{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WALTER  A RUNION","gend":0,"add":"366 SHENANDOAH AVE","city":"BROADWAY","state":"VA","zip":"22815-9998","dob":"1989-12-16","age":"","mstatus":"","insh":"1270642*01","cliId":"","pno":"540\/246-3126","cno":"540\/246-3126","email":"","ename":"","eno":"","pphy":"HILL, JORDAN L DO","ppno":"540\/564-5622","pcpadd":"13892 TIMBER WAY","pcpcity":"BROADWAY","pcpstate":"VA","pcpzip":22815,"pcpcounty":"","pcpid":188285,"pcpname":"SRMHMG - Sentara Timber Way Health Center","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/578-8547","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F15.21","S72.362A","R26.9","S72.362D","S36.030D","G89.18","E03.9","Z96.89","M62.81","R26.2","F33.0","R52.","S36.030A","S01.81XA","G89.29","F41.9","F17.210","Z79.890","S12.690A","S12.691D","S72.92XA","R40.4","R45.6","F10.929","R11.11","Z20.822","E89.0","F17.200","S79.912A","S39.93XA","S10.91XA","S20.319A","V59.40XA","Y92.413","R11.2","F10.120","R30.0","R36.9","Z20.828"],"date":["2021-06-14","2021-06-16","2021-07-04","2021-07-04","2021-07-04","2021-07-04","2021-07-04","2021-07-04","2021-07-02","2021-07-02","2021-06-29","2021-06-29","2021-06-16","2021-06-16","2021-06-16","2021-06-16","2021-06-16","2021-06-16","2021-06-16","2021-06-30","2021-07-29","2021-03-06","2021-03-06","2021-03-06","2021-03-06","2021-08-18","2020-05-14","2020-05-14","2021-06-15","2021-06-15","2021-06-15","2021-06-15","2021-06-15","2021-06-15","2021-03-06","2021-03-06","2020-07-31","2020-07-31","2021-06-07"],"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":[["","00781518292","LEVOTHYROXIN ","75MCG","7","Select","Select",""],["","72305008830","EUTHYROX ","88MCG","30","Select","Select",""],["","70010077001","METHOCARBAM ","750MG","15","Select","Select",""],["","47335038186","DULOXETINE ","20MG","90","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","70710136703","EMTR\/TENOFOV ","200-300","90","Select","Select",""],["","00406324301","HYDROMORPHON ","2MG","9","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}