{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TERRY WOODS","gend":0,"add":"19455 WHITE TAIL LN","city":"CRIDERS","state":"VA","zip":"22820-9998","dob":"1963-08-10","pno":"540\/325-0905","cno":"540\/325-0905","email":"","pphy":"HILL, JORDAN L DO","ppno":"","pcpadd":"13892 TIMBER WAY","pcpcity":"BROADWAY","pcpstate":"VA","pcpzip":22815,"pcpcounty":"","pcpid":188285,"pcpname":"SRMHMG - Sentara Timber Way Health Center","insh":"2053817*01","cliId":"","plan":"OHP","program":"ACA","lob":"Individual","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/578-8547","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E55.9","E78.2","R00.2","Z71.1","R94.31","R07.9","Z12.11","M79.601","R07.89","E78.00","Z79.899","Z82.49","F17.210","I49.3","R61.","N43.3","N43.40","D18.01","L21.8","L82.1","D23.62"],"date":["2021-01-18","2021-01-18","2021-01-18","2020-07-16","2020-07-16","2020-07-31","2021-05-23","2020-01-16","2020-07-31","2020-07-31","2020-07-31","2020-07-31","2020-07-31","2020-10-29","2021-01-24","2020-01-07","2020-01-07","2020-01-30","2020-01-30","2020-01-30","2020-01-30"],"priorHcc":["","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","00378395005","ATORVASTATIN","10MG","30","Select","Select",""],["","27241012403","SILDENAFIL","20MG","30","Select","Select",""],["","33332032001","AFLURIA","2020-21","0","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","00116200116","CHLORHEX","0.12%","-473","Select","Select",""],["","00406052201","OXYCOD\/APAP","7.5-325","-6","Select","Select",""],["","68462017901","NAPROXEN","550MG","14","Select","Select",""],["","00143993905","AMOXICILLIN","500MG","28","Select","Select",""],["","57237004105","PENICILLN","500MG","21","Select","Select",""],["","70461032103","FLUCLVX","2021-22","0","Select","Select",""],["","00378395005","ATORVASTATIN ","TAB 10MG","-30","Select","Select",""],["","27241012403","SILDENAFIL ","TAB 20MG","30","Select","Select",""],["","58160082311","SHINGRIX ","INJ 50\/0.5ML","1","Select","Select",""],["","33332032001","AFLURIA ","INJ 2020-21","0","Select","Select",""],["","00116200116","CHLORHEX ","SOL 0.0012","473","Select","Select",""],["","00143993905","AMOXICILLIN ","CAP 500MG","28","Select","Select",""],["","00406052201","OXYCOD\/APAP ","TAB 7.5-325","6","Select","Select",""],["","68462017901","NAPROXEN ","TAB 550MG","14","Select","Select",""],["","57237004105","PENICILLN ","TAB 500MG","21","Select","Select",""],["","70461032103","FLUCLVX ","INJ 2021-22","0","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":""}]}]}