{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" YELHSAGNIMELF","gend":1,"add":"NALREBMIT 043402 TPA NL D","city":"CHARLOTTESVILLE","state":"VA","zip":"22903-9998","dob":"1987-07-16","age":"","mstatus":"","insh":"37200210*34","cliId":"","pno":"08\/4345599-6","cno":"","email":"","ename":"","eno":"","pphy":"HADA, MARIA S NP","ppno":"434\/227-5624","pcpadd":"800 PRESTON AVENUE","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22903,"pcpcounty":"","pcpid":"","pcpname":"CENTRAL VIRGINIA HEALTH SERVICES 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":["Z30.42","Z78.9","F41.8","M54.2","NO DATA","M25.551","H92.09","U07.1","J06.9","H65.02","N76.0","B80.","L29.3","R11.14","Z32.00","R51.","R09.81","E66.01","F79.","E66.9","Z62.810","H92.03","R39.9","N89.8","Z01.419","Z11.3","R12.","Z23.","H66.92","N91.2","Z72.51","H66.002","K52.9","R63.4","R19.7","K59.00","R10.84","M62.838","K21.9","H10.33","J34.89","B37.3","N39.0","L29.8","N90.89","Z20.2","S09.90XA","S19.9XXA","R10.9","Z71.89","Z71.3","R11.2","R10.2","R11.0","R19.8","V89.2XXA","Z30.432","Z30.09","S16.1XXA","S29.9XXA"],"date":["2020-02-18","2020-02-18","2021-11-11","2020-08-19","2020-08-19","2020-04-22","2021-05-20","2021-08-24","2021-08-24","2020-10-09","2021-04-09","2020-05-24","2020-05-24","2020-10-02","2020-10-02","2020-01-30","2020-10-09","2020-10-09","2020-10-09","2020-10-09","2020-10-09","2020-10-09","2021-04-30","2021-11-11","2021-10-06","2021-10-06","2021-10-06","2021-10-06","2020-11-12","2021-03-25","2021-03-25","2019-03-18","2019-06-13","2019-08-29","2019-08-29","2019-08-29","2019-08-29","2019-09-04","2019-09-18","2019-10-04","2019-10-04","2019-04-17","2019-04-04","2019-12-05","2019-04-17","2019-08-11","2019-10-04","2019-10-04","2019-11-11","2019-07-08","2019-07-08","2019-08-15","2019-11-11","2019-08-22","2019-08-22","2019-10-06","2019-01-07","2019-01-07","2019-10-06","2019-10-04"],"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":[["","68682045570","METRONIDAZOL","GEL 0.75%VAG","70","Select","Select",""],["","13668013601","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","4","Select","Select",""],["","59651000305","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","","NORTRIPTYLIN","CAP 25MG","","Select","Select",""],["","","ALBENDAZOLE","TAB 200MG","","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","10","Select","Select",""],["","","CETIRIZINE","TAB 10MG","","Select","Select",""],["","","NASAL","TAB 30MG","","Select","Select",""],["","","MELOXICAM","TAB 7.5MG","","Select","Select",""],["","","MED","PAD 0.00025","","Select","Select",""],["","","AMOXICILLIN","CAP 500MG","","Select","Select",""],["","","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","00591565810","CYCLOBENZAPR","TAB 10MG","20","Select","Select",""],["","59779006200","CLOTRIMAZOLE","CRE 0.02","21","Select","Select",""],["","","IBUPROFEN","TAB 600MG","","Select","Select",""],["","00781185220","AMOX\/K","TAB 875-125","20","Select","Select",""],["","75826011510","PHENAZOPYRID","TAB 200MG","6","Select","Select",""],["","00093031101","LOPERAMIDE","CAP 2MG","30","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","30","Select","Select",""],["","61958070101","TRUVADA","TAB 200-300","30","Select","Select",""],["","60505025203","TIZANIDINE","TAB 4MG","20","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","28","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","00006022761","ISENTRESS","TAB 400MG","60","Select","Select",""],["","00378041510","DIPHEN\/ATROP","TAB 2.5MG","50","Select","Select",""],["","24208091055","ERYTHROMYCIN","OIN OP","4","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":""}]}]}