{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"B ELOCINNESNERHE","gend":1,"add":"NEVAR 891NL EGDIR ","city":"MINERAL","state":"VA","zip":"23117-9998","dob":"1993-06-17","age":"","mstatus":"","insh":"7142210*09","cliId":"","pno":"63\/4083879-6","cno":"","email":"","ename":"","eno":"","pphy":"JACKSON, JORDAN MD","ppno":"804\/741-6200","pcpadd":"9600 PATTERSON AVE","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23229,"pcpcounty":"","pcpid":"","pcpname":"PATTERSON AVENUE FAMILY PRACTICE","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":["R10.2","D25.9","F11.20","F41.9","Z76.89","F33.41","F17.210","M54.5","Z13.1","Z13.0","Z13.89","Z13.220","G89.29","R00.0","N81.84","M62.9","K76.0","Z72.0","R07.81","Z32.02","D21.9","R10.817","R07.89"],"date":["2021-05-07","2021-05-27","2021-12-13","2021-04-28","2020-11-05","2020-11-17","2020-11-05","2020-11-05","2020-11-05","2020-11-05","2020-11-05","2020-11-05","2020-11-05","2021-03-11","2021-04-30","2021-04-28","2021-04-28","2021-04-28","2021-06-04","2021-04-07","2021-03-05","2021-03-05","2021-06-04"],"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":[["","00093031401","KETOROLAC","TAB 10MG","20","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","21","Select","Select",""],["","52817032010","BACLOFEN","TAB 10MG","80","Select","Select",""],["","65162035803","ZAFEMY","DIS 150\/35","12","Select","Select",""],["","","XULANE","DIS 150-35","","Select","Select",""],["","65862037301","ESCITALOPRAM","TAB 5MG","30","Select","Select",""],["","65162062711","TRAMADOL","TAB 50MG","30","Select","Select",""],["","","IBUPROFEN","TAB 600MG","","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","20","Select","Select",""],["","68382091634","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00054023525","MORPHINE","TAB 15MG","6","Select","Select",""],["","23155050001","HYDROXYZ","TAB 10MG","90","Select","Select",""],["","59762500801","MISOPROSTOL","TAB 200MCG","2","Select","Select",""],["","00813001206","FERRETTS","TAB 325MG","90","Select","Select",""],["","","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","","AMOXICILLIN","CAP 500MG","","Select","Select",""],["","","BUSPIRONE","TAB 5MG","","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":""}]}]}