{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   YRNEHYELLOF M","gend":0,"add":"B N 201TS REKA","city":"CHARLOTTESVILLE","state":"VA","zip":"22903-9998","dob":"1970-06-28","age":"","mstatus":"","insh":"6132210*53","cliId":"","pno":"03\/4349258-5","cno":"434\/305-8529","email":"","ename":"","eno":"","pphy":"CALLENDER, DAVID M MD","ppno":"434\/924-1931","pcpadd":"1222 JEFFERSON PARK AVE FL 3","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22903,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J45.21","G44.53","C47.9","M54.2","H57.9","I10.","D17.1","Z01.812","Z20.822","J98.4","F11.90","H54.7","F14.10","J45.41","J84.9","J45.909","J06.9","H40.1212","H40.002","H10.13","NO DATA","H04.123","H52.7","Z92.89","R07.0","H52.13","L98.9","J45.901","R22.32","R51.9","R73.9","R74.01","D50.9","F14.20","H47.391","H35.033","H04.129","H25.13","J30.2","N52.9","R82.5","R06.02","H40.1231","H10.45","G56.92","R68.3","G89.29","D36.10"],"date":["2021-09-18","2021-03-08","2021-06-10","2022-02-10","2021-10-05","2022-02-10","2021-07-07","2021-07-02","2021-09-15","2022-02-10","2022-02-10","2022-02-10","2022-02-10","2022-04-21","2022-04-21","2022-04-21","2022-04-21","2022-10-03","2022-10-03","2022-10-03","2022-10-03","2022-10-03","2022-10-03","2020-04-06","2020-01-27","2020-04-06","2020-05-18","2020-02-18","2022-08-11","2021-06-10","2021-06-10","2021-11-11","2021-11-11","2021-09-22","2021-10-05","2021-10-05","2021-11-18","2021-10-05","2021-09-18","2021-11-11","2021-11-16","2021-09-15","2021-11-18","2022-08-04","2022-08-11","2022-08-11","2020-01-23","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":[]},{"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":[["","11917003688","ARTIFICIAL","SOL TEARS","15","Select","Select",""],["","16571040110","CETIRIZINE","TAB 5MG","60","Select","Select",""],["","29300022010","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","43547035610","LISINOPRIL","TAB 40MG","90","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","90","Select","Select",""],["","00054001925","PREDNISONE","TAB 50MG","5","Select","Select",""],["","66993058597","FLUTIC\/SALME","AER 250\/50","60","Select","Select",""],["","00536130723","OLOPATADINE","SOL 0.002","2","Select","Select",""],["","00173069600","ADVAIR","AER 250\/50","60","Select","Select",""],["","24208046325","LATANOPROST","SOL 0.00005","2","Select","Select",""],["","00093534256","SILDENAFIL","TAB 50MG","6","Select","Select",""],["","43547040011","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00065815001","PATADAY","SOL 0.002","2","Select","Select",""],["","00536128294","LUBRICATING","SOL TEARS","15","Select","Select",""],["","00023079815","REFRESH","DRO 0.5% OP","15","Select","Select",""],["","00065042915","SYSTANE","SOL ","15","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","21","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","00378967193","IPRATROPIUM\/","SOL ALBUTER","270","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","90","Select","Select",""],["","42799080601","IVERMECTIN","TAB 3MG","5","Select","Select",""],["","60432053716","NYSTATIN","SUS 100000","200","Select","Select",""],["","00172409680","BACLOFEN","TAB 10MG","90","Select","Select",""],["","00143122710","DICYCLOMINE","TAB 20MG","60","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","00085113204","PROVENTIL","AER HFA","7","Select","Select",""],["","00173088210","BREO","INH 200-25","60","Select","Select",""],["","50111078710","AZITHROMYCIN","TAB 250MG","6","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":""}]}]}