{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   ANIADREMRAF C","gend":1,"add":"UNOM 439TS TNEM","city":"DANVILLE","state":"VA","zip":"24541-9998","dob":"1992-05-07","age":"","mstatus":"","insh":"7696910*90","cliId":"","pno":"27\/4348566-8","cno":"","email":"","ename":"","eno":"","pphy":"CONDER, BRYAN DO","ppno":"434\/799-4488","pcpadd":"109 BRIDGE STREET SUITE 201","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":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R06.00","G47.33","D86.9","J96.11","R06.09","D86.0","J96.01","Z92.25","Z51.81","D64.9","R76.0","Z99.81","R93.3","D84.9","Z30.09","J84.9","R26.2","J18.9","R06.02","R05.","K21.9","R35.8","D50.9","E66.01","Z68.39","R79.89","J98.4","R59.9","Z87.01","G47.10","E66.9","R93.89","J32.9","R05.9","R79.9","R07.89","R91.8","H25.13","H52.13","H52.223","G47.30","R59.0","F32.9","S83.91XA","W08.XXXA","N89.8","Z68.41","I10.","Z68.42","Z00.00","R03.0","H40.013","H53.143","L73.9","E11.21","NO DATA","Z79.52"],"date":["2022-06-28","2022-09-14","2022-10-11","2022-10-19","2022-01-10","2022-10-11","2022-03-08","2022-10-11","2022-03-08","2022-03-08","2022-03-08","2022-03-08","2022-03-08","2022-10-11","2022-03-08","2022-03-08","2022-06-15","2021-06-07","2022-04-12","2021-09-20","2021-07-12","2021-07-12","2021-09-08","2021-09-27","2021-07-12","2021-09-14","2022-06-28","2022-06-28","2021-09-27","2021-09-08","2021-09-29","2021-09-27","2021-11-23","2021-11-23","2021-11-23","2021-06-20","2021-06-20","2021-09-23","2021-09-23","2021-09-23","2021-12-02","2021-12-02","2021-08-10","2020-08-07","2020-08-07","2021-03-22","2022-03-09","2022-10-18","2022-10-04","2022-10-04","2022-08-05","2022-07-19","2022-07-19","2022-08-05","2022-10-18","2022-10-11","2022-10-11"],"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":[]},{"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":[["","53885024450","ONETOUCH","TES ULTRA","50","Select","Select",""],["","56151146004","TRUE","TES GLUCOSE","50","Select","Select",""],["","00193708050","CONTOUR","TES BLD GLUC","50","Select","Select",""],["","00054016629","MYCOPHENOLAT","TAB 500MG","120","Select","Select",""],["","00378064110","PREDNISONE","TAB 10MG","30","Select","Select",""],["","70954013610","DAPSONE","TAB 100MG","30","Select","Select",""],["","00093214028","TRI-LO-","TAB SPRINTEC","28","Select","Select",""],["","70010006305","METFORMIN","TAB 500MG","60","Select","Select",""],["","80777028299","MODERNA","INJ BA4\/BA5","0","Select","Select",""],["","16729018317","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","68180098003","LISINOPRIL","TAB 10MG","30","Select","Select",""],["","00085461001","DULERA","AER 200-5MCG","13","Select","Select",""],["","23155065205","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","33342002332","LEVOFLOXACIN","TAB 750MG","5","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","04351088710","AERCHMBR","MIS STAT PLS","1","Select","Select",""],["","69452014430","BENZONATATE","CAP 200MG","90","Select","Select",""],["","59762306001","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","65862085999","FAMOTIDINE","TAB 20MG","180","Select","Select",""],["","65862056099","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","43547028111","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","00904216680","FERROUS","TAB 325MG EC","60","Select","Select",""],["","00173088710","TRELEGY","AER ELLIPTA","60","Select","Select",""],["","00143314250","DOXYCYCL","CAP 100MG","14","Select","Select",""],["","69097015807","MELOXICAM","TAB 7.5MG","20","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":""}]}]}