{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ANAERDALLENNIT","gend":1,"add":"SAMOHT 4255YWH NOSLEN ","city":"ARRINGTON","state":"VA","zip":"22922-9998","dob":"2003-07-22","age":"","mstatus":"","insh":"1509810*24","cliId":"","pno":"73\/0458505-7","cno":"512\/785-5984","email":"","ename":"","eno":"","pphy":"SHANNON, KRISTINE G NP","ppno":"434\/361-2555","pcpadd":"2871 ROCKFISH VALLEY HWY","pcpcity":"NELLYSFORD","pcpstate":"VA","pcpzip":22958,"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":["F33.0","Z20.828","Z20.822","E66.01","F41.9","E78.1","R73.03","Z68.54","F32.9","E28.2","Z71.3","Z71.89","R73.09","J00.","U07.1","Z00.129","J30.2","R79.89","E88.81","R51.9","NO DATA","N92.6","G89.29","Z68.43","Z30.41","L05.91","M79.604","L03.317","L02.31"],"date":["2021-02-09","2021-01-12","2022-01-15","2022-06-29","2022-06-23","2022-03-10","2022-06-23","2022-06-23","2021-09-10","2022-03-10","2022-06-29","2020-11-25","2020-11-25","2021-10-10","2021-10-10","2021-07-15","2022-03-10","2022-03-10","2021-07-15","2022-03-10","2022-06-23","2022-05-10","2022-03-10","2022-06-29","2022-05-10","2022-05-10","2022-08-25","2022-04-26","2022-04-26"],"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":[["","00169406013","VICTOZA","INJ 18MG\/3ML","9","Select","Select",""],["","","FLUOXETINE","CAP 20MG","","Select","Select",""],["","11822312760","LORATADINE","TAB 10MG","30","Select","Select",""],["","68180088673","NIKKI","TAB 3-0.02MG","84","Select","Select",""],["","69097012203","TOPIRAMATE","TAB 25MG","120","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","70700011585","SYEDA","TAB 3-0.03MG","84","Select","Select",""],["","00378718705","METFORMIN","TAB 1000MG","180","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","11917010303","WAL-ITIN","TAB 10MG","30","Select","Select",""],["","00169413212","OZEMPIC","INJ 2\/1.5ML","3","Select","Select",""],["","08290320119","BD  PEN NEEDL","MIS 31GX5MM","100","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","30","Select","Select",""],["","50428042799","ALLRGY","TAB 10-240MG","30","Select","Select",""],["","00555902742","JUNEL","TAB ","42","Select","Select",""],["","","AUROVELA","TAB 1.5\/30","","Select","Select",""],["","00781577626","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","68180086613","BLISOVI","TAB 1.5\/30","84","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}