{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   AILAMREKCUT A","gend":1,"add":"UNTSEHC 4401DAOR KEERC T","city":"HALIFAX","state":"VA","zip":"24558-9998","dob":"2002-04-10","age":"","mstatus":"","insh":"7698710*91","cliId":"","pno":"17\/4340603-3","cno":"434\/446-9128","email":"","ename":"","eno":"","pphy":"TRIEU, DUC K MD","ppno":"434\/572-8921","pcpadd":"1020 BILL TUCK HWY STE 900","pcpcity":"SOUTH BOSTON","pcpstate":"VA","pcpzip":24592,"pcpcounty":"","pcpid":"","pcpname":"FULLER ROBERTS OBGYN & PRIMARY CARE","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":["M10.9","F33.0","Z83.3","Z82.49","Z80.3","F17.210","M79.89","N92.1","R11.2","E86.0","B34.9","M25.522","Z20.828","N91.2","Z01.419","Z28.21","N30.00","Z20.2","L02.225","N76.89","R30.0","N91.1","Z32.02","F17.200","R05.","N39.0","N76.0","R42.","N89.8","N90.7","O70.1","Z3A.40","Z37.0","Z30.017","Z01.812","O99.824","Z87.891","J03.90","J05.10","R10.84"],"date":["2020-12-29","2021-09-08","2020-12-29","2020-12-29","2020-12-29","2020-12-29","2020-12-29","2021-07-27","2020-05-04","2020-05-04","2020-05-04","2020-09-18","2021-03-09","2021-01-26","2020-02-06","2020-02-06","2021-05-23","2021-05-23","2021-12-22","2020-01-24","2020-01-24","2020-02-18","2020-02-18","2020-11-13","2020-11-13","2021-06-29","2021-11-22","2020-01-08","2020-03-28","2021-08-23","2019-03-02","2019-03-02","2019-03-02","2019-04-15","2019-04-15","2019-03-02","2019-03-02","2019-07-27","2019-07-27","2019-11-28"],"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":[["","53489012002","DOXYCYCL","TAB 100MG","20","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","","IBUPROFEN","TAB 800MG","","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","","AMOXICILLIN","CAP 500MG","","Select","Select",""],["","65862001205","SERTRALINE","TAB 50MG","30","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","","MECLIZINE","TAB 12.5MG","","Select","Select",""],["","","NYSTATIN","SUS 100000","","Select","Select",""],["","","KETOROLAC","TAB 10MG","","Select","Select",""],["","","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","","ONDANSETRON","TAB 4MG ODT","","Select","Select",""],["","","APAP\/CODEINE","TAB 300-30MG","","Select","Select",""],["","","COLCHICINE","TAB 0.6MG","","Select","Select",""],["","","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","","CIPROFLOXACN","TAB 500MG","","Select","Select",""],["","","BENZONATATE","CAP 100MG","","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","00642007530","SELECT-OB+","PAK DHA","60","Select","Select",""],["","54838055080","RANITIDINE","SYP 75MG\/5ML","60","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","20","Select","Select",""],["","00591544305","PREDNISONE","TAB 20MG","5","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":""}]}]}