{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" NYLORACYALC M  ","gend":1,"add":"OLOC 764DAOR YN","city":"MADISON HEIGHTS","state":"VA","zip":"24572-9998","dob":"1984-11-15","age":"","mstatus":"","insh":"2012110*99","cliId":"","pno":"32\/4347782-8","cno":"","email":"","ename":"","eno":"","pphy":"PHILLIPS, JESSICA NP","ppno":"434\/929-1400","pcpadd":"134 ELON RD","pcpcity":"MADISON HEIGHTS","pcpstate":"VA","pcpzip":24572,"pcpcounty":"","pcpid":"","pcpname":"JOHNSON HEALTH CENTER","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":["F43.10","F11.20","F41.0","M54.5","M54.30","F17.210","R07.89","D64.9","K21.9","Z79.899","F41.9","R10.9","N83.201","Z71.1","M62.81","R26.2","F41.1","D50.9","R07.9","R10.13","M54.89","W19.XXXA","R00.2","R06.02","R00.0","R51.9","R42.","N94.6","R20.2","M54.16","G57.02","S39.012A","N92.1","E66.01","Z68.41","X58.XXXA"],"date":["2021-10-01","2021-12-26","2021-10-01","2020-09-17","2020-10-26","2020-10-26","2021-01-19","2020-10-30","2020-10-30","2020-10-30","2021-12-02","2021-01-19","2019-03-30","2019-10-17","2020-09-17","2020-09-17","2019-03-27","2021-12-02","2021-12-02","2020-10-30","2020-10-30","2020-10-30","2021-10-05","2021-10-05","2021-10-05","2021-10-05","2021-10-05","2021-12-02","2021-01-19","2020-10-22","2020-10-30","2020-10-30","2020-10-30","2020-10-30","2020-10-30","2020-10-30"],"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":[["","10702001150","HYDROXYZ","TAB 25MG","90","Select","Select",""],["","00093083205","CLONAZEPAM","TAB 0.5MG","10","Select","Select",""],["","13668013701","ESCITALOPRAM","TAB 20MG","30","Select","Select",""],["","42806029601","GUANFACINE","TAB 2MG","30","Select","Select",""],["","00536100901","FERROUS","TAB 325MG","60","Select","Select",""],["","59651000305","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","59779030602","CVS","POW ","238","Select","Select",""],["","64380080307","RANITIDINE","TAB 150MG","60","Select","Select",""],["","","IBUPROFEN","TAB 800MG","","Select","Select",""],["","","METAXALONE","TAB 800MG","","Select","Select",""],["","","KETOROLAC","TAB 10MG","","Select","Select",""],["","","METHYLPRED","TAB 4MG","","Select","Select",""],["","","CYCLOBENZAPR","TAB 5MG","","Select","Select",""],["","","DICLOFENAC","GEL 0.01","","Select","Select",""],["","","TRAMADOL","TAB 50MG","","Select","Select",""],["","13107015590","PAROXETINE","TAB 20MG","30","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":""}]}]}