{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"REHTAEHYRREB ","gend":1,"add":"BRAH DLOC 0627103 TPA DR RO","city":"MECHANICSVILLE","state":"VA","zip":"23111-9998","dob":"1988-08-19","age":"","mstatus":"","insh":"5942110*42","cliId":"","pno":"94\/4082946-6","cno":"804\/503-3174","email":"","ename":"","eno":"","pphy":"SYKES, PHYLLIS ROMAN NP","ppno":"804\/829-6600","pcpadd":"9950 COURTHOUSE ROAD","pcpcity":"CHARLES CITY","pcpstate":"VA","pcpzip":23030,"pcpcounty":"","pcpid":"","pcpname":"CENTRAL VIRGINIA HEALTH SERVICES INC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","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":["O34.211","Z3A.39","Z37.0","O34.219","O24.410","Z3A.00","Z41.2","S31.105A","Z32.01","F41.8","Z36.82","Z34.81","Z3A.12","Z13.89","O65.5","O99.213","Z68.36","Z3A.32","F41.9","F32.9","Z71.89","Z71.3","Z30.09","G89.18","R10.84","Z23.","Z86.32","Z90.49","Z87.891","Z80.9","Z83.3","Z82.49"],"date":["2020-07-21","2020-07-21","2020-07-21","2020-07-21","2020-07-21","2020-07-21","2020-07-23","2020-07-28","2021-10-12","2021-10-12","2020-01-15","2020-01-15","2020-01-15","2020-01-15","2020-07-21","2020-06-02","2020-06-02","2020-06-02","2021-06-21","2021-06-21","2021-06-21","2021-06-21","2019-04-29","2020-07-22","2020-07-22","2020-07-21","2020-07-21","2020-07-21","2020-07-21","2020-07-21","2020-07-21","2020-07-21"],"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":[["","","DULOXETINE"," DULOXETINE ","60","Select","Select",""],["","","LORYNA"," LORYNA ","28","Select","Select",""],["","","OXYCOD\/APAP"," OXYCOD\/APAP ","8","Select","Select",""],["","","CEPHALEXIN"," CEPHALEXIN ","14","Select","Select",""],["","","METRONIDAZOL"," METRONIDAZOL ","4","Select","Select",""],["","","AMOXICILLIN"," AMOXICILLIN ","30","Select","Select",""],["","","IBU"," IBU ","15","Select","Select",""],["","","TINIDAZOLE"," TINIDAZOLE ","4","Select","Select",""],["","","PRENATL"," PRENATL ","30","Select","Select",""],["","","BUPROPION"," BUPROPION ","60","Select","Select",""],["","","ONETOUCH","TES VERIO","","Select","Select",""],["","","CHLORHEX","SOL 0.0012","","Select","Select",""],["","","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","","ONE","KIT VERIO FL","","Select","Select",""],["","","IBUPROFEN","TAB 800MG","","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":""}]}]}