{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MADYSON PLAUTZ","gend":1,"add":"146 FAIRFIELD AVENUE                                        ","city":"DANVILLE                      ","state":"VA","zip":"24541-4816","dob":"2003-07-05","age":"","mstatus":"","insh":4822290,"cliId":"","pno":7577639172,"cno":"","email":"","ename":"","eno":"","pphy":"","ppno":"","pcpadd":",","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"CHILDRENS HEALTHCARE CENTER","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"146 FAIRFIELD AVENUE                                        ","add3":"","madd1":"133 Bean Land Rd                                            ","madd2":"                                                            ","madd3":"","mcity":"Dry Fork                      ","mstate":"VA","mzip":"24549-3744","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F32.9","H66.91","J06.9","F32.1","F12.10","M54.5","R11.2","R35.0","F43.10","F32.2","R45.851","Z00.00","Z23","Z00.129","A08.4","Z20.828","Z11.3","F31.81","F17.200","F41.1","M79.645","V49.40XA","S63.602A","S20.219A","V49.49XA","S63.682A","R10.9","M79.642","V89.2XXA","Y92.410","R07.81","N30.00","Z13.9","Z20.2","Z72.51","O21.9","O21.0","Z32.01","O09.891","O99.321","O99.341","O98.511","Z3A.09","F12.90","B01.9","Z34.91","O35.2XX0","Z3A.13"],"date":["2022-05-25","2020-01-28","2020-01-28","2021-05-20","2021-10-26","2020-08-22","2020-08-22","2022-06-30","2022-10-17","2020-10-01","2020-09-24","2020-10-30","2020-10-30","2020-10-30","2021-03-27","2021-03-27","2022-10-17","2022-10-17","2021-12-30","2022-10-17","2022-05-22","2022-05-22","2022-05-22","2022-05-25","2022-05-22","2022-05-22","2022-05-25","2022-05-22","2022-05-22","2022-05-22","2022-06-01","2022-06-30","2022-07-31","2022-07-31","2022-06-30","2022-10-17","2022-09-30","2022-10-06","2022-10-17","2022-10-17","2022-10-17","2022-10-17","2022-10-17","2022-10-17","2022-10-17","2022-10-17","2022-11-16","2022-11-16"],"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":[]},{"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":[["","00555904358","APRI","TAB ","28","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","10","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","21","Select","Select",""],["","65162052110","PROMETHAZINE","TAB 25MG","14","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","50111064801","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","15","Select","Select",""],["","65862022801","LAMOTRIGINE","TAB 100MG","60","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","20","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","14","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":""}]}]}