{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   XINEOHPLLEMMART A","gend":0,"add":"ROKCIH 322241 TPA DR Y","city":"CHATHAM","state":"VA","zip":"24531-9998","dob":"2004-01-24","age":"","mstatus":"","insh":"6552910*08","cliId":"","pno":"02\/4344719-3","cno":"","email":"","ename":"","eno":"","pphy":"STANFIELD, AMY L NP","ppno":"434\/791-3009","pcpadd":"SUITE 1100 201 SOUTH MAIN STREET","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"pcpcounty":"","pcpid":"","pcpname":"DANVILLE PHYSICIAN PRACTICES LLC","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":["E10.9","E10.65","E10.649","E10.8","Z79.4","E11.65","R82.4","R11.2","E87.2","L70.0","E10.628","Z79.899","S99.921A","Z20.822","Z20.828","J06.9","R05.9","S05.01XA","H57.11","F41.1","R50.9","J02.9","J00.","L81.4","L90.5","T16.2XXA","H92.03","F90.2","Z77.22","J40.","E11.9","B34.9","Z96.41","Z71.3"],"date":["2021-12-21","2021-12-21","2021-12-21","2021-12-21","2021-12-21","2021-05-28","2021-05-28","2021-05-28","2021-05-28","2021-11-10","2021-11-10","2021-11-10","2021-09-28","2021-10-23","2021-09-01","2021-10-27","2021-10-27","2020-02-08","2020-02-08","2020-02-08","2020-02-10","2020-02-10","2020-02-10","2021-01-14","2021-01-14","2019-11-12","2019-11-12","2019-02-12","2021-12-01","2019-12-05","2019-12-05","2019-09-30","2021-12-01","2021-12-01"],"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":[["","00168020260","CLINDAMYCIN","GEL 0.01","60","Select","Select",""],["","66733077301","INSULIN","INJ 100\/ML","10","Select","Select",""],["","","MINOCYCLINE","CAP 100MG","","Select","Select",""],["","08214040734","UNIFINE","MIS 32GX5\/32","200","Select","Select",""],["","00002751001","HUMALOG","INJ 100\/ML","10","Select","Select",""],["","","RETIN-A","CRE 0.0005","","Select","Select",""],["","89152168005","AUTOSOFT","MIS 23\"\/6MM","15","Select","Select",""],["","98302014059","COMFORT","MIS 32GX4MM","200","Select","Select",""],["","89152637301","T:SLIM","MIS BASAL6.4","1","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","15","Select","Select",""],["","00002803101","GLUCAGON","KIT 1MG","2","Select","Select",""],["","65162027250","SMZ\/TMP","TAB 800-160","60","Select","Select",""],["","69238117603","ISOTRETINOIN","CAP 40MG","60","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","8","Select","Select",""],["","","AZELASTINE","SPR 0.001","","Select","Select",""],["","13668008190","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","45802018242","TRETINOIN","CRE 0.00025","45","Select","Select",""],["","","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","51672129803","KETOCONAZOLE","CRE 0.02","60","Select","Select",""],["","68462026830","ATOMOXETINE","CAP 40MG","30","Select","Select",""],["","16729029901","TRAZODONE","TAB 50MG","15","Select","Select",""],["","51660052601","ALLERGY","TAB 10MG","30","Select","Select",""],["","54092038101","ADDERALL","CAP 5MG","30","Select","Select",""],["","52817018000","CLONIDINE","TAB 0.1MG","30","Select","Select",""],["","45802065087","LORATADINE","TAB 10MG","30","Select","Select",""],["","00536641208","MELATONIN","TAB 3MG","60","Select","Select",""],["","00228306211","AMPHET\/DEXTR","CAP 5MG ER","30","Select","Select",""],["","00193288050","KETOSTIX","TES STRIP","50","Select","Select",""],["","68382024701","BENZONATATE","CAP 100MG","30","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","59310057922","PROAIR","AER ","8","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}