{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  YDNEWNNUD G ","gend":1,"add":" RONAM 051B1 TPA RD","city":"KEYSVILLE","state":"VA","zip":"23947-9998","dob":"1968-03-31","age":"","mstatus":"","insh":"76200210*17","cliId":"","pno":"37\/4344749-6","cno":"434\/265-2109","email":"","ename":"","eno":"","pphy":"PRUITT, DAVID E MD","ppno":"434\/315-5340","pcpadd":"935 SOUTH MAIN STREET","pcpcity":"FARMVILLE","pcpstate":"VA","pcpzip":23901,"pcpcounty":"","pcpid":"","pcpname":"CENTRA MEDICAL GROUP LLC","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":["Z30.42","I10.","E78.5","G80.9","F32.9","F41.9","K21.9","E66.9","Z68.34","E55.9","Z12.11","Z80.0","K64.1"],"date":["2021-07-07","2021-05-27","2021-05-27","2021-05-27","2021-05-27","2021-05-27","2021-05-27","2021-05-27","2021-05-27","2021-05-27","2022-04-28","2022-04-28","2022-04-28"],"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":[["","","VITAMIN"," VITAMIN ","4","Select","Select",""],["","","DESVENLAFAX"," DESVENLAFAX ","30","Select","Select",""],["","","METOPROL"," METOPROL ","90","Select","Select",""],["","67877050651","COLESEVELAM","TAB 625MG","180","Select","Select",""],["","","AMLODIPINE"," AMLODIPINE ","30","Select","Select",""],["","00093342501","LORAZEPAM","TAB 0.5MG","60","Select","Select",""],["","","OMEPRAZOLE"," OMEPRAZOLE ","30","Select","Select",""],["","78742000985","SV","TAB 1000 TR","30","Select","Select",""],["","","MELOXICAM"," MELOXICAM ","30","Select","Select",""],["","","QUETIAPINE"," QUETIAPINE ","30","Select","Select",""],["","","ALPRAZOLAM"," ALPRAZOLAM ","30","Select","Select",""],["","00009045003","COLESTID","TAB 1GM","120","Select","Select",""],["","31604004070","D3","TAB 1000UNIT","30","Select","Select",""],["","","NYSTATIN","SUS 100000","","Select","Select",""],["","65597070118","WELCHOL","TAB 625MG","180","Select","Select",""],["","59762045001","COLESTIPOL","TAB 1GM","120","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":""}]}]}