{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  ENNAYEHCNOSDOD R ","gend":1,"add":"EB 953TS YRR","city":"ORANGE","state":"VA","zip":"22960-9998","dob":"2004-05-26","age":"","mstatus":"","insh":"8983110*38","cliId":"","pno":"63\/0451714-0","cno":"540\/661-3433","email":"","ename":"","eno":"","pphy":"SCHINSTOCK, ELIZABETH C MD","ppno":"540\/661-3025","pcpadd":"661 UNIVERSITY LN STE A","pcpcity":"ORANGE","pcpstate":"VA","pcpzip":22960,"pcpcounty":"","pcpid":"","pcpname":"Orange Pediatrics: UVA","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":["F41.9","Z51.81","Z30.8","J02.8","H10.9","Z00.121","K21.9","Z13.31","Z30.42","L70.9","J45.20","F41.1","F40.10","N94.6","N30.01","Z23.","Z00.129","F32.9","Z11.3","E04.1","J02.9","E89.0","Z86.16","Z20.818","J38.7","E01.0","R09.89","H53.8","J30.2","J06.9","F41.8","B34.9","Z98.890","H47.333","R63.5","E07.9","B17.9","R94.5","R53.82","R76.8","H52.13","R10.84","E04.9","J10.1","D72.819"],"date":["2021-12-07","2021-12-07","2021-04-05","2020-02-03","2020-02-06","2020-04-10","2021-05-25","2020-04-10","2021-12-07","2020-04-10","2020-04-10","2020-04-10","2020-04-10","2020-10-13","2020-10-13","2020-10-13","2021-04-05","2021-05-03","2021-04-05","2021-07-27","2021-09-10","2021-10-15","2021-10-15","2020-01-30","2021-06-04","2021-05-25","2021-05-25","2020-02-06","2020-02-27","2020-02-27","2020-07-07","2020-11-17","2021-07-27","2020-02-07","2019-08-20","2019-11-25","2019-01-08","2019-02-25","2019-03-28","2019-01-08","2019-06-04","2019-09-26","2019-01-10","2019-02-25","2019-02-25"],"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":[["","","ALBUTEROL","AER HFA","","Select","Select",""],["","","FLUTICASONE"," FLUTICASONE ","16","Select","Select",""],["","","PROAIR"," PROAIR ","17","Select","Select",""],["","","ESCITALOPRAM"," ESCITALOPRAM ","60","Select","Select",""],["","","FAMOTIDINE"," FAMOTIDINE ","180","Select","Select",""],["","","CLINDAMY\/BEN","GEL 1.2-5%","","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","10","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","10","Select","Select",""],["","","POLYMYXIN","SOL TRIMETHP","","Select","Select",""],["","","ALLERGY","CHW 10MG","","Select","Select",""],["","","CLEOCIN-T","GEL 0.01","","Select","Select",""],["","","ERYTHROMYCIN","OIN OP","","Select","Select",""],["","","CLINDAMYCIN","GEL 0.01","","Select","Select",""],["","","ALL","CHW 10MG","","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":""}]}]}