{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LAURA   M MCKIRAHAN","gend":1,"add":"2021 EARLY ST","city":"LYNCHBURG","state":"VA","zip":"24503-9998","dob":"1988-01-19","age":"","mstatus":"","insh":"1580143*01","cliId":"","pno":"434\/534-7350","cno":"434\/534-7350","email":"","ename":"","eno":"","pphy":"BURKHOLDER, BRENDEN DO","ppno":"434\/656-1717","pcpadd":"291 MCBRIDE LANE","pcpcity":"GRETNA","pcpstate":"VA","pcpzip":24557,"pcpcounty":"","pcpid":135922,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","F31.32","F31.81","G89.29","R76.8","Z23.","L60.0","F90.0"],"date":["2021-10-18","2020-11-02","2021-09-20","2020-10-21","2020-10-21","2020-10-21","2020-03-06","2020-12-07"],"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":[["","12496120803","SUBOXONE ","8-2MG","28","Select","Select",""],["","00093816201","QUETIAPINE ","100MG","30","Select","Select",""],["","43598029890","PREGABALIN ","300MG","26","Select","Select",""],["","51672413304","LAMOTRIGINE ","200MG","30","Select","Select",""],["","00536110888","NICOTINE ","21MG\/24H","28","Select","Select",""],["","00115166101","PROPRANOLOL ","40MG","60","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","20","Select","Select",""],["","52268001201","SUPREP ","PREP KIT","354","Select","Select",""],["","43598058230","BUPREN\/NALOX ","8-2MG","28","Select","Select",""],["","60505283203","ATOMOXETINE ","25MG","60","Select","Select",""],["","59267100002","PFIZER ","COVID-19","0","Select","Select",""],["","00093816201","QUETIAPINE","100MG","30","Select","Select",""],["","12496120803","SUBOXONE","8-2MG","28","Select","Select",""],["","43598029890","PREGABALIN","300MG","60","Select","Select",""],["","59746024860","LAMOTRIGINE","200MG","30","Select","Select",""],["","00536110888","NICOTINE","21MG\/24H","28","Select","Select",""],["","52268001201","SUPREP","PREP KIT","354","Select","Select",""],["","00115166101","PROPRANOLOL","40MG","60","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","43598058230","BUPREN\/NALOX","8-2MG","28","Select","Select",""],["","60505283203","ATOMOXETINE","25MG","60","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","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","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","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":""}]}]}