{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HS YRAMTTELFFI","gend":1,"add":"UNTSEHC 7277DAOR EVORG T","city":"ESMONT","state":"VA","zip":"22937-9998","dob":"1968-12-25","age":"","mstatus":"","insh":"1612210*91","cliId":"","pno":"","cno":"","email":"","ename":"","eno":"","pphy":"OBRIEN, GRACE ELIZABETH PA","ppno":"434\/975-7700","pcpadd":"2335 SEMINOLE LN STE 200","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22901,"pcpcounty":"","pcpid":"","pcpname":"","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":["R06.02","J98.4","Z12.11","K64.8","N95.0","Z90.710","Z20.822","J22.","R13.13","R09.89","R13.10","H92.02","H69.82","K21.9","Q43.8","Z80.49","R82.998","R63.4","N84.1","N84.0","J44.9","Z71.6","Z71.89","J38.3","R13.14","G47.00","NO DATA","J43.9","J38.2","H93.11","R09.81","J01.90","R03.0","F17.200","K59.00","Z72.0","R87.613","Z01.411","Z11.51","Z12.4","Z12.31","R19.8","Z13.220","D50.9","Z00.00","E78.5","Z23.","Z09.","N76.0","B96.89","N92.1","N88.8","D25.0"],"date":["2020-06-23","2020-06-23","2021-12-27","2021-12-27","2022-05-04","2022-03-28","2022-11-26","2022-11-26","2021-09-30","2021-09-30","2021-11-30","2021-11-30","2021-11-30","2022-02-21","2021-12-27","2022-03-22","2022-03-22","2022-11-16","2020-02-07","2020-02-07","2020-07-07","2021-07-15","2020-07-07","2021-09-30","2021-11-30","2022-02-21","2021-12-09","2022-11-16","2022-11-16","2020-09-04","2022-09-19","2022-09-19","2022-09-19","2020-05-18","2021-10-04","2021-10-04","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2021-11-30","2021-07-15","2021-07-15","2021-10-04","2021-10-04","2021-10-04","2020-03-06","2020-03-06","2020-03-06","2020-03-06","2020-03-06","2022-05-04"],"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":[["","59310057922","PROAIR","AER ","8","Select","Select",""],["","10370010150","BUPROPN","TAB 150MG XL","90","Select","Select",""],["","50111056102","TRAZODONE","TAB 100MG","90","Select","Select",""],["","16714079902","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","50111078751","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00904386575","DEEP","SPR 0.0065","44","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","36800013029","NASAL","SPR 0.0065","44","Select","Select",""],["","42192060704","BROM\/PSE\/DM","SYP 2\/30\/10","180","Select","Select",""],["","42806040021","METHYLPRED","TAB 4MG","21","Select","Select",""],["","65162068090","PROMETHAZINE","SOL DM","120","Select","Select",""],["","16714047802","AMOX\/K","TAB 875-125","20","Select","Select",""],["","00186037220","SYMBICORT","AER 80-4.5","10","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","00069046956","CHANTIX","TAB 1MG","56","Select","Select",""],["","00054001925","PREDNISONE","TAB 50MG","5","Select","Select",""],["","10572010001","PEG-3350","SOL ELECTROL","4000","Select","Select",""],["","68382050010","OMEPRAZOLE","CAP 40MG","90","Select","Select",""],["","00135008969","CITRUCEL","POW ORANGE","454","Select","Select",""],["","62332000191","FAMOTIDINE","TAB 20MG","90","Select","Select",""],["","00143980305","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","67877032005","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","00904671980","ACETAMINOPHE","TAB 325MG","60","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","00310737220","BUDES\/FORMOT","AER 80-4.5","10","Select","Select",""],["","00591354105","BUPROPION","TAB 150MG SR","180","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":""}]}]}