{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"A   EANERRENIART ","gend":1,"add":"VAD 04NL SI","city":"WAYNESBORO","state":"VA","zip":"22980-9998","dob":"1965-05-23","age":"","mstatus":"","insh":"36300210*86","cliId":"","pno":"59\/0455041-8","cno":"","email":"","ename":"","eno":"","pphy":"CHEEK, KIMBERLY M MD","ppno":"540\/245-7950","pcpadd":"201 LEW DEWITT BLVD","pcpcity":"WAYNESBORO","pcpstate":"VA","pcpzip":22980,"pcpcounty":"","pcpid":"","pcpname":"AUGUSTA MEDICAL 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":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z85.118","F17.210","R51.","R42.","J90.","E87.1","R18.8","C34.90","R06.00","R64.","Z87.891","F17.200","M79.2","Z51.5","E22.2","E87.6","Z12.31","Z12.11","Z12.12","C34.12","NO DATA","K21.9","G89.4","F34.1","N13.9","M25.511","J30.2","Z23.","Z00.00","J70.1","G44.89","N95.1","R05.","R07.81","C34.92","M12.811","J18.9","R06.02","J44.9","I67.1","R07.89"],"date":["2021-07-19","2021-08-30","2020-06-18","2020-06-18","2021-03-03","2021-07-19","2020-07-30","2021-08-04","2021-08-04","2021-08-30","2020-07-23","2020-08-11","2020-08-11","2020-04-20","2020-08-11","2020-06-05","2020-06-05","2020-06-05","2020-06-05","2021-08-30","2020-08-11","2020-08-11","2020-08-11","2020-08-11","2021-01-11","2019-06-03","2019-12-06","2019-12-06","2019-12-06","2019-12-06","2019-12-06","2019-12-06","2019-08-19","2019-08-19","2019-09-19","2019-07-11","2019-10-09","2019-07-26","2019-07-26","2019-06-04","2019-10-09"],"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":[["","49884028901","MEGESTROL","TAB 20MG","120","Select","Select",""],["","00223176001","SOD","TAB 1GM","30","Select","Select",""],["","","PREDNISONE","TAB 20MG","","Select","Select",""],["","00591024005","LORAZEPAM","TAB 0.5MG","2","Select","Select",""],["","58160084252","BOOSTRIX","INJ ","0","Select","Select",""],["","31722072320","LEVOFLOXACIN","TAB 750MG","5","Select","Select",""],["","00069047103","CHANTIX","PAK 0.5& 1MG","53","Select","Select",""],["","00185041501","BUPROPION","TAB 150MG SR","60","Select","Select",""],["","00006483703","PNEUMOVAX","INJ 25\/0.5","0","Select","Select",""],["","00781635587","MOMETASONE","SPR 50MCG","17","Select","Select",""],["","58160082311","SHINGRIX","INJ 50MCG","1","Select","Select",""],["","00005197102","PREVNAR","INJ ","0","Select","Select",""],["","43528000305","HEPLISAV-B","INJ 20\/0.5ML","0","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","00135014502","NICODERM","DIS 21MG\/24H","28","Select","Select",""],["","11822222590","RA","DIS 21MG\/24H","2","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","65162003311","APAP\/CODEINE","TAB 300-30MG","10","Select","Select",""],["","00143980305","DOXYCYCL","CAP 100MG","20","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":""}]}]}