{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOAN   E CRAIG-WOOD","gend":1,"add":"107 BUCKINGHAM CIR","city":"CHARLOTTESVILLE","state":"VA","zip":"22903-9998","dob":"1963-06-05","age":"","mstatus":"","insh":"2021771*01","cliId":"","pno":"434\/293-3813","cno":"434\/293-3813","email":"","ename":"","eno":"","pphy":"ABRAHAMSON, ANNIKA M MD","ppno":"434\/973-4040","pcpadd":"SUITE 200 535 WESTFIELD RD","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22901,"pcpcounty":"","pcpid":210188,"pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/974-1780","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.0","K21.9","E55.9","E66.9","F41.9","M17.11","Z57.5","Z59.8","Z72.0","Z12.31","F41.1","F32.9","J45.909","R91.8","Z87.891","Z12.11","J01.90","M25.561","M25.562","J34.2","L98.9","Z23.","Z00.00","Z12.2","Z28.21","N95.2","K76.9","Z68.32","Z12.39","B35.1","M62.838","Z01.411","R79.89","N76.0","F17.290","B07.0","Z13.820","F17.200","R91.1"],"date":["2020-06-24","2020-06-24","2020-06-24","2020-10-16","2020-06-24","2020-06-24","2020-06-24","2020-06-24","2020-06-24","2020-10-16","2021-10-26","2021-10-26","2020-03-30","2020-11-19","2020-11-19","2020-10-24","2020-08-07","2021-10-19","2020-12-03","2020-12-03","2020-12-03","2020-09-15","2021-10-18","2021-11-22","2020-10-16","2021-10-26","2020-12-03","2020-10-16","2020-10-16","2021-02-11","2020-12-03","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2021-11-22","2021-11-22"],"priorHcc":["","","","","","","","","","",null,null,"","","","","",null,"","","","",null,null,"",null,"","","","","",null,null,null,null,null,null,null,null]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","59762500901","CLINDAMYCIN","2% VAG","40","Select","Select",""],["","24979010206","BUPROPN","300MG XL","30","Select","Select",""],["","00228300411","CLONAZEPAM","1MG","60","Select","Select",""],["","68682045570","METRONIDAZOL","0.75%VAG","70","Select","Select",""],["","42806016005","HYDROXYZ","25MG","30","Select","Select",""],["","43547040010","CYCLOBENZAPR","10MG","30","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00781808926","AZITHROMYCIN","250MG","-6","Select","Select",""],["","00093322397","ESTRADIOL","10MCG","-18","Select","Select",""],["","68462018022","MUPIROCIN","2%","22","Select","Select",""],["","00093314701","CEPHALEXIN","500MG","21","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","68001024604","ONDANSETRON","4MG ODT","10","Select","Select",""],["","45802014167","CICLOPIROX","8%","7","Select","Select",""],["","59762500901","CLINDAMYCIN ","2% VAG","40","Select","Select",""],["","68682045570","METRONIDAZOL ","0.75%VAG","70","Select","Select",""],["","24979010206","BUPROPN ","300MG XL","30","Select","Select",""],["","00228300411","CLONAZEPAM ","1MG","60","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","00781808926","AZITHROMYCIN ","250MG","-6","Select","Select",""],["","68462018022","MUPIROCIN ","2%","22","Select","Select",""],["","42806016005","HYDROXYZ ","25MG","30","Select","Select",""],["","00093322397","ESTRADIOL ","10MCG","-18","Select","Select",""],["","43547040010","CYCLOBENZAPR ","10MG","30","Select","Select",""],["","68001024604","ONDANSETRON ","4MG ODT","10","Select","Select",""],["","00093314701","CEPHALEXIN ","500MG","21","Select","Select",""],["","45802014167","CICLOPIROX ","8%","7","Select","Select",""],["","00574222520","TRETINOIN ","CRE 0.00025","20","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}