{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ACCEBERSDLEIF ","gend":1,"add":"ART NACANOM 840519 XOB OP DR LI","city":"COVESVILLE","state":"VA","zip":"22931-9998","dob":"1991-07-15","age":"","mstatus":"","insh":"27200210*96","cliId":"","pno":"28\/4349359-5","cno":"","email":"","ename":"","eno":"","pphy":"DEGEORGE, KATHARINE C MD","ppno":"434\/243-4660","pcpadd":"4916 PLANK ROAD UNIT 205","pcpcity":"NORTH GARDEN","pcpstate":"VA","pcpzip":22959,"pcpcounty":"","pcpid":"","pcpname":"UNIVERSITY OF VIRGINIA PHYSICIANS GROUP","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":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G47.33","E11.9","Z00.00","E66.01","Z12.4","M77.8","Z68.43","F17.200","J45.40","F33.41","N94.6","M46.1","Z23.","G47.00","G43.009","F32.9","Z72.0","H40.053","H40.013","M54.31","R63.4","R25.2","S09.90XA","R51.9","Z68.44","N92.6","T78.40XS","J30.2","R87.619","Z79.84","T78.40XA","R06.02","J06.9","B97.89","Z30.46","Z30.430","N93.9","Z97.5","Z30.431","J45.30","L60.0"],"date":["2021-12-05","2021-09-17","2020-12-18","2021-09-29","2020-12-18","2021-09-17","2021-09-29","2021-03-05","2021-03-05","2021-03-05","2021-09-17","2021-09-17","2021-09-17","2020-08-28","2020-08-28","2020-08-28","2020-08-28","2021-05-12","2021-05-12","2021-10-29","2021-10-29","2021-10-29","2021-02-16","2021-02-16","2021-03-12","2020-02-21","2020-02-21","2020-02-21","2020-04-02","2019-05-03","2019-10-26","2019-10-26","2019-10-26","2019-10-26","2019-01-18","2019-01-18","2019-01-18","2019-01-18","2019-03-01","2019-03-01","2019-04-29"],"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":[["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","08373747800","OPTICHAMBER","MIS DIAMOND","1","Select","Select",""],["","00093742610","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","00378563159","SUMATRIPTAN","TAB 50MG","9","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","00904673080","ACETAMIN","TAB 500MG","180","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","180","Select","Select",""],["","","LORATADINE","TAB 10MG","","Select","Select",""],["","","MELATONIN","TAB 3MG","","Select","Select",""],["","50458014090","INVOKANA","TAB 100MG","30","Select","Select",""],["","00781148901","AMITRIPTYLIN","TAB 75MG","60","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","30","Select","Select",""],["","10702000610","CYCLOBENZAPR","TAB 5MG","30","Select","Select",""],["","51660052605","ALLERGY","TAB 10MG","30","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","66993058597","FLUTIC\/SALME","AER 250\/50","60","Select","Select",""],["","00085113204","PROVENTIL","AER HFA","7","Select","Select",""],["","00597015290","JARDIANCE","TAB 10MG","30","Select","Select",""],["","68180035106","SERTRALINE","TAB 25MG","30","Select","Select",""],["","00555077902","MEDROXYPR","TAB 10MG","20","Select","Select",""],["","00173069600","ADVAIR","AER 250\/50","60","Select","Select",""],["","00173088210","BREO","INH 200-25","60","Select","Select",""],["","62856052960","BELVIQ","TAB 10MG","60","Select","Select",""],["","00143973805","PREDNISONE","TAB 20MG","4","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","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":{"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":""}]}]}