{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  YDNARRRAT D ","gend":0,"add":" N 3002TS NIAM","city":"DANVILLE","state":"VA","zip":"24540-9998","dob":"1963-05-05","age":"","mstatus":"","insh":"82600210*03","cliId":"","pno":"48\/0457455-9","cno":"","email":"","ename":"","eno":"","pphy":"CHAUHAN, AJIT MD","ppno":"434\/792-4400","pcpadd":"1045 MAIN ST #1","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"pcpcounty":"","pcpid":"","pcpname":"CARDIOLOGY CLINIC INC","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":["F33.1","Z12.11","K63.5","D12.3","J44.9","R05.","R19.7","F33.3","I70.213","F41.1","R06.00","K29.70","F10.10","J30.2","R07.9","Z72.0","R52.","I87.2","Z11.59","Z23."],"date":["2020-12-20","2020-03-27","2020-03-27","2020-03-27","2021-09-08","2021-09-08","2020-02-12","2020-12-27","2021-12-07","2020-07-10","2021-12-07","2021-12-07","2021-12-07","2021-12-07","2021-12-07","2021-12-07","2021-08-25","2021-08-25","2020-09-19","2021-03-12"],"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":[["","49483048110","ASPIRIN","TAB 81MG EC","30","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","48","Select","Select",""],["","76204060060","IPRATROPIUM\/","SOL ALBUTER","360","Select","Select",""],["","37000045502","PRILOSEC","TAB 20MG","28","Select","Select",""],["","59762040101","SUCRALFATE","TAB 1GM","30","Select","Select",""],["","41167412000","ALLEGRA","TAB 180MG","30","Select","Select",""],["","00135019602","NICODERM","DIS 7MG\/24HR","28","Select","Select",""],["","11917014143","VITAMIN","LIQ ","30","Select","Select",""],["","12547049380","VISINE","SOL 0.05% EY","150","Select","Select",""],["","31722072690","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","62175011843","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","69230030030","ALLERGY","TAB 180MG","30","Select","Select",""],["","74312001707","ASCORBIC","TAB 1000MG","30","Select","Select",""],["","","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","","SERTRALINE","TAB 50MG","","Select","Select",""],["","","HYDROCO\/APAP","TAB 7.5-325","","Select","Select",""],["","","AMOXICILLIN","TAB 500MG","","Select","Select",""],["","","GAVILYTE-G","SOL ","","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":""}]}]}