{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" AKEIMATSGNINNEJ","gend":1,"add":" YRREB 109DAOR LLIH","city":"SOUTH BOSTON","state":"VA","zip":"24592-9998","dob":"1998-03-31","age":"","mstatus":"","insh":"9404610*06","cliId":"","pno":"44\/4341606-6","cno":"","email":"","ename":"","eno":"","pphy":"RIGBY, FIDELMA MD","ppno":"804\/825-4409","pcpadd":"403 N 11TH STREET","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23219,"pcpcounty":"","pcpid":"","pcpname":"MCV ASSOCIATED PHYSICIANS","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":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O99.89","N89.8","Z3A.29","O24.419","Z3A.35","O14.04","O41.1230","O72.1","O62.1","O76.","O24.424","O99.824","Z37.0","Z3A.39","Z82.49","Z83.3","O14.13","O62.2","F33.0","O24.414","Z3A.34","V23.9","Z3A.36","Z11.59","Z39.1","Z34.82","Z34.83","O99.820","Z3A.38","V23.89","Z3A.32","O99.013","Z3A.37","N36.1"],"date":["2020-07-03","2020-07-03","2020-07-03","2020-08-13","2020-08-13","2020-09-13","2020-09-12","2020-09-12","2020-09-12","2020-09-12","2020-09-13","2020-09-12","2020-09-13","2020-09-13","2020-09-12","2020-09-12","2020-09-13","2020-09-13","2020-10-06","2020-09-08","2020-08-06","2020-09-08","2020-08-20","2020-09-08","2020-07-29","2020-07-29","2020-07-29","2020-09-08","2020-09-01","2020-07-21","2020-07-21","2020-08-27","2020-08-27","2021-01-20"],"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":[["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","","LANTUS","INJ 100\/ML","","Select","Select",""],["","","IRON","TAB 325MG","","Select","Select",""],["","","PEG","POW ","","Select","Select",""],["","","OXYCODONE","TAB 5MG","","Select","Select",""],["","","CLOBETASOL","OIN 0.0005","","Select","Select",""],["","","RELION","TES GLUCOSE","","Select","Select",""],["","","HUMULIN","INJ U-100","","Select","Select",""],["","","INSULIN","MIS 0.5\/31G","","Select","Select",""],["","","IBUPROFEN","TAB 600MG","","Select","Select",""],["","","SERTRALINE","TAB 100MG","","Select","Select",""],["","","FLUZONE","INJ 2020-21","","Select","Select",""],["","","FEROSUL","TAB 325MG","","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":""}]}]}