{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" LYRRADRJ ZTIF","gend":0,"add":"SSELWAL 9831DAOR KEERC ","city":"BLAIRS","state":"VA","zip":"24527-9998","dob":"2002-01-04","age":"","mstatus":"","insh":"37200210*01","cliId":"","pno":"38\/4349507-6","cno":"","email":"","ename":"","eno":"","pphy":"LEWIS, AMANDA NP","ppno":"919\/620-4700","pcpadd":"2301 ERWIN ROAD","pcpcity":"DURHAM","pcpstate":"NC","pcpzip":27710,"pcpcounty":"","pcpid":"","pcpname":"PRIVATE DIAGNOSTIC CLINIC PLLC","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":["E11.65","R09.02","V89.2XXA","Z09.","E10.9","S00.511A","R04.0","Z87.828","V89.9XXA","S06.0X0A","Z00.00","Z23.","J06.9","E11.9","Z79.4","R51.","G43.019","F07.81","R42.","Z13.9","S00.81XA","Z87.891","R51.9","T14.90XA","V49.59XA","S00.10XA","S09.93XA","Z68.54","L83."],"date":["2021-10-09","2021-10-09","2021-10-09","2021-10-28","2021-12-29","2019-12-11","2019-12-11","2019-12-17","2019-12-17","2020-03-11","2019-08-27","2019-08-27","2019-08-27","2021-10-09","2021-10-09","2020-02-21","2020-08-10","2020-08-10","2020-06-04","2020-03-11","2021-10-09","2021-10-09","2021-10-09","2019-12-11","2021-10-09","2021-10-19","2019-12-11","2020-09-11","2020-09-11"],"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":[["","","ONETOUCH"," ONETOUCH ","100","Select","Select",""],["","","LANTUS"," LANTUS ","15","Select","Select",""],["","","METFORMIN"," METFORMIN ","60","Select","Select",""],["","","PEN  NEEDLES"," PEN  NEEDLES  ","300","Select","Select",""],["","","FREESTYLE    MIS READER"," FREESTYLE    MIS READER","1","Select","Select",""],["","","FREESTYLE    KIT SENSOR"," FREESTYLE    KIT SENSOR","2","Select","Select",""],["","","INSULIN"," INSULIN ","15","Select","Select",""],["","","CYCLOBENZAPR"," CYCLOBENZAPR ","6","Select","Select",""],["","","BD  PEN NEEDL"," BD  PEN NEEDL","200","Select","Select",""],["","","HUMALOG"," HUMALOG ","15","Select","Select",""],["","","NOVOLOG"," NOVOLOG ","15","Select","Select",""],["","","IBUPROFEN"," IBUPROFEN ","30","Select","Select",""],["","","TOPIRAMATE","TAB 25MG","","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":""}]}]}