{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AIVILONIWRE ","gend":1,"add":"AIDNI 21143DAOR NWOTN","city":"LOCUST GROVE","state":"VA","zip":"22508-9998","dob":"2002-11-02","age":"","mstatus":"","insh":"2080110*49","cliId":"","pno":"93\/0458505-9","cno":"","email":"","ename":"","eno":"","pphy":"HALSEY, ROBYN J NP","ppno":"540\/825-6100","pcpadd":"1200 SUNSET LN STE 2210","pcpcity":"CULPEPER","pcpstate":"VA","pcpzip":"22701","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":["F33.1","S39.012A","F90.2","F33.0","F41.1","R63.2","E66.01","R05.","R43.2","R43.0","T19.2XXA"],"date":["2020-10-15","2020-12-10","2021-11-01","2021-11-01","2021-11-01","2021-07-27","2021-07-27","2021-05-13","2021-05-13","2021-05-13","2021-11-12"],"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":[["","29300046801","CLONIDINE","TAB 0.1MG","30","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","60","Select","Select",""],["","16714008210","HYDROXYZ","TAB 25MG","60","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","10","Select","Select",""],["","00093100301","BUSPIRONE","TAB 15MG","24","Select","Select",""],["","13668001990","VENLAFAXINE","CAP 75MG ER","30","Select","Select",""],["","00378727253","NORETHINDRON","TAB 0.35MG","28","Select","Select",""],["","11845069305","VITAMIN","TAB 1000MCG","30","Select","Select",""],["","70700016406","LEVONORGESTR","TAB 1.5MG","8","Select","Select",""],["","61783000012","FC2","MIS CONDOM","24","Select","Select",""],["","70069000510","CYANOCOBALAM","INJ 1000MCG","30","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","7","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","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":""}]}]}