{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ELC YMMIJRJ STNEM","gend":0,"add":"RAWDRAH 881RIC SLLIH E","city":"SCOTTSVILLE","state":"VA","zip":"24590-9998","dob":"1980-09-12","age":"","mstatus":"","insh":"4362210*86","cliId":"","pno":"59\/4348425-3","cno":"","email":"","ename":"","eno":"","pphy":"MIX, WILLIAM A MD","ppno":"434\/654-1800","pcpadd":"435 MERCHANT WALK SQUARE SUITE 400","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22902,"pcpcounty":"","pcpid":"","pcpname":"SMJMG - Sentara Family Medicine at 5th Street Station","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":["S46.212A","G47.33","K21.9","F32.9","Z87.891","Z79.899","S49.92XA","I10.","J06.9","R10.32","K62.5","K92.1","R22.42","M79.2","D36.13","F51.02","J20.9","R05.","R06.2","K76.0","F34.1","F32.5","F41.1","F10.20","F17.200","R09.81","R05.9","T50.905A","J30.2","K64.1","F33.1"],"date":["2020-04-22","2021-07-22","2021-06-17","2020-04-16","2020-04-16","2020-04-16","2020-04-16","2021-10-29","2021-09-23","2020-09-28","2020-10-16","2020-09-28","2021-02-03","2021-03-10","2021-03-10","2021-07-22","2020-03-09","2020-03-09","2020-03-09","2021-07-14","2020-12-11","2020-12-11","2020-12-11","2020-12-11","2020-11-04","2021-10-29","2021-10-29","2021-06-17","2021-10-07","2020-10-16","2021-07-29"],"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":[["","","TRAZODONE","TAB 100MG","","Select","Select",""],["","65162010250","GABAPENTIN","CAP 300MG","30","Select","Select",""],["","43598050990","ESOMEPRA","CAP 20MG DR","60","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","68001033408","LISINOPRIL","TAB 10MG","30","Select","Select",""],["","65862020399","LOSARTAN","TAB 100MG","30","Select","Select",""],["","68001044000","FEXOFENADINE","TAB 180MG","30","Select","Select",""],["","42806071405","BENZONATATE","CAP 100MG","20","Select","Select",""],["","00254101196","SUCRALFATE","SUS 1GM\/10ML","400","Select","Select",""],["","00591544305","PREDNISONE","TAB 20MG","18","Select","Select",""],["","42571016242","AMOX\/K","TAB 875-125","20","Select","Select",""],["","","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","","DULOXETINE","CAP 60MG","","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","16729018317","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","60432060416","PROMETHAZINE","SYP DM","74","Select","Select",""],["","","OXYCOD\/APAP","TAB 5-325MG","","Select","Select",""],["","","HYDROCORT","SUP 25MG","","Select","Select",""],["","","SUPREP","SOL PREP KIT","","Select","Select",""],["","","MELOXICAM","TAB 15MG","","Select","Select",""],["","","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","","PROAIR","AER ","","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","","KETOROLAC","TAB 10MG","","Select","Select",""],["","","DICYCLOMINE","CAP 10MG","","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","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":""}]}]}