{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CRYSTAL HUBBARD","gend":1,"add":"1137 MORNING GLORY TURN","city":"RUCKERSVILLE","state":"VA","zip":"22968-9998","dob":"1981-10-22","age":"","mstatus":"","insh":"2238398*01","cliId":"","pno":"434\/996-1763","cno":"434\/996-1763","email":"","ename":"","eno":"","pphy":"RICE, HANNAH R MD","ppno":"434\/654-1800","pcpadd":"435 MERCHANT WALK SQUARE SUITE 400","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22902,"pcpcounty":"","pcpid":192714,"pcpname":"SMJMG - Sentara Family Medicine at 5th Street Station","plan":"OHP","program":"ACA","lob":"Individual","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"844\/883-6065","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R39.9","N76.0","B96.89","L29.2","D22.61","L82.0","L57.8","L85.3","Z12.83","N63.12","N92.0","D72.829","R79.89","I73.00","Z88.0","Z88.2","Z79.899","Z79.3","I10.","Z01.411","R00.2","D48.5","L73.8","D18.01","D23.5","F43.21","L02.818","Z80.8","Z30.9","R76.0","R59.0","D47.3","D50.0","D72.820"],"date":["2021-05-11","2021-07-07","2021-05-11","2021-07-07","2020-01-02","2020-02-13","2021-02-25","2020-08-27","2021-02-25","2020-12-31","2021-04-02","2020-07-16","2020-07-16","2021-06-18","2020-07-16","2020-07-16","2020-07-16","2020-07-16","2020-09-02","2021-07-07","2020-08-04","2020-12-30","2021-02-25","2021-02-25","2021-02-25","2020-03-02","2020-12-11","2020-12-11","2021-07-07","2021-06-18","2021-08-06","2021-07-22","2021-07-22","2021-07-22"],"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":[["","69452015120","VITAMIN","50000UNT","4","Select","Select",""],["","0","","","180","Select","Select",""],["","68180051303","LISINOPRIL","5MG","-30","Select","Select",""],["","24208039830","IPRATROPIUM","0.03%","30","Select","Select",""],["","00555902542","JUNEL","","84","Select","Select",""],["","65862053750","LEVOFLOXACIN","500MG","7","Select","Select",""],["","61314064305","TOBRAMYCIN","0.3% OP","5","Select","Select",""],["","68180083773","TRI-LO-","MARZIA","28","Select","Select",""],["","50458025106","ORTHO","CYCLN LO","84","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","Select","Select",""],["","24208031510","POLYMYXIN","TRIMETHP","-10","Select","Select",""],["","51672130406","TERCONAZOLE","0.40%","-45","Select","Select",""],["","68180088673","NIKKI","3-0.02MG","28","Select","Select",""],["","43386009661","CLOBETASOL","0.05%","30","Select","Select",""],["","68462013281","NORETH\/ETHIN","20-Jan","84","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","10","Select","Select",""],["","68682045570","METRONIDAZOL","0.75%VAG","70","Select","Select",""],["","68180051303","LISINOPRIL ","5MG","30","Select","Select",""],["","24208039830","IPRATROPIUM ","0.03%","30","Select","Select",""],["","00555902542","JUNEL ","","84","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","4","Select","Select",""],["","61314064305","TOBRAMYCIN ","0.3% OP","5","Select","Select",""],["","68180016013","AZITHROMYCIN ","250MG","6","Select","Select",""],["","24208031510","POLYMYXIN ","TRIMETHP","-10","Select","Select",""],["","65862053750","LEVOFLOXACIN ","500MG","-7","Select","Select",""],["","68180083773","TRI-LO- ","MARZIA","-28","Select","Select",""],["","50458025106","ORTHO ","CYCLN LO","84","Select","Select",""],["","68462013281","NORETH\/ETHIN ","20-Jan","84","Select","Select",""],["","68180088673","NIKKI ","3-0.02MG","84","Select","Select",""],["","51672130406","TERCONAZOLE ","0.40%","45","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","10","Select","Select",""],["","68682045570","METRONIDAZOL ","0.75%VAG","70","Select","Select",""],["","43386009661","CLOBETASOL ","0.05%","30","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":""}]}]}