{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"D R   ASILHTIMS-SIVA","gend":1,"add":"DA 191NL SMA","city":"NEW CANTON","state":"VA","zip":"23123-9998","dob":"1964-07-08","age":"","mstatus":"","insh":"36200210*42","cliId":"","pno":"08\/4346205-8","cno":"","email":"","ename":"","eno":"","pphy":"LANFORD, RANDOLPH E MD","ppno":"434\/842-3244","pcpadd":"4064 JAMES MADISON HIGHWAY","pcpcity":"FORK UNION","pcpstate":"VA","pcpzip":23055,"pcpcounty":"","pcpid":"","pcpname":"FORK UNION MEDICAL ASSOCIATES INC","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":["M25.562","Z96.652","N39.46","M13.0","I10.","M79.7","M54.5","M06.9","M51.36","R06.02","M10.9","B18.2","Z23.","Z96.651","M50.30","F33.0","M51.37","F41.8","R29.898","F33.1","Z20.822","Z20.828","M51.34","M17.12","V58.89","M47.816","M43.06","J06.9","M43.17","M43.00","M43.10","M46.1","Z12.11","D12.3","K64.1","Z71.89","Z71.3","Z79.899","G47.33","J30.9","NO DATA","M47.812","E78.2","F33.9","M43.16"],"date":["2021-07-08","2021-07-08","2021-12-28","2020-03-18","2021-12-06","2020-03-18","2020-03-18","2021-12-06","2021-04-14","2020-10-09","2021-12-06","2020-10-09","2020-10-09","2021-07-08","2021-07-23","2021-07-23","2021-12-06","2021-12-06","2020-01-31","2020-04-10","2021-10-19","2021-10-19","2019-09-06","2019-08-30","2019-04-12","2019-09-25","2019-06-11","2019-12-23","2019-04-25","2019-07-03","2019-07-03","2019-09-25","2019-06-26","2019-06-26","2019-06-26","2019-08-30","2019-08-30","2019-08-30","2019-08-30","2019-04-12","2019-09-06","2019-07-11","2019-10-11","2019-10-11","2019-07-03"],"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":[["","68382012205","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","65862020399","LOSARTAN","TAB 100MG","30","Select","Select",""],["","50111043302","TRAZODONE","TAB 50MG","93","Select","Select",""],["","69315012710","FOLIC","TAB 1000MCG","30","Select","Select",""],["","57237001999","DULOXETINE","CAP 60MG","60","Select","Select",""],["","00054455015","METHOTREXATE","TAB 2.5MG","42","Select","Select",""],["","","OMEPRAZOLE","CAP 40MG","","Select","Select",""],["","29300016915","TIZANIDINE","TAB 4MG","124","Select","Select",""],["","50111078751","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","68382005101","MELOXICAM","TAB 15MG","30","Select","Select",""],["","","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","57237017099","ROSUVASTATIN","TAB 20MG","30","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","00143301801","COLCHICINE","CAP 0.6MG","60","Select","Select",""],["","50383070016","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","20","Select","Select",""],["","51672400201","NORTRIPTYLIN","CAP 25MG","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":""}]}]}