{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" L   ANADNERUBNAV","gend":1,"add":"AORB W 115U TPA TS D","city":"WAYNESBORO","state":"VA","zip":"22980-9998","dob":"1970-03-30","age":"","mstatus":"","insh":"8022110*09","cliId":"","pno":"46\/0455919-9","cno":"","email":"","ename":"","eno":"","pphy":"DURLAND, MICHELE NP","ppno":"540\/245-7950","pcpadd":"201 LEW DEWITT BLVD","pcpcity":"WAYNESBORO","pcpstate":"VA","pcpzip":22980,"pcpcounty":"","pcpid":"","pcpname":"AUGUSTA MEDICAL GROUP","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":["R87.612","N76.0","R42.","I10.","R18.8","Z11.59","E78.00","I77.1","F41.8","E78.5","F17.200","R60.9","I73.9","I70.8","R10.13","R73.03","Z83.49","R11.2","R10.2","M79.652","M25.552","M79.605","K57.92","R14.0","R10.9","K59.00","K57.32","R19.5","Z72.0","Z79.899","Z88.5","Z88.8","Z91.14","K57.30","K63.5","R05.","J02.9","Z20.822","M79.651","Z01.810","R09.89","R73.9","F41.9","R74.8","F10.10","K64.0","R51.","A41.9","L02.419","J96.01","M60.08","R65.21","E87.2","B00.1","I74.5","Z12.31","E55.9","R00.0","A77.0","F17.210","K76.0","S76.311A","S39.012A","X58.XXXA","R74.0","K68.12","M60.009","R10.30","V58.89","X58.XXXD","R06.00","R10.32","M79.604","NO DATA","R94.5","R87.619","Z91.19","M60.051","J44.9","B00.9","I70.90","Z79.2","I51.7","I31.3","R11.0","R53.1","J81.0","N39.0","J81.1","B00.2","R06.1","E87.70","M79.662","R39.9"],"date":["2020-02-18","2020-02-18","2020-07-20","2021-09-02","2020-07-20","2020-08-30","2021-08-06","2021-08-06","2021-08-06","2021-08-06","2021-08-06","2021-08-06","2021-08-06","2021-08-06","2021-08-12","2021-09-02","2021-09-02","2020-07-20","2021-12-23","2021-12-23","2021-12-23","2021-12-23","2020-07-28","2020-07-01","2020-07-17","2020-07-01","2020-07-17","2020-07-17","2020-07-17","2020-07-17","2020-07-17","2020-07-17","2020-07-17","2020-09-03","2020-09-03","2021-08-25","2021-08-25","2021-08-25","2021-03-09","2020-02-17","2020-02-17","2020-07-28","2020-01-30","2020-07-20","2020-07-20","2020-09-03","2020-02-03","2019-03-04","2019-02-25","2019-02-25","2019-02-21","2019-02-25","2019-02-21","2019-02-21","2019-03-06","2019-04-04","2019-04-04","2019-05-10","2019-05-10","2019-05-10","2019-09-17","2019-02-08","2019-02-08","2019-02-08","2019-02-18","2019-02-18","2019-02-25","2019-10-28","2019-02-16","2019-02-16","2019-02-18","2019-09-16","2019-09-17","2019-09-17","2019-09-17","2019-11-05","2019-11-05","2019-03-04","2019-03-04","2019-03-04","2019-03-04","2019-03-04","2019-02-20","2019-02-20","2019-02-17","2019-02-17","2019-02-18","2019-02-18","2019-02-18","2019-02-18","2019-02-18","2019-02-18","2019-09-16","2019-10-28"],"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":[["","","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","65862019430","FLUOXETINE","CAP 40MG","30","Select","Select",""],["","55111046601","METOPROL","TAB 25MG ER","30","Select","Select",""],["","57896048914","POLYETH","POW 3350 NF","238","Select","Select",""],["","31722071290","PANTOPRAZOLE","TAB 20MG","30","Select","Select",""],["","","LOSARTAN","TAB 25MG","","Select","Select",""],["","29300012510","MELOXICAM","TAB 15MG","30","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","20","Select","Select",""],["","","DICYCLOMINE","TAB 20MG","","Select","Select",""],["","00781185220","AMOX\/K","TAB 875-125","14","Select","Select",""],["","","GAVILYTE-G","SOL ","","Select","Select",""],["","","METOPROLOL","TAB 25MG ER","","Select","Select",""],["","69315011610","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","6","Select","Select",""],["","55111012701","CIPROFLOXACN","TAB 500MG","13","Select","Select",""],["","68462010340","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","69097084615","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","68682037090","DILTIAZEM","CAP 300MG\/24","30","Select","Select",""],["","60505076900","CEFAZOLIN","INJ 10GM","18","Select","Select",""],["","53191036201","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","62037059990","CARTIA","CAP 240\/24HR","30","Select","Select",""],["","00093894305","ACYCLOVIR","TAB 400MG","2","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":""}]}]}