{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ITNOITGNIK ","gend":1,"add":"NOBUDUA 333A7 TPA RD ","city":"DANVILLE","state":"VA","zip":"24540-9998","dob":"2003-06-12","age":"","mstatus":"","insh":"2999810*97","cliId":"","pno":"02\/4342028-3","cno":"434\/228-9722","email":"","ename":"","eno":"","pphy":"HALSEY, KATIE RENEE CNM","ppno":"434\/791-4122","pcpadd":"705 MAIN STREET","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"pcpcounty":"","pcpid":"","pcpname":"PIEDMONT ACCESS TO HEALTH SERVICES INC","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":["K59.00","N39.0","N91.2","Z32.01","F33.1","Z20.828","Z39.1","G44.89","O03.9","R00.0","I95.9","O98.511","U07.1","Z3A.10","R10.32","O47.03","O34.219","Z3A.36","O34.211","Z37.0","Z3A.39","O99.324","F12.90","D64.9","O99.02"],"date":["2020-09-23","2020-09-23","2021-12-11","2021-12-11","2021-11-08","2022-01-15","2022-08-22","2022-01-17","2022-01-17","2022-01-17","2022-01-17","2022-01-18","2022-01-18","2022-01-18","2022-01-18","2022-07-23","2022-07-23","2022-07-23","2022-08-08","2022-08-08","2022-08-08","2022-08-08","2022-08-08","2022-08-08","2022-08-08"],"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":[["","63304069301","CLINDAMYCIN","CAP 300MG","14","Select","Select",""],["","47781030801","NITROFUR","CAP 100MG","14","Select","Select",""],["","59267102501","PFIZER","INJ ADLT RTU","0","Select","Select",""],["","77333071510","PRENATAL","TAB ","30","Select","Select",""],["","00536100901","FERROUS","TAB 325MG","90","Select","Select",""],["","49483060350","IBUPROFEN","TAB 600MG","16","Select","Select",""],["","00093226301","AMOXICILLIN","TAB 500MG","21","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","12","Select","Select",""],["","00093117410","PENICILLN","TAB 500MG","28","Select","Select",""],["","59762453701","MEDROXYPR","INJ 150MG\/ML","1","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","69097083412","SERTRALINE","TAB 50MG","70","Select","Select",""],["","65862039110","ONDANSETRON","TAB 8MG ODT","21","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","68180016113","AZITHROMYCIN","TAB 500MG","2","Select","Select",""],["","49884028901","MEGESTROL","TAB 20MG","120","Select","Select",""],["","24658031205","DOXYCYCL","TAB 100MG","14","Select","Select",""],["","16729020001","BUSPIRONE","TAB 5MG","60","Select","Select",""],["","","CVS","PAK ","","Select","Select",""],["","","NITROFURANTN","CAP 100MG","","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":""}]}]}