{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"V   ASOROYORRA ","gend":1,"add":" HTUOS 04I TPA EVA","city":"HARRISONBURG","state":"VA","zip":"22801-9998","dob":"1976-07-05","age":"","mstatus":"","insh":"23200210*67","cliId":"","pno":"38\/0455874-0","cno":"","email":"","ename":"","eno":"","pphy":"AAMODT, LEONARD W MD","ppno":"540\/438-1314","pcpadd":"240 LUCY DRIVE","pcpcity":"HARRISONBURG","pcpstate":"VA","pcpzip":22801,"pcpcounty":"","pcpid":"","pcpname":"Shenandoah Womens Health Center","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":["K81.1","F33.42","N92.0","R10.13","Z90.49","Z88.5","Z88.8","Z88.2","Z88.6","F17.210","R19.7","R11.2","L50.9","D25.9","Z98.51","N93.9","R10.30","K81.9","M54.5","L25.9","R21.","Z79.899","Z79.1","R11.0","R10.11","I44.4","R07.9","R10.2","D25.1","F41.9","D64.9","M25.561","M25.512","M25.522","K80.50"],"date":["2020-02-20","2021-12-06","2021-12-17","2021-12-23","2021-12-23","2021-12-23","2021-12-23","2021-12-23","2021-12-23","2021-12-23","2021-12-23","2021-02-10","2021-06-23","2021-11-15","2021-11-10","2021-11-15","2021-11-15","2020-02-20","2020-08-09","2021-06-21","2021-06-21","2021-11-15","2021-11-15","2021-11-15","2020-02-19","2020-02-20","2020-02-20","2021-11-10","2021-11-18","2021-11-18","2020-02-19","2019-01-10","2019-01-10","2019-01-10","2019-12-26"],"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":[["","13107008305","LORAZEPAM","TAB 0.5MG","30","Select","Select",""],["","51672300302","HYDROCORT","CRE 0.025","28","Select","Select",""],["","69097083512","SERTRALINE","TAB 100MG","60","Select","Select",""],["","00054001925","PREDNISONE","TAB 50MG","5","Select","Select",""],["","42806016005","HYDROXYZ","TAB 25MG","20","Select","Select",""],["","50428047392","CVS","CAP 25MG","24","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","28","Select","Select",""],["","00093221001","SUCRALFATE","TAB 1GM","120","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":""}]}]}