{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  RADFASDEYS A ","gend":0,"add":"IHSKOORB 0213931 TPA RD ER","city":"HARRISONBURG","state":"VA","zip":"22801-9998","dob":"1941-09-27","age":"","mstatus":"","insh":"85300210*57","cliId":"","pno":"34\/0456507-5","cno":"","email":"","ename":"","eno":"","pphy":"FOWLER, SCOTT M MD","ppno":"540\/564-5622","pcpadd":"1790 EAST MARKET STREET SUITE 64B","pcpcity":"HARRISONBURG","pcpstate":"VA","pcpzip":22801,"pcpcounty":"","pcpid":"","pcpname":"SRMHMG - Sentara East Market Street Health Center","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":["R10.30","F41.9","K21.9","R09.89","R14.0","R10.13","Z20.822","R10.84","K64.8","K31.9","G25.0","R10.9","I21.4","I42.2","R53.1","G25.2","E78.5","M54.2","V58.69","Z91.138","I13.10","N18.9","Z85.46","Z90.79","Z86.39","I77.1","I25.10","R74.8","F13.230","F51.05","F99.","I35.1","I49.3","R07.9","R06.02","R25.1","I10.","F13.239","C61.","I49.9","R13.10","R12.","G47.01"],"date":["2021-02-24","2021-02-24","2021-03-30","2021-02-24","2021-03-30","2021-01-25","2021-03-26","2021-03-30","2021-03-30","2021-03-30","2021-02-26","2021-03-30","2019-05-29","2019-07-08","2019-05-28","2019-05-28","2019-05-28","2019-05-28","2019-05-28","2019-05-28","2019-05-28","2019-05-28","2019-05-28","2019-05-28","2019-05-28","2019-05-28","2019-05-30","2019-05-30","2019-08-05","2019-08-05","2019-08-05","2019-05-28","2019-05-30","2019-05-30","2019-05-30","2019-10-01","2019-10-01","2019-05-28","2019-08-20","2019-05-28","2019-05-30","2019-09-23","2019-10-01"],"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":[["","00603548321","PROPRANOLOL","TAB 20MG","120","Select","Select",""],["","68645049254","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","68645057054","CITALOPRAM","TAB 20MG","30","Select","Select",""],["","00781279010","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","00378459401","METOPROLOL","TAB 75MG","60","Select","Select",""],["","00469260130","MYRBETRIQ","TAB 25MG","30","Select","Select",""],["","58160082311","SHINGRIX","INJ 50MCG","1","Select","Select",""],["","00005197102","PREVNAR","INJ ","0","Select","Select",""],["","16729013716","CLONAZEPAM","TAB 1MG","30","Select","Select",""],["","68645049554","ATORVASTATIN","TAB 80MG","30","Select","Select",""],["","49281040565","FLUZONE","INJ PF 19-20","0","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":""}]}]}