{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ANITSIRHCUCSUK D  ","gend":1,"add":"CREMMOC N 21420A TPA EVA E","city":"WAYNESBORO","state":"VA","zip":"22980-9998","dob":"1980-06-13","age":"","mstatus":"","insh":"8652110*68","cliId":"","pno":"48\/0456460-9","cno":"540\/221-9569","email":"","ename":"","eno":"","pphy":"TOMLIN, VICTORIA NP","ppno":"540\/245-7880","pcpadd":"2570 STUARTS DRAFT HWY STE 101","pcpcity":"STUARTS DRAFT","pcpstate":"VA","pcpzip":24477,"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":["F90.2","Z79.899","Z34.90","H60.92","H61.22","F15.10","O16.5","R60.0","F42.9","H60.501","R42.","S29.019A","X50.0XXA","I10.","R53.83","G47.00","F17.200","M54.5","H72.01","D17.1","E66.01","R22.2","H66.011","Z20.822","Z30.430","K08.89","K21.9","H66.91","R22.43","H53.2","R51.","B36.9","R07.89","Z32.02","F15.20","F90.9","N92.0","Z72.0","S39.92XA","F42.8","F90.1","F41.9","F51.09","O13.9","Z34.83","V23.82","Z23.","Z3A.37","O34.211","Z3A.38","Z37.0","O99.824","O24.420","O10.02","O99.62","K66.0","O34.219","G89.18","R10.9","M25.522","L73.9","O10.919","Z32.01","O13.3","O24.419","G56.03","O10.912","O99.212","O99.342","F32.9","O99.332","F17.210","Z3A.24","O09.522","O35.8XX0","Z98.891","Z34.80","D17.30"],"date":["2021-11-18","2021-11-18","2020-01-31","2020-12-08","2020-12-08","2021-11-30","2020-01-02","2020-01-02","2021-11-18","2020-08-03","2020-09-16","2020-08-03","2020-08-03","2021-03-28","2020-02-21","2020-08-31","2020-08-31","2020-09-16","2020-08-31","2020-08-31","2021-05-13","2020-09-10","2021-03-28","2021-03-28","2020-07-01","2020-08-13","2020-09-16","2020-08-13","2020-01-02","2020-02-21","2020-02-21","2020-02-21","2020-02-21","2020-07-01","2020-08-06","2020-08-06","2020-02-12","2020-02-21","2020-08-10","2019-03-19","2019-03-19","2019-03-19","2019-03-19","2019-12-27","2019-12-30","2019-12-27","2019-12-27","2019-12-27","2019-12-30","2019-12-30","2019-12-30","2019-12-30","2019-12-30","2019-12-30","2019-12-30","2019-12-30","2019-12-30","2019-12-30","2019-12-30","2019-04-18","2019-04-18","2019-12-18","2019-06-05","2019-12-30","2019-12-30","2019-12-16","2019-09-24","2019-09-24","2019-09-24","2019-09-24","2019-09-24","2019-11-12","2019-09-24","2019-09-24","2019-09-24","2019-09-24","2019-09-24","2019-12-16"],"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":[["","69543025216","VIRTUSSIN","SOL 100-10\/5","70","Select","Select",""],["","69452014430","BENZONATATE","CAP 200MG","30","Select","Select",""],["","","AMLODIPINE","TAB 5MG","","Select","Select",""],["","00555097402","AMPHET\/DEXTR","TAB 30MG","60","Select","Select",""],["","","CETIRIZINE","SOL 1MG\/ML","","Select","Select",""],["","69367027204","CODEINE\/GG","SOL 10-100\/5","118","Select","Select",""],["","57844013001","ADDERALL","TAB 30MG","60","Select","Select",""],["","","LISINOPRIL","TAB 20MG","","Select","Select",""],["","68001023703","CLONIDINE","TAB 0.1MG","90","Select","Select",""],["","","FLUOXETINE","CAP 20MG","","Select","Select",""],["","","ESCITALOPRAM","TAB 10MG","","Select","Select",""],["","17478007035","ERYTHROMYCIN","OIN 5MG\/GM","4","Select","Select",""],["","49035094935","MILK","SUS 400\/5ML","300","Select","Select",""],["","","ALBUTEROL","NEB 0.00083","","Select","Select",""],["","","OMEPRAZOLE","CAP 40MG","","Select","Select",""],["","16714008210","HYDROXYZ","TAB 25MG","75","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","","OXYCODONE","TAB 5MG","","Select","Select",""],["","","FAMOTIDINE","SUS 40MG\/5ML","","Select","Select",""],["","00591060505","LABETALOL","TAB 100MG","120","Select","Select",""],["","","HOMENEB","MIS SIDESTRE","","Select","Select",""],["","68001018000","QUETIAPINE","TAB 50MG","30","Select","Select",""],["","","NICOTROL","INH ","","Select","Select",""],["","","MELOXICAM","TAB 15MG","","Select","Select",""],["","","METHOCARBAM","TAB 750MG","","Select","Select",""],["","","MECLIZINE","TAB 25MG","","Select","Select",""],["","","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","","PREDNISONE","PAK 10MG","","Select","Select",""],["","","ENOXAPARIN","INJ 40\/0.4ML","","Select","Select",""],["","","NEO\/POLY\/HC","SUS 1% OTIC","","Select","Select",""],["","","GERBR","DRO COLIC","","Select","Select",""],["","","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","","CIPRO\/DEXA","SUS 0.3-0.1%","","Select","Select",""],["","","TRAMADOL","TAB 50MG","","Select","Select",""],["","","CIPRODEX","SUS 0.3-0.1%","","Select","Select",""],["","","CEFDINIR","CAP 300MG","","Select","Select",""],["","55111029109","SUMATRIPTAN","TAB 25MG","9","Select","Select",""],["","68382013805","TOPIRAMATE","TAB 25MG","60","Select","Select",""],["","87701040799","GNP","TAB 28-0.8MG","30","Select","Select",""],["","57896070310","IRON","TAB 325MG","60","Select","Select",""],["","53885027150","ONETOUCH","TES VERIO","100","Select","Select",""],["","65702072310","ACCU-CHEK","KIT AVIVA PL","1","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","14","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","44","Select","Select",""],["","68001016208","PROMETHAZINE","TAB 25MG","30","Select","Select",""],["","24208041005","OFLOXACIN","DRO 0.3%OTIC","5","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":""}]}]}