{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NETSIRHCELDDAW ","gend":1,"add":"L KAO 3603DAOR LEVE","city":"HALIFAX","state":"VA","zip":"24558-9998","dob":"1987-01-11","age":"","mstatus":"","insh":"5273110*17","cliId":"","pno":"96\/0458023-1","cno":"434\/476-7796","email":"","ename":"","eno":"","pphy":"LE, UYEN MD","ppno":"434\/572-8921","pcpadd":"1020 BILL TUCK HWY STE 900","pcpcity":"SOUTH BOSTON","pcpstate":"VA","pcpzip":24592,"pcpcounty":"","pcpid":"","pcpname":"FULLER ROBERTS OBGYN & PRIMARY CARE","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":["J11.1","R68.84","G89.21","M19.171","Z79.899","F33.1","R21.","F41.8","G89.29","L73.2","R05.","Z20.828","S93.401A","M25.571","J01.00","J06.9","F11.23","R51.9","R12.","Z96.9","Z48.89","R11.0","N61.1","R45.0","F17.200","Z79.1","Z79.2","L03.311","B02.9","N61.0","F32.0","Z51.81","M25.579","W01.0XXA","M79.604","M79.89","Z51.89","N64.4","L02.435","J30.9","Z11.52","J32.0","NO DATA","Z39.1","O42.92","Z3A.39","Z98.890","O42.90","Z30.2","L65.9","J02.9","Z34.83","O80.","Z37.0","S20.119A","L02.31","F41.1","M25.771","V54.16","L02.91","Z68.30","O99.334","O99.344","F41.9","O77.0","O99.333","M25.871"],"date":["2020-02-12","2020-03-10","2020-09-23","2021-11-17","2021-09-28","2021-05-17","2021-11-18","2021-12-29","2021-07-26","2021-06-10","2021-08-03","2021-09-15","2021-11-25","2021-12-12","2021-11-01","2021-11-01","2021-01-16","2021-01-16","2021-04-30","2021-09-24","2020-01-06","2021-09-26","2021-09-26","2021-09-26","2021-09-28","2021-09-28","2021-09-28","2020-09-15","2021-01-02","2021-07-02","2021-07-02","2021-08-12","2021-09-10","2021-11-25","2020-02-04","2020-02-04","2021-09-28","2021-09-28","2020-06-22","2021-03-31","2021-09-01","2020-03-08","2021-10-21","2019-02-05","2019-03-22","2019-03-22","2019-08-09","2019-03-22","2019-05-07","2019-07-30","2019-01-26","2019-03-13","2019-03-23","2019-03-22","2019-09-07","2019-09-30","2019-11-19","2019-11-21","2019-11-21","2019-05-13","2019-07-15","2019-03-22","2019-03-22","2019-03-22","2019-03-22","2019-03-22","2019-11-21"],"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":[["","","FLUOXETINE"," FLUOXETINE ","30","Select","Select",""],["","","PROMETHAZINE"," PROMETHAZINE ","14","Select","Select",""],["","","LEVOCETIRIZI","TAB 5MG","","Select","Select",""],["","69097083412","SERTRALINE","TAB 50MG","30","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","48","Select","Select",""],["","","HYDROCO\/APAP"," HYDROCO\/APAP ","28","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","20","Select","Select",""],["","","IBUPROFEN"," IBUPROFEN ","60","Select","Select",""],["","","PANTOPRAZOLE"," PANTOPRAZOLE ","30","Select","Select",""],["","00093312501","DICLOXACILL","CAP 500MG","30","Select","Select",""],["","51991074890","DULOXETINE","CAP 60MG","30","Select","Select",""],["","58657050016","CODEINE\/GG","SOL 10-100\/5","236","Select","Select",""],["","24658031205","DOXYCYCL","TAB 100MG","60","Select","Select",""],["","","AMOX\/K"," AMOX\/K ","20","Select","Select",""],["","59762374401","CLINDAMYCIN","LOT 10MG\/ML","60","Select","Select",""],["","67405083506","BENZOYL","LIQ 0.06","170","Select","Select",""],["","00093083205","CLONAZEPAM","TAB 0.5MG","14","Select","Select",""],["","","TRIAMCINOLON","CRE 0.005","","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","","SMZ\/TMP"," SMZ\/TMP ","20","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","20","Select","Select",""],["","","VALACYCLOVIR","TAB 1GM","","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","15","Select","Select",""],["","","FLUCONAZOLE"," FLUCONAZOLE ","1","Select","Select",""],["","53746051501","SPIRONOLACT","TAB 100MG","90","Select","Select",""],["","42806016005","HYDROXYZ","TAB 25MG","30","Select","Select",""],["","","AZITHROMYCIN"," AZITHROMYCIN ","6","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","00603188016","LIDOCAINE","PAD 0.05","60","Select","Select",""],["","","SULINDAC","TAB 150MG","","Select","Select",""],["","","CELECOXIB","CAP 100MG","","Select","Select",""],["","","ARTHRTS","TAB 650MG","","Select","Select",""],["","","PROMETH\/COD","SOL 6.25-10","","Select","Select",""],["","","OSELTAMIVIR","CAP 75MG","","Select","Select",""],["","","AMITRIPTYLIN","TAB 50MG","","Select","Select",""],["","","AMOXICILLIN","TAB 500MG","","Select","Select",""],["","","PENICILLN","TAB 500MG","","Select","Select",""],["","","METRONIDAZOL","TAB 250MG","","Select","Select",""],["","","NAPROXEN","TAB 500MG","","Select","Select",""],["","","CHLORHEX","SOL 0.0012","","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":""}]}]}