{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   YENTIHWKAZCBOS D","gend":1,"add":"XOB OP1501 ","city":"LOUISA","state":"VA","zip":"23093-9998","dob":"1992-04-15","age":"","mstatus":"","insh":"4034710*62","cliId":"","pno":"54\/0459620-7","cno":"","email":"","ename":"","eno":"","pphy":"DAVIES, CATHERINE W DO","ppno":"540\/213-2630","pcpadd":"53 S MEDICAL PARK DRIVE","pcpcity":"FISHERSVILLE","pcpstate":"VA","pcpzip":22939,"pcpcounty":"","pcpid":"","pcpname":"AUGUSTA MEDICAL GROUP","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":["G31.84","Z30.017","N91.0","G43.009","S06.9X0S","Z30.9","Z01.419","G43.001","F79.","Z87.820","A08.4","L64.9","E04.2","L70.9","L65.9","Z30.46","L70.0","L81.0","R52.","J11.1","H66.92","J02.9","L03.90","Z71.89","Z71.3","D06.9","E60.","R87.612","S43.401A","R05.9","R50.9","Z20.822","F32.0","V58.89","M62.838","Z00.00","Z28.21","F17.201","S29.012A","E55.9","Z51.81","Z68.36","NO DATA","R10.30","Z53.21","R87.613","Z30.09","L73.0","L68.0","L70.8","L64.8","Z79.899","F32.9","Z87.828","Z13.220","Z12.4","Z72.0","F90.0","F34.1","Z86.39","J06.9","R51.","Z13.1","Z28.3","Z68.29"],"date":["2020-08-03","2021-08-18","2021-08-18","2021-08-31","2021-08-31","2021-07-13","2021-07-13","2021-08-31","2021-08-31","2021-08-31","2020-05-19","2020-10-13","2021-11-05","2020-10-13","2020-10-13","2020-11-09","2021-08-27","2021-08-27","2020-02-11","2020-02-11","2020-02-11","2020-02-11","2020-10-09","2020-10-09","2020-10-09","2021-10-06","2020-03-27","2020-10-21","2021-02-27","2021-11-23","2021-11-23","2021-11-23","2020-02-04","2020-02-04","2020-09-11","2021-11-05","2021-11-05","2021-11-05","2021-11-05","2021-11-05","2021-11-05","2021-11-05","2021-12-29","2021-01-04","2021-01-04","2021-04-06","2021-04-06","2021-05-28","2021-05-28","2019-01-03","2019-01-03","2019-02-19","2019-02-19","2019-02-19","2019-08-08","2019-04-02","2019-05-02","2019-09-10","2019-01-25","2019-04-02","2019-06-26","2019-09-10","2019-08-08","2019-08-08","2019-08-08"],"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":[["","29300011716","TOPIRAMATE","TAB 100MG","60","Select","Select",""],["","68382005005","MELOXICAM","TAB 7.5MG","20","Select","Select",""],["","33342008841","RIZATRIPTAN","TAB 10MG","9","Select","Select",""],["","00378868835","CLINDAMY\/BEN","GEL 1-5%","50","Select","Select",""],["","","AMOXICILLIN","TAB 875MG","","Select","Select",""],["","69238110002","DOXYCYCL","CAP 100MG","60","Select","Select",""],["","","PREDNISONE","TAB 20MG","","Select","Select",""],["","49035045660","EQ","GUM 2MG MINT","20","Select","Select",""],["","00536136234","NICOTINE","GUM 2MG","20","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","15","Select","Select",""],["","","CYCLOBENZAPR","TAB 5MG","","Select","Select",""],["","00135047408","NICORETTE","GUM 2MG MINT","20","Select","Select",""],["","65162019011","NAPROXEN","TAB 500MG","30","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","30","Select","Select",""],["","59746011506","PROCHLORPER","TAB 10MG","30","Select","Select",""],["","","IBUPROFEN","SUS 100\/5ML","","Select","Select",""],["","","OSELTAMIVIR","CAP 75MG","","Select","Select",""],["","16571040250","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","","PAIN","TAB 500MG","","Select","Select",""],["","","PENICILLN","TAB 500MG","","Select","Select",""],["","59746021801","SPIRONOLACT","TAB 100MG","60","Select","Select",""],["","68645057054","CITALOPRAM","TAB 20MG","45","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","","ACETAMINOPHN","TAB 500MG","","Select","Select",""],["","00067611730","ALLERGY","TAB 10MG","90","Select","Select",""],["","00406048410","APAP\/CODEINE","TAB 300-30MG","10","Select","Select",""],["","","ONDANSETRON","TAB 4MG ODT","","Select","Select",""],["","","METHYLPRED","TAB 4MG","","Select","Select",""],["","","METRONIDAZOL","TAB 500MG","","Select","Select",""],["","00168020230","CLINDAMYCIN","GEL 0.01","30","Select","Select",""],["","43598075205","BUPROPION","TAB 150MG SR","60","Select","Select",""],["","27808009101","DEXMETHYLPH","TAB 2.5MG","60","Select","Select",""],["","55513084101","AIMOVIG","INJ 70MG\/ML","1","Select","Select",""],["","69452014430","BENZONATATE","CAP 200MG","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":""}]}]}