{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   REIVAJENUTROF D","gend":0,"add":"B N 201TS REKA","city":"CHARLOTTESVILLE","state":"VA","zip":"22903-9998","dob":"2001-09-10","age":"","mstatus":"","insh":"2235710*01","cliId":"","pno":"08\/4344382-6","cno":"","email":"","ename":"","eno":"","pphy":"FETCHO, STEVE NP","ppno":"434\/297-7140","pcpadd":"650 PETER JEFFERSON PKWY STE 290","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22911,"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":["F33.2","F43.20","F41.1","F32.9","F40.10","F63.3","NO DATA","Z20.822","F43.25","K92.1","R46.89","F60.3","Z00.00","Z23.","K62.5","F33.1","R63.4","Z72.52","R06.2","K21.9","F41.9","D12.5","K57.30","K64.8","R05.9","R50.9","R51.9","R06.02","M94.0","R07.9","E66.01","Z68.41","K51.40"],"date":["2020-11-19","2020-02-07","2022-11-23","2022-08-10","2022-11-23","2022-11-23","2022-10-20","2022-03-08","2022-10-20","2022-02-07","2020-01-23","2020-01-23","2022-04-11","2022-10-06","2021-11-02","2019-03-18","2019-12-06","2022-10-10","2022-10-06","2022-10-06","2022-07-25","2022-02-07","2022-02-07","2022-02-07","2022-03-08","2022-03-08","2022-03-08","2022-03-08","2022-05-12","2022-05-12","2022-10-10","2022-10-10","2022-02-07"],"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":[["","65862019399","FLUOXETINE","CAP 20MG","14","Select","Select",""],["","68462039610","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","10572010001","PEG-3350","SOL ELECTROL","4000","Select","Select",""],["","45802086802","POLYETH","POW 3350 NF","238","Select","Select",""],["","63402030830","LATUDA","TAB 80MG","90","Select","Select",""],["","00093506110","HYDROXYZ","TAB 25MG","90","Select","Select",""],["","61958200201","DESCOVY","TAB 200\/25MG","30","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","72578000105","DOXYCYCL","TAB 100MG","14","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","70710136703","EMTR\/TENOFOV","TAB 200-300","30","Select","Select",""],["","61958070101","TRUVADA","TAB 200-300","30","Select","Select",""],["","68001019600","ESCITALOPRAM","TAB 10MG","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":""}]}]}