{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CAZS NAIRBIKSWOTINH","gend":0,"add":"1 5031TS HT0","city":"WAYNESBORO","state":"VA","zip":"22980-9998","dob":"1992-10-07","age":"","mstatus":"","insh":"85300210*58","cliId":"","pno":"42\/0459426-1","cno":"","email":"","ename":"","eno":"","pphy":"SNYDER, JOHN A DO","ppno":"540\/245-7870","pcpadd":"2570 STUARTS DRAFT HWY","pcpcity":"STUARTS DRAFT","pcpstate":"VA","pcpzip":24477,"pcpcounty":"","pcpid":"","pcpname":"AUGUSTA MEDICAL GROUP","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":["E03.9","J45.40","J30.2","J20.9","R00.0","R07.89","Z20.828","E11.65","E11.9","F33.9","Z00.00","R79.89","F39.","B35.3","L30.9","R25.2","L21.0","E55.9","S06.2X0S","E66.9","J45.909","R21.","L28.2","L03.032","L60.0","B35.1","M79.675","L40.0","L81.0","L85.3","L57.8","Z79.891","R94.6","Z87.820","L40.9","E66.01"],"date":["2021-03-18","2021-03-18","2021-03-18","2021-02-15","2021-02-15","2021-02-15","2021-02-15","2021-05-26","2022-10-10","2020-01-27","2021-03-18","2020-03-05","2021-03-18","2020-03-05","2020-03-05","2021-03-18","2021-03-18","2021-03-18","2022-05-23","2021-03-18","2021-02-15","2022-05-23","2021-05-06","2021-11-05","2021-11-05","2021-11-05","2021-11-05","2021-11-09","2021-11-09","2021-11-09","2021-11-09","2019-11-05","2019-05-28","2019-05-28","2022-05-23","2022-05-23"],"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":[["","68645057290","GLIMEPIRIDE","TAB 2MG","30","Select","Select",""],["","","LORATADINE","TAB 10MG","","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","67877041301","METFORMIN","TAB 500MG ER","120","Select","Select",""],["","53885000810","ONETOUCH","MIS PLUS 33G","100","Select","Select",""],["","","EUTHYROX","TAB 50MCG","","Select","Select",""],["","45802046564","KETOCONAZOLE","SHA 0.02","120","Select","Select",""],["","55111014512","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","","TRIAMCINOLON","CRE 0.001","","Select","Select",""],["","","LEVOTHYROXIN","TAB 50MCG","","Select","Select",""],["","59746017310","PREDNISONE","TAB 10MG","15","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","","ALLERGY","TAB 10MG","","Select","Select",""],["","42806054701","VITAMIN","CAP 1.25MG","12","Select","Select",""],["","63304061650","DOXYCYC","CAP 100MG","14","Select","Select",""],["","59676058015","JANSSEN","INJ COVID-19","0","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","65162027250","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","42806031250","DOXYCYCL","TAB 100MG","14","Select","Select",""],["","00472024260","PERMETHRIN","CRE 0.05","120","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","69238153206","CLOBETASOL","CRE 0.0005","60","Select","Select",""],["","","CLOTRIMAZOLE","CRE 0.01","","Select","Select",""],["","59310057922","PROAIR","AER ","8","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}