{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANAIRBKLUF ","gend":1,"add":"LOJ S 14NL TTEL","city":"GROTTOES","state":"VA","zip":"24441-9998","dob":"1997-01-10","age":"","mstatus":"","insh":"57200210*19","cliId":"","pno":"65\/0455626-0","cno":"","email":"","ename":"","eno":"","pphy":"DEATON, JUSTIN D DO","ppno":"540\/438-1314","pcpadd":"240 LUCY DRIVE","pcpcity":"HARRISONBURG","pcpstate":"VA","pcpzip":22801,"pcpcounty":"","pcpid":"","pcpname":"Shenandoah Womens Health Center","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":["O99.281","E84.8","O99.611","K86.89","O24.911","Z3A.08","O99.282","E84.9","O24.812","E08.9","Z79.4","Z3A.25","O99.283","O24.813","Z3A.33","O24.913","E84.0","V23.9","O99.513","Z3A.37","O09.523","Z39.1","E50.9","B44.89","Z71.89","Z79.899","J45.30","B35.9","J18.9","Z3A.28","O24.113","E11.9","O47.03","Z3A.34","Z3A.35","Z3A.36","O75.89","Z37.0","E08.649","Z20.828","U07.1","Z23.","B44.9","S60.221A","W22.8XXA","L28.2","Z30.011","Z45.2","O24.811","K86.81","Z3A.11","Z34.80","O99.511","Z3A.20","J45.40","Z3A.32","E84.19","C08.9","Z39.2","E08.65","Z3A.15","O24.313","Z3A.31","O70.0","O99.284","O24.82","O99.285","Z20.822","J06.9","B97.89","Z79.51","Z79.2","Z03.74","Z30.432","R00.0","E55.9"],"date":["2020-07-02","2021-02-25","2020-07-02","2021-02-25","2020-06-12","2020-06-12","2020-10-08","2021-09-27","2020-10-08","2021-09-27","2020-12-31","2020-10-08","2020-12-28","2020-12-14","2020-11-30","2020-12-28","2021-12-14","2020-12-28","2020-12-28","2020-12-31","2020-12-28","2020-12-31","2021-02-25","2021-02-25","2021-02-25","2021-02-25","2021-08-05","2021-02-25","2020-01-13","2020-11-05","2020-12-08","2020-12-21","2020-12-08","2020-12-08","2020-12-14","2020-12-21","2020-12-31","2020-12-31","2020-12-31","2020-12-31","2021-12-14","2021-12-14","2020-12-03","2020-04-15","2020-04-15","2021-07-19","2021-11-02","2020-01-14","2020-07-02","2021-01-01","2020-07-02","2020-07-30","2020-07-30","2020-10-15","2020-10-15","2020-11-25","2020-01-17","2020-01-17","2021-03-02","2020-07-30","2020-07-30","2020-11-19","2020-11-19","2020-12-31","2020-12-31","2020-12-31","2021-01-01","2021-05-20","2021-05-20","2020-01-10","2020-01-14","2020-01-14","2020-11-30","2019-05-14","2019-08-29","2019-02-07"],"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":[["","00378727253","NORETHINDRON","TAB 0.35MG","28","Select","Select",""],["","00032122407","CREON","CAP 24000UNT","900","Select","Select",""],["","50242010040","PULMOZYME","SOL 1MG\/ML","150","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","","PRENATAL","CAP 200MG","","Select","Select",""],["","00002751001","HUMALOG","INJ 100\/ML","10","Select","Select",""],["","68176000011","DEKAS","CAP ","60","Select","Select",""],["","31722072690","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","","TRIKAFTA","TAB ","","Select","Select",""],["","00173071920","FLOVENT","AER 110MCG","12","Select","Select",""],["","11917014722","ALGAL-900DHA","CAP 300MG","90","Select","Select",""],["","08290328438","INSULIN","MIS 0.3\/31G","100","Select","Select",""],["","","LANTUS","INJ 100\/ML","","Select","Select",""],["","","ONETOUCH","KIT ULTRA 2","","Select","Select",""],["","58204000409","MVW","CAP D5000","60","Select","Select",""],["","60258015001","SF","CRE 0.011","51","Select","Select",""],["","50111078710","AZITHROMYCIN","TAB 250MG","24","Select","Select",""],["","59746017310","PREDNISONE","TAB 10MG","24","Select","Select",""],["","00487900360","SODIUM","NEB 0.03","360","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","56","Select","Select",""],["","08290320550","BD  PEN NEEDL","MIS 32GX5\/32","400","Select","Select",""],["","31604001306","VITAMIN","CAP 8000UNIT","30","Select","Select",""],["","50228043605","NAPROXEN","TAB 500MG","180","Select","Select",""],["","00363010412","PAIN","TAB 325MG","30","Select","Select",""],["","","TOBRAMYCIN","NEB 300\/5ML","","Select","Select",""],["","55111012701","CIPROFLOXACN","TAB 500MG","42","Select","Select",""],["","","KITABIS","NEB 300\/5ML","","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","51167066101","SYMDEKO","TAB 100-150","56","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","00078063035","TOBI","CAP 28MG","224","Select","Select",""],["","63323001002","GENTAMICIN","INJ 40MG\/ML","200","Select","Select",""],["","83490023560","HYPERSAL","NEB 0.035","240","Select","Select",""],["","52380127208","CHLOR","LIQ 0.04","236","Select","Select",""],["","00234057508","HIBICLENS","LIQ 0.04","236","Select","Select",""],["","08290309579","3ML","MIS 20GX1.5\"","60","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","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":""}]}]}