{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  HTEBAZILETSAGOBRA C ","gend":1,"add":"HCNARB 005361 TOL NL ","city":"ELKTON","state":"VA","zip":"22827-9998","dob":"1963-04-03","age":"","mstatus":"","insh":"23200210*63","cliId":"","pno":"34\/0452833-0","cno":"","email":"","ename":"","eno":"","pphy":"GIBSON, SARAH COLEMAN FNP","ppno":"540\/433-4913","pcpadd":"1380 LITTLE SORRELL DR STE 100","pcpcity":"HARRISONBURG","pcpstate":"VA","pcpzip":22801,"pcpcounty":"","pcpid":"","pcpname":"Healthy Community Health Center - Stone Port (HCHC-Stone Port)","plan":"OHP","program":"MEDICAID","lob":"OHCC","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":["E03.9","E04.1","N95.9","Z01.810","R13.10","Z01.812","J06.9","Z20.822","H66.003","G47.33","F32.9","H60.503","Z23.","H92.09","M54.5","K04.7","E11.9","R74.01","Z01.818","T17.308A","K21.9","M54.42","M54.41","R21.","L08.9","M79.89","H60.392","G47.34","R53.83","G47.19","E55.9","R63.5","E07.9","Z79.890","Z79.899","Z88.8","M54.2","Z71.89","F39.","Z13.89","H66.002","H60.502","S39.012A"],"date":["2021-07-08","2021-07-08","2020-05-11","2020-06-05","2020-06-05","2020-06-05","2021-09-17","2021-09-17","2021-09-17","2021-03-29","2020-03-02","2021-02-02","2021-02-02","2021-02-02","2021-02-02","2021-02-05","2021-04-12","2021-03-29","2021-03-29","2020-05-15","2020-05-15","2021-05-26","2021-05-26","2021-12-01","2021-12-01","2021-12-01","2019-10-06","2019-06-28","2019-06-16","2019-06-16","2019-09-23","2019-09-23","2019-10-06","2019-10-06","2019-10-06","2019-10-06","2019-10-06","2019-03-07","2019-07-08","2019-07-08","2019-10-10","2019-10-10","2019-02-27"],"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":[["","","METFORMIN"," METFORMIN ","60","Select","Select",""],["","","ONETOUCH"," ONETOUCH ","50","Select","Select",""],["","","HYDROCO\/APAP"," HYDROCO\/APAP ","10","Select","Select",""],["","00781165501","PENICILLN","TAB 500MG","40","Select","Select",""],["","","LEVOTHYROXIN"," LEVOTHYROXIN ","30","Select","Select",""],["","","LORATADINE","TAB 10MG","","Select","Select",""],["","00378395205","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","00597015330","JARDIANCE","TAB 25MG","90","Select","Select",""],["","","SERTRALINE"," SERTRALINE ","30","Select","Select",""],["","","FLUTICASONE"," FLUTICASONE ","16","Select","Select",""],["","00093506105","HYDROXYZ","TAB 25MG","10","Select","Select",""],["","45802006435","TRIAMCINOLON","CRE 0.001","15","Select","Select",""],["","","MELOXICAM"," MELOXICAM ","30","Select","Select",""],["","","CYCLOBENZAPR"," CYCLOBENZAPR ","30","Select","Select",""],["","59310057922","PROAIR","AER ","26","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","16571020210","DICLOFENAC","TAB 50MG DR","60","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","10","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","51672300701","HC\/ACET","SOL OTIC","10","Select","Select",""],["","","WAL-ITIN","TAB 10MG","","Select","Select",""],["","","RANITIDINE"," RANITIDINE ","60","Select","Select",""],["","","TRAMADOL"," TRAMADOL ","42","Select","Select",""],["","","ESZOPICLONE"," ESZOPICLONE ","1","Select","Select",""],["","","MUCINEX"," MUCINEX ","20","Select","Select",""],["","","FLUCONAZOLE"," FLUCONAZOLE ","2","Select","Select",""],["","","CIPRODEX"," CIPRODEX ","15","Select","Select",""],["","","CIPROFLOXACN"," CIPROFLOXACN ","10","Select","Select",""],["","","AMOX\/K"," AMOX\/K ","20","Select","Select",""],["","","ACCU-CHEK","KIT AVIVA PL","","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}