{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  ELLEINADRETSBEW R ","gend":1,"add":"ELRAH 6811213 TPA NL Y","city":"ORANGE","state":"VA","zip":"22960-9998","dob":"1983-10-13","age":"","mstatus":"","insh":"8113210*68","cliId":"","pno":"58\/0455409-9","cno":"","email":"","ename":"","eno":"","pphy":"DEVINCENTIS, CHRISTINA M MD","ppno":"540\/825-6263","pcpadd":"16268 BENNETT RD","pcpcity":"CULPEPER","pcpstate":"VA","pcpzip":22701,"pcpcounty":"","pcpid":"","pcpname":"UNIVERSITY OF VIRGINIA PHYSICIANS 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":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N99.840","G89.18","N80.3","D50.9","D56.3","E66.9","Z79.899","Z79.891","Z98.891","Z80.3","Z87.891","N93.8","N94.6","L76.22","N80.0","N92.0","Z79.3","Z30.42","R19.04","R10.32","Z98.51","N93.9","N85.8","N99.842","G40.B19","E53.8","G25.81","G43.909","I10.","R07.89","R06.09","R69.","U07.1","J06.9","G40.B09","F32.9","D75.89","R74.8","Z51.81","Z13.29","Z59.8","N80.9","Z01.818","N80.1","R56.9","R03.0","D64.9","R53.83","R10.9","G89.29","R42.","I20.0","R07.9","R55.","R06.02","R53.81"],"date":["2020-11-02","2020-11-02","2020-11-02","2021-08-17","2021-08-17","2021-10-28","2020-11-09","2020-11-09","2021-08-17","2020-11-02","2021-12-28","2021-11-04","2021-08-17","2020-11-02","2021-10-28","2021-10-28","2021-10-28","2021-11-04","2020-11-03","2020-11-03","2020-11-03","2021-08-17","2020-10-20","2020-11-09","2021-03-03","2021-08-16","2021-08-16","2021-08-16","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-12-28","2021-12-28","2021-03-03","2020-08-24","2020-08-24","2020-08-24","2020-08-24","2020-08-24","2020-08-24","2020-10-07","2020-10-07","2020-10-06","2021-03-03","2021-06-02","2021-03-15","2021-03-15","2021-10-23","2021-10-23","2021-10-23","2021-11-17","2021-11-17","2021-11-17","2021-11-17","2021-09-24"],"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":[["","","GABAPENTIN","CAP 400MG","","Select","Select",""],["","","CELECOXIB","CAP 400MG","","Select","Select",""],["","","ACETAMIN","TAB 500MG","","Select","Select",""],["","","OXYCOD\/APAP","TAB 5-325MG","","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","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":""}]}]}