{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   ADNAMANONNAC J","gend":1,"add":"IW S 143STS WOLL","city":"HARRISONBURG","state":"VA","zip":"22801-9998","dob":"1980-05-03","age":"","mstatus":"","insh":"5913210*32","cliId":"","pno":"47\/0450244-6","cno":"","email":"","ename":"","eno":"","pphy":"SULLIVAN, VICTORIA F NP","ppno":"540\/564-7300","pcpadd":"1661 S MAIN STREET","pcpcity":"HARRISONBURG","pcpstate":"VA","pcpzip":22801,"pcpcounty":"","pcpid":"","pcpname":"SRMHMG - Sentara South Main Health Center","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":["F33.1","O76.","V23.82","Z37.9","M79.641","M79.642","M54.12","Z01.419","Z30.42","O99.89","F41.1","Z23.","R25.2","G56.20","M50.30","Z01.812","Z20.828","Z34.90","F41.9","F32.9","R53.83","I10.","G56.23","O77.9","O62.0","O48.0","Z3A.41","Z37.0","O16.5","R39.9","Z39.1","D18.01","D48.5","D22.39","D22.5","M77.01","M77.02","O99.52","O99.284","J30.1","L29.9","O99.72","O99.344","E55.9","Z79.82","Z88.1","Z91.048","Z91.09","Z87.891","Z82.5","D22.9","R11.0","Z29.13","R20.2"],"date":["2021-01-19","2020-11-23","2020-11-23","2020-11-23","2021-08-06","2021-08-06","2021-08-06","2021-08-11","2021-08-11","2020-09-10","2021-03-01","2020-09-10","2020-09-10","2021-08-20","2021-08-20","2020-11-20","2020-11-20","2021-08-10","2021-04-29","2021-04-29","2021-03-04","2021-04-29","2021-10-21","2020-11-23","2020-11-23","2020-11-23","2020-11-23","2020-11-23","2021-02-12","2021-02-03","2021-02-12","2021-04-06","2021-04-06","2021-04-06","2021-04-06","2021-10-21","2021-10-21","2020-11-23","2020-11-23","2020-11-23","2020-11-23","2020-11-23","2020-11-23","2020-11-23","2020-11-23","2020-11-23","2020-11-23","2020-11-23","2020-12-01","2020-11-23","2021-03-01","2021-03-01","2020-08-27","2021-08-02"],"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":[["","00228202750","ALPRAZOLAM","TAB 0.25MG","10","Select","Select",""],["","","BUPROPION","TAB 75MG","","Select","Select",""],["","","LABETALOL","TAB 100MG","","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","13668013501","ESCITALOPRAM","TAB 5MG","30","Select","Select",""],["","","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","","MEDROXYPR","INJ 150MG\/ML","","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","","PRILOSEC","TAB 20MG","","Select","Select",""],["","19515081852","FLULAVAL","INJ 2021-22","0","Select","Select",""],["","","IBUPROFEN","TAB 600MG","","Select","Select",""],["","33332032101","AFLURIA","INJ 2021-22","0","Select","Select",""],["","","DOCUSATE","CAP 100MG","","Select","Select",""],["","","BUPROPN","TAB 150MG XL","","Select","Select",""],["","","CVS","CAP 2000UNIT","","Select","Select",""],["","","OXYCOD\/APAP","TAB 5-325MG","","Select","Select",""],["","","FERROUS","TAB 325MG","","Select","Select",""],["","","FERRALET","TAB ","","Select","Select",""],["","","ONDANSETRON","TAB 4MG ODT","","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":""}]}]}