{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PAUL   A QUICK","gend":0,"add":"200 MAIN ST","city":"LOVINGSTON","state":"VA","zip":"22949-9998","dob":"1978-07-13","age":"","mstatus":"","insh":"900040917*01","cliId":"","pno":"434\/263-8734","cno":"434\/882-4508","email":"","ename":"","eno":"","pphy":"SHANNON, KRISTINE G NP","ppno":"434\/361-2555","pcpadd":"2871 ROCKFISH VALLEY HWY","pcpcity":"NELLYSFORD","pcpstate":"VA","pcpzip":22958,"pcpcounty":"","pcpid":"","pcpname":"UNIVERSITY OF VIRGINIA PHYSICIANS GROUP","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/361-2363","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G40.409","R25.1","G93.49","Z00.00","Z13.220","Q93.51","E55.9","R39.81","E73.9","G47.00","L30.9","K59.00","Z13.6","Z23."],"date":["2021-11-16","2021-11-16","2021-11-08","2021-11-08","2021-11-16","2021-11-08","2021-11-16","2021-11-08","2021-11-08","2021-11-08","2021-11-08","2021-11-08","2021-11-16","2021-10-20"],"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":[]}]},{"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":[["","54838000650","AQUEOUS VITAMIN D INFANTS                                             ","10MCG\/ML","300","Select","Select",""],["","00121067516","VALPROIC ACID                                                         ","250\/5ML","900","Select","Select",""],["","07610022640","MELATONIN                                                             ","3MG","31","Select","Select",""],["","00904645780","DOK                                                                   ","100MG","28","Select","Select",""],["","66424039910","STOOL SOFTENER                                                        ","100MG","31","Select","Select",""],["","59762371809","TRIAZOLAM                                                             ","0.25MG","2","Select","Select",""],["","69618001959","VITAMIN D INFANT                                                      ","400UNIT","300","Select","Select",""],["","00904699880","DOCUSATE SODIUM                                                       ","100MG","31","Select","Select",""],["","68382013805","TOPIRAMATE                                                            ","25MG","23","Select","Select",""],["","51672200202","CLOTRIMAZOLE                                                          ","1%","60","Select","Select",""],["","57896062912","GERI-LANTA                                                            ","","355","Select","Select",""],["","00904001259","ALLERGY                                                               ","4MG","30","Select","Select",""],["","69618002201","CHLORPHENIRAMINE MALEATE                                              ","MAL 4MG","30","Select","Select",""],["","49348014370","SM CLEARLAX                                                           ","","238","Select","Select",""],["","64980030550","DENTA 5000 PLUS                                                       ","PLUS","102","Select","Select",""],["","49348001737","SM TUSSIN DM                                                          ","100-10\/5","236","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":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"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":""}]}]}