","2021-08-22","2020-04-15","2020-09-26","2020-09-26","2020-09-26","2020-09-27","2020-09-26","2020-09-26","2020-09-26","2020-09-29","2020-09-03","2020-09-03","2020-09-03","2020-09-03","2020-09-03","2020-09-03","2020-09-03","2020-09-26","2020-05-07","2020-05-07","2020-07-29","2020-07-29","2020-07-29","2020-07-29","2020-08-26","2021-08-23"],"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":[["","","GAVILAX","POW ","","Select","Select",""],["","","OXYCODONE","TAB 5MG","","Select","Select",""],["","","ONDANSETRON","TAB 4MG ODT","","Select","Select",""],["","","SERTRALINE","TAB 50MG","","Select","Select",""],["","","NAPROXEN","TAB 500MG","","Select","Select",""],["","","PROMETHAZINE","TAB 25MG","","Select","Select",""],["","","VITAMIN","TAB 25MG","","Select","Select",""],["","","EC-NAPROXEN","TAB 500MG","","Select","Select",""],["","","LIDOCAINE\/HC","CRE 3%-0.5%","","Select","Select",""],["","","ACETAMIN","TAB 325MG","","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":""}]}]}