{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ZOE   OLIVIA KINNEY","gend":1,"add":"4185 GARTH ROAD","city":"CHARLOTTESVILLE","state":"VA","zip":"22901-9998","dob":"1991-03-08","age":"","mstatus":"","insh":"2087285*01","cliId":"","pno":"804\/928-9651","cno":"804\/928-9651","email":"","ename":"","eno":"","pphy":"MUNSON, AMIE R MD","ppno":"434\/823-4567","pcpadd":"1646 PARK RIDGE DR","pcpcity":"CROZET","pcpstate":"VA","pcpzip":22932,"pcpcounty":"","pcpid":145518,"pcpname":"SMJMG - Sentara Crozet Family Medicine","plan":"OHP","program":"ACA","lob":"Individual","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"434\/823-2998","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/823-4272","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.89","F42.8","G25.81","N89.8","Z12.4","M79.641","W55.01XA","R56.9","Z87.2","R09.82","F31.9","F25.0","Z51.81","R32.","H53.8","Z20.828","Z11.59","F42.9","R53.83","Z00.01","Z23.","F42.2","K21.0","E79.2","Z13.21","Z30.8","M70.62","S61.431A","L23.7","N39.46","L70.8","L72.0","L72.11","S61.432A","M25.561","L03.90","T14.8XXA","Z79.899","G25.1","G47.19","F40.10","M54.2","K58.1","F31.75","Z11.3","N30.01","L70.0","G47.13","F41.9","G47.00"],"date":["2021-02-03","2021-02-03","2021-07-08","2021-01-18","2020-11-25","2021-01-07","2021-01-07","2021-03-22","2021-02-22","2020-02-13","2021-06-28","2021-03-22","2020-06-12","2021-01-18","2021-02-22","2020-08-20","2020-08-20","2021-10-27","2021-01-13","2021-06-28","2021-11-08","2021-06-28","2020-06-08","2020-06-08","2020-06-08","2020-06-08","2020-06-08","2020-09-16","2020-09-16","2021-02-22","2021-11-09","2020-12-08","2021-06-17","2021-02-21","2020-09-02","2020-06-15","2020-06-15","2021-06-28","2021-06-28","2021-06-28","2021-06-28","2021-06-28","2021-07-08","2021-10-27","2021-11-08","2021-11-08","2021-11-09","2021-11-15","2021-11-15","2021-11-15"],"priorHcc":["","","","","","","","","","","","","","","","","","","","",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":[["","69097094312","GABAPENTIN","300MG","60","Select","Select",""],["","68462022401","LITHIUM","450MG ER","60","Select","Select",""],["","68382001014","LAMOTRIGINE","200MG","45","Select","Select",""],["","13668013710","ESCITALOPRAM","20MG","30","Select","Select",""],["","63402031230","LATUDA","120MG","30","Select","Select",""],["","16729022501","SPIRONOLACT","25MG","90","Select","Select",""],["","68462030529","NORETHINDRON","0.35MG","28","Select","Select",""],["","55111025960","ZIPRASIDONE","80MG","60","Select","Select",""],["","00781278531","OMEPRAZOLE","10MG","30","Select","Select",""],["","00781185220","AMOX\/K","875-125","20","Select","Select",""],["","45802004064","SELENIUM","2.50%","120","Select","Select",""],["","51672138708","DAPSONE","5%","90","Select","Select",""],["","00168008031","HYDROCORT","2.50%","30","Select","Select",""],["","49281072010","FLUBLOK","2020-21","0","Select","Select",""],["","52817018010","CLONIDINE","0.1MG","-20","Select","Select",""],["","27241016701","DOXEPIN","10MG","30","Select","Select",""],["","59746017509","PREDNISONE","20MG","10","Select","Select",""],["","68382001014","LAMOTRIGINE ","200MG","45","Select","Select",""],["","63402031230","LATUDA ","120MG","30","Select","Select",""],["","69097094312","GABAPENTIN ","300MG","60","Select","Select",""],["","13668013710","ESCITALOPRAM ","20MG","30","Select","Select",""],["","68462022401","LITHIUM ","450MG ER","60","Select","Select",""],["","68462030529","NORETHINDRON ","0.35MG","28","Select","Select",""],["","16729022501","SPIRONOLACT ","25MG","30","Select","Select",""],["","55111025660","ZIPRASIDONE ","20MG","84","Select","Select",""],["","00781285931","OMEPRAZOLE ","10MG DR","30","Select","Select",""],["","27241016701","DOXEPIN ","10MG","30","Select","Select",""],["","00781185220","AMOX\/K ","875-125","20","Select","Select",""],["","00168008031","HYDROCORT ","2.50%","30","Select","Select",""],["","49281072010","FLUBLOK ","2020-21","0","Select","Select",""],["","45802004064","SELENIUM ","2.50%","120","Select","Select",""],["","51672138708","DAPSONE ","5%","90","Select","Select",""],["","59746017509","PREDNISONE ","20MG","10","Select","Select",""],["","52817018010","CLONIDINE ","0.1MG","-20","Select","Select",""],["","68462030329","HEATHER","0.35MG","28","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","10","Select","Select",""],["","68462030329","HEATHER ","TAB 0.35MG","28","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","10","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","",""],["No","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":""}]}]}