{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TESS HILTON","gend":1,"add":"149 SPRINGCREST LANE","city":"STAUNTON                      ","state":"VA","zip":"24401-5660","dob":"1990-10-02","age":"","mstatus":"","insh":4868303,"cliId":"","pno":5404309437,"cno":5403392171,"email":"","ename":"","eno":"","pphy":"ALEXANDER, KERRY A","ppno":5408866259,"pcpadd":"42 Lambert St,Ste 511","pcpcity":"Staunton                      ","pcpstate":"VA","pcpzip":244012437,"pcpcounty":"","pcpid":"","pcpname":"STAUNTON MEDICAL ASSOCIATES","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"149 SPRINGCREST LANE","add3":"","madd1":"149 SPRINGCREST LANE","madd2":"APARTMENT 209","madd3":"","mcity":"STAUNTON                      ","mstate":"VA","mzip":"24401-5660","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F43.23","J11.1","R10.2","R51","G43.909","R10.9","J45.909","F32.9","Z72.0","Z88.2","F90.0","F31.63","F43.12","F31.61","Z79.899","F90.2","F43.10","K04.7","N93.9","O26.851","K08.89","S02.5XXA","F41.9","Z92.21","Z92.3","Z85.41","F15.10"],"date":["2021-02-09","2020-02-23","2021-06-23","2020-06-26","2020-06-26","2020-06-26","2020-06-26","2020-06-26","2021-10-08","2021-10-08","2021-06-16","2021-06-16","2021-06-16","2021-06-16","2021-10-08","2021-06-15","2021-06-15","2021-05-14","2021-06-23","2021-06-23","2021-10-08","2021-10-08","2021-10-08","2021-10-08","2021-10-08","2021-10-08","2021-11-23"],"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":[["","55111015330","ONDANSETRON","TAB 4MG","12","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","20","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","8","Select","Select",""],["","42806034301","AMPHET\/DEXTR","TAB 15MG","60","Select","Select",""],["","54092038501","ADDERALL","CAP 15MG","30","Select","Select",""],["","57237004101","PENICILLN","TAB 500MG","40","Select","Select",""],["","13668021730","ARIPIPRAZOLE","TAB 5MG","30","Select","Select",""],["","60505392701","GUANFACINE","TAB 1MG ER","60","Select","Select",""],["","69238126601","OSELTAMIVIR","CAP 75MG","10","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":""}]}]}