{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHYANNA MILLER","gend":1,"add":"520 MOUNTAIN VIEW CIR APT 4","city":"PENN LAIRD","state":"VA","zip":"22846-9998","dob":"1997-05-19","age":"","mstatus":"","insh":"1852552*01","cliId":"","pno":"540\/820-4837","cno":"540\/820-4837","email":"","ename":"","eno":"","pphy":"MOSS, JONATHAN D MD","ppno":"540\/828-2634","pcpadd":"200 HIGH ST","pcpcity":"BRIDGEWATER","pcpstate":"VA","pcpzip":22812,"pcpcounty":"","pcpid":147705,"pcpname":"Carilion Family Medicine - Bridgewater","plan":"OHP","program":"MEDICAID","lob":"OHCC","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":["O90.0","F32.9","O32.4XX0","G89.18","R07.9","Z39.1","O76.","Z3A.39","Z37.0","F41.9","F90.0","Z79.899","F33.1","Z30.09","Z11.59","R11.2","R19.7","Z20.822","F33.41","Z34.90","Z34.82","Z34.83","Z30.42","O99.344","Q93.89","F79.","F81.9","O99.52","J45.909","Z81.8","Z34.03","M54.89","S83.92XA","R52.","M25.562"],"date":["2020-01-31","2021-03-31","2020-02-05","2020-02-05","2021-03-24","2020-01-27","2020-02-04","2020-02-04","2020-02-04","2020-09-09","2021-06-16","2021-06-16","2021-04-15","2020-06-30","2020-06-30","2021-03-24","2021-03-24","2021-03-24","2021-06-16","2020-03-05","2020-01-27","2020-01-27","2021-11-01","2020-02-04","2020-02-04","2020-02-04","2020-02-04","2020-02-04","2020-02-04","2020-02-04","2020-02-04","2020-02-18","2021-07-27","2021-07-27","2021-07-27"],"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":[["","00603497821","OXYCOD\/APAP ","2.5-325","20","Select","Select",""],["","51672130406","TERCONAZOLE ","0.40%","45","Select","Select",""],["","00472016630","NYSTATIN ","100000","30","Select","Select",""],["","65162046550","IBUPROFEN ","600MG","30","Select","Select",""],["","00228306011","AMPHET\/DEXTR ","20MG ER","30","Select","Select",""],["","54092038701","ADDERALL ","20MG","30","Select","Select",""],["","00548570100","MEDROXYPR ","150MG\/ML","1","Select","Select",""],["","43547028111","ESCITALOPRAM ","10MG","30","Select","Select",""],["","60505024701","MIRTAZAPINE ","15MG","30","Select","Select",""],["","00555904958","CRYSELLE-28 ","28 TABS","28","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","50458058601","CONCERTA ","36MG","30","Select","Select",""],["","00527331237","METHYLPHENID ","36MG ER","30","Select","Select",""],["","51672130406","TERCONAZOLE","0.40%","45","Select","Select",""],["","00603497821","OXYCOD\/APAP","2.5-325","20","Select","Select",""],["","65162046550","IBUPROFEN","600MG","30","Select","Select",""],["","00228306011","AMPHET\/DEXTR","20MG ER","30","Select","Select",""],["","00472016630","NYSTATIN","100000","30","Select","Select",""],["","54092038701","ADDERALL","20MG","30","Select","Select",""],["","00548570100","MEDROXYPR","150MG\/ML","1","Select","Select",""],["","00555904958","CRYSELLE-28","28 TABS","28","Select","Select",""],["","43547028111","ESCITALOPRAM","10MG","30","Select","Select",""],["","50458058601","CONCERTA","36MG","30","Select","Select",""],["","00527331237","METHYLPHENID","36MG ER","30","Select","Select",""],["","60505024701","MIRTAZAPINE","15MG","30","Select","Select",""],["","59267100001","PFIZER","COVID-19","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","",""],["No","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":""}]}]}