{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" L   DRAHCIRII DROFANNAH","gend":0,"add":" REDNEFFO63480916","city":"HALIFAX","state":"VA","zip":"24558-9998","dob":"1979-09-27","age":"","mstatus":"","insh":"9057110*72","cliId":"","pno":"75\/4344856-9","cno":"","email":"","ename":"","eno":"","pphy":"SHROFF, SHARUKH DARIVS MD","ppno":"434\/793-4711","pcpadd":"109 BRIDGE STREET SUITE 300","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"pcpcounty":"","pcpid":"","pcpname":"SPECTRUM MEDICAL INC","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":["N20.0","R06.00","R60.9","R94.5","R10.2","R00.0","R03.0","G47.33","I10.","R10.0","M05.79","E55.9","E53.8","M54.5","E66.3","Z79.899","Z72.0","R94.31","R00.2","F17.210","E78.2","M79.89","R07.89","K21.9","K22.2","R13.19","R11.0","Z79.1","R10.84","Z80.0","Z83.71","R12.","R14.0","R19.4","F17.200","N20.1","K58.1","Z68.42","M79.641","M79.642","M70.71","M70.72","Z28.21","R68.89","G47.00","E66.01","N13.39","R31.29","N23.","N39.0","J44.9","R91.1","M25.50","N13.2","M54.9","Z87.442","M79.671","M79.672","K64.8","K62.1","K29.70","N20.2","D12.4","K63.5","K29.50","R68.81","J45.40","G47.8","R31.9","R10.31","Z01.89","Z01.810","Z01.812"],"date":["2021-08-10","2020-07-14","2020-06-11","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-12-03","2021-12-03","2020-02-03","2020-07-24","2020-07-24","2020-07-24","2020-07-24","2020-07-24","2020-07-24","2020-07-24","2020-07-14","2020-07-14","2020-07-14","2020-07-14","2020-07-14","2020-07-14","2021-11-09","2021-11-09","2021-05-07","2021-11-09","2021-05-07","2021-05-07","2021-11-09","2021-11-09","2021-05-07","2021-05-07","2021-04-07","2021-11-09","2020-02-03","2021-11-09","2021-11-09","2020-07-24","2020-07-24","2020-07-24","2020-07-24","2020-07-24","2021-08-11","2021-09-15","2021-09-15","2019-07-15","2019-06-26","2019-06-26","2019-07-07","2019-05-24","2019-05-24","2019-02-25","2019-03-05","2019-07-15","2019-04-01","2019-05-28","2019-05-28","2019-10-16","2019-10-16","2019-10-16","2019-03-19","2019-10-16","2019-10-16","2019-10-16","2019-10-16","2019-01-30","2019-01-30","2019-02-19","2019-07-07","2019-07-05","2019-07-05","2019-07-05"],"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":[["","59310057922","PROAIR","AER ","8","Select","Select",""],["","57237001401","TAMSULOSIN","CAP 0.4MG","90","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","23155000810","HYDROCHLOROT","TAB 25MG","90","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","20","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":""}]}]}