{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" AALAMELAS","gend":0,"add":"TTUB 1602TC DOOWNO","city":"HARRISONBURG","state":"VA","zip":"22802-9998","dob":"1974-07-20","age":"","mstatus":"","insh":"3656110*40","cliId":"","pno":"47\/0451581-6","cno":"","email":"","ename":"","eno":"","pphy":"PFLUGRADT, CORI T PA","ppno":"540\/901-0800","pcpadd":"13892 TIMBER WAY","pcpcity":"BROADWAY","pcpstate":"VA","pcpzip":22815,"pcpcounty":"","pcpid":"","pcpname":"SRMHMG - Sentara Gastroenterology Specialists","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":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M47.812","M54.2","B34.9","Z20.822","E78.5","K21.9","K62.5","Z68.33","E66.9","R03.0","E55.9","S86.891A","S86.892A","M17.11","M25.361","K59.00","K64.8","Z86.010","I10.","D12.3","E78.00","M54.9","Z79.899","Z87.442","K92.1","M79.604","M79.605","Q43.8","K59.01","M54.12","NO DATA"],"date":["2021-10-07","2022-03-02","2022-01-14","2022-01-14","2022-02-14","2022-02-15","2022-02-15","2022-02-01","2022-02-01","2022-02-01","2020-10-07","2020-10-07","2020-10-07","2021-10-27","2021-10-27","2022-05-03","2022-05-03","2022-05-03","2022-02-15","2022-02-15","2022-02-15","2022-02-15","2022-02-15","2022-02-15","2022-02-15","2020-08-26","2020-08-26","2022-02-15","2020-01-07","2021-10-07","2021-10-07"],"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":[]},{"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":[["","43386009019","GAVILYTE-G","SOL ","4000","Select","Select",""],["","31722070090","LOSARTAN","TAB 25MG","30","Select","Select",""],["","00574709012","HYDROCORT","SUP 25MG","12","Select","Select",""],["","55111015810","OMEPRAZOLE","CAP 20MG","60","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","10572010001","PEG-3350","SOL ELECTROL","4000","Select","Select",""],["","52268020101","SUTAB","TAB ","24","Select","Select",""],["","52268001201","SUPREP","SOL PREP KIT","354","Select","Select",""],["","69097082112","GEMFIBROZIL","TAB 600MG","60","Select","Select",""],["","55111018010","TIZANIDINE","TAB 4MG","90","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","69097015807","MELOXICAM","TAB 7.5MG","90","Select","Select",""],["","68180098003","LISINOPRIL","TAB 10MG","30","Select","Select",""],["","70461042010","FLUCLVX","INJ 2020-21","0","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":""}]}]}