{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   ARBEDTNAYRB B","gend":1,"add":"SAMOHT 6931YWH NOSLEN ","city":"ARRINGTON","state":"VA","zip":"22922-9998","dob":"1961-09-08","age":"","mstatus":"","insh":"64200210*76","cliId":"","pno":"35\/4347382-4","cno":"434\/218-8082","email":"","ename":"","eno":"","pphy":"DAVIS, TABATHA MD","ppno":"434\/263-4000","pcpadd":"4038 THOMAS NELSON HWY","pcpcity":"ARRINGTON","pcpstate":"VA","pcpzip":22922,"pcpcounty":"","pcpid":"","pcpname":"BLUE RIDGE HEALTH CENTER INC","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":["R39.81","M62.81","N32.81","F41.1","F33.1","R51.9","R41.3","H53.9","H04.123","H10.45","H47.233","G43.109","H53.40","B34.2","U07.1","J30.2","J02.0","J02.9","R30.0","Z11.59","M72.2","Q66.70","G56.22","H31.092","H40.023","H25.13","M79.602","M54.2","M25.522","W18.39XD","Z23.","H53.8"],"date":["2021-12-07","2021-12-07","2021-12-07","2021-12-29","2021-12-29","2021-10-26","2021-12-13","2021-10-26","2020-09-11","2020-07-31","2020-09-11","2020-09-11","2020-07-31","2020-08-04","2020-08-04","2020-04-10","2021-09-23","2021-09-23","2021-09-23","2021-09-23","2021-11-10","2021-11-10","2021-11-10","2020-09-11","2021-11-30","2021-11-30","2019-04-22","2019-04-22","2019-04-22","2019-04-22","2021-10-07","2021-12-13"],"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":[["","","IBUPROFEN"," IBUPROFEN ","30","Select","Select",""],["","","HYDROCHLOROT"," HYDROCHLOROT ","90","Select","Select",""],["","","PANTOPRAZOLE"," PANTOPRAZOLE ","30","Select","Select",""],["","","KETOCONAZOLE"," KETOCONAZOLE ","15","Select","Select",""],["","","ESCITALOPRAM"," ESCITALOPRAM ","30","Select","Select",""],["","","NYSTATIN"," NYSTATIN ","30","Select","Select",""],["","","NYSTOP"," NYSTOP ","15","Select","Select",""],["","","TIZANIDINE"," TIZANIDINE ","60","Select","Select",""],["","","LORATADINE"," LORATADINE ","30","Select","Select",""],["","","FLUTICASONE"," FLUTICASONE ","16","Select","Select",""],["","","AMITRIPTYLIN"," AMITRIPTYLIN ","30","Select","Select",""],["","","CETIRIZINE","TAB 10MG","","Select","Select",""],["","","HYDROXYZ","TAB 10MG","","Select","Select",""],["","","DOXYCYCL","CAP 100MG","","Select","Select",""],["","","AMOX\/K","TAB 875-125","","Select","Select",""],["","","KETOTIF","DRO 0.025%OP","","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":""}]}]}