{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  ALAHAMHTIMS R ","gend":1,"add":"IATNUOM 2623DAOR MRAF N","city":"ELKTON","state":"VA","zip":"22827-9998","dob":"2004-08-26","age":"","mstatus":"","insh":"7421210*22","cliId":"","pno":"02\/0453885-9","cno":"","email":"","ename":"","eno":"","pphy":"MOTYKA, ZACHARY S NP","ppno":"540\/298-1200","pcpadd":"13737 SPOTSWOOD TRAIL","pcpcity":"ELKTON","pcpstate":"VA","pcpzip":22827,"pcpcounty":"","pcpid":"","pcpname":"SRMHMG - Sentara East Rockingham Health Center","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":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.8","R11.2","J02.9","N92.1","N94.6","Z30.017","R10.31","M25.562","F99.","F33.2","H00.015","R43.0","R05.","N64.4","F33.1","B34.9","R50.9","NO DATA","Z20.822","Z77.22","Z79.899","Z79.1","Z82.49","Z82.5","Z30.09","Z90.49","Z11.59","R30.0","R10.9","T14.91XA","Z00.8"],"date":["2020-05-28","2020-05-28","2020-05-28","2020-05-28","2020-05-28","2021-02-22","2021-10-21","2019-01-25","2019-02-15","2019-03-07","2019-07-17","2020-12-21","2021-05-13","2021-11-19","2019-07-03","2021-05-13","2021-05-13","2021-05-13","2021-05-13","2021-10-21","2021-10-21","2021-05-13","2021-05-13","2021-05-13","2020-11-20","2021-10-21","2020-11-20","2021-09-13","2021-09-13","2019-03-24","2019-03-24"],"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":[["","","FLUOXETINE"," FLUOXETINE ","7","Select","Select",""],["","","MALATHION"," MALATHION ","59","Select","Select",""],["","","AMOX\/K"," AMOX\/K ","20","Select","Select",""],["","","HYDROXYZ"," HYDROXYZ ","60","Select","Select",""],["","","NIKKI"," NIKKI ","28","Select","Select",""],["","","DROSPIR\/ETHI"," DROSPIR\/ETHI ","28","Select","Select",""],["","","LORYNA","TAB 3-0.02MG","","Select","Select",""],["","","ONDANSETRON","TAB 4MG","","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":""}]}]}