{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ABBY   P BURGOS MARTINEZ","gend":1,"add":"800 RUNNEL CT UNIT 4","city":"CHARLOTTESVILLE","state":"VA","zip":"22901-9998","dob":"2002-12-14","age":"","mstatus":"","insh":"1994491*01","cliId":"","pno":"434\/306-4347","cno":"434\/306-4347","email":"","ename":"","eno":"","pphy":"ARMENGOL, CARLOS MD","ppno":"434\/296-9161","pcpadd":"1011 E JEFFERSON ST","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22902,"pcpcounty":"","pcpid":102092,"pcpname":"Pediatric Associates of Charlottesville Downtown","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":["Z3A.39","O99.210","O99.213","E66.9","J02.9","Z72.51","F43.9","Z34.03","Z3A.29","Z39.1","Z3A.33","V54.12","V58.89","O48.0","O14.14","O66.0","O72.1","O99.214","E66.01","O99.824","Z3A.41","Z37.0","Z00.129","Z11.3","H65.191","F41.9","Z34.02","J37.0","L30.9","R09.82","S09.90XA","S61.421A","R00.0","Z3A.40","Z39.2","N92.6","Z23.","O99.211","Z3A.11","S62.632A","S61.312A","O36.8130","Z3A.38","NO DATA","S00.83XA","R03.0","Z34.01","O99.212","Z3A.14","B37.3","Z3A.34","O23.593","Z3A.36","Z79.82","Z80.3","Z83.3","N89.8","Z30.09","Z32.01","O20.9","Z36.89","Z3A.20","Z04.89","Z36.3","O98.512","J18.9","O99.512","Z3A.23","B34.9","R82.71","O99.612","R50.9","Z3A.24","Z3A.37","O14.15","N93.9","B35.4","L83.","Z72.0","O26.892","O99.345","L91.0"],"date":["2021-05-12","2021-05-12","2021-05-12","2021-05-23","2020-03-17","2020-03-17","2020-03-17","2021-05-19","2021-02-25","2021-03-22","2021-03-25","2021-08-30","2021-04-06","2021-05-24","2021-05-24","2021-05-24","2021-05-24","2021-05-24","2021-05-24","2021-05-24","2021-05-24","2021-05-24","2020-01-17","2020-06-29","2020-01-17","2021-05-26","2020-12-24","2021-02-04","2021-02-04","2021-02-04","2021-02-23","2021-02-23","2021-02-23","2021-05-19","2021-07-14","2020-08-05","2020-08-05","2020-10-22","2020-10-22","2021-03-02","2021-03-02","2021-05-05","2021-05-05","2020-07-16","2020-07-16","2020-07-16","2020-12-24","2021-01-21","2020-11-12","2021-04-05","2021-04-05","2021-04-05","2021-04-21","2021-05-23","2021-05-23","2021-05-23","2020-09-14","2020-06-29","2020-09-14","2020-09-14","2020-12-24","2020-12-24","2020-12-24","2020-12-24","2021-01-18","2021-01-18","2021-01-19","2021-01-19","2021-01-18","2021-01-19","2021-01-21","2021-01-21","2021-01-21","2021-04-28","2021-05-26","2020-06-29","2020-06-29","2020-06-29","2020-06-29","2021-01-19","2021-05-26","2021-09-09"],"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":[["","00781261305","AMOXICILLIN ","500MG","10","Select","Select",""],["","45802005505","TRIAMCINOLON ","0.10%","15","Select","Select",""],["","16571040250","CETIRIZINE ","10MG","90","Select","Select",""],["","00093314705","CEPHALEXIN ","500MG","28","Select","Select",""],["","51862088603","ERRIN ","0.35MG","84","Select","Select",""],["","51672127502","CLOTRIMAZOLE ","1%","30","Select","Select",""],["","00536338601","NICOTINE ","2MGFRUIT","100","Select","Select",""],["","71930001752","ONDANSETRON ","4MG","20","Select","Select",""],["","68462030529","NORETHINDRON ","0.35MG","84","Select","Select",""],["","00536440601","VITAMIN ","25MG","90","Select","Select",""],["","00363022302","WAL-SOM ","25MG","90","Select","Select",""],["","00363025602","WAL-SLEEP ","25MG","90","Select","Select",""],["","50111033402","METRONIDAZOL ","500MG","14","Select","Select",""],["","41167000140","UNISOM ","25MG","90","Select","Select",""],["","70000017803","ASPIRIN ","81MG EC","90","Select","Select",""],["","00904531360","PRENATAL ","27-0.8MG","90","Select","Select",""],["","50111078751","AZITHROMYCIN ","250MG","6","Select","Select",""],["","63824000815","MUCINEX ","600MG ER","20","Select","Select",""],["","68462019005","NAPROXEN ","500MG","20","Select","Select",""],["","59267100003","PFIZER ","COVID-19","0","Select","Select",""],["","59762501701","FLUCONAZOLE ","150MG","1","Select","Select",""],["","10702001801","OXYCODONE ","5MG","10","Select","Select",""],["","70000036502","STOOL ","100MG","15","Select","Select",""],["","69618001001","ACETAMIN ","325MG","30","Select","Select",""],["","00093226301","AMOXICILLIN","500MG","10","Select","Select",""],["","45802005505","TRIAMCINOLON","0.10%","15","Select","Select",""],["","16571040250","CETIRIZINE","10MG","90","Select","Select",""],["","51672127502","CLOTRIMAZOLE","1%","30","Select","Select",""],["","00536338601","NICOTINE","2MGFRUIT","100","Select","Select",""],["","68462030529","NORETHINDRON","0.35MG","84","Select","Select",""],["","00363022302","WAL-SOM","25MG","90","Select","Select",""],["","41167000140","UNISOM","25MG","90","Select","Select",""],["","00536440601","VITAMIN","25MG","90","Select","Select",""],["","00363025602","WAL-SLEEP","25MG","90","Select","Select",""],["","71930001752","ONDANSETRON","4MG","20","Select","Select",""],["","50111033402","METRONIDAZOL","500MG","14","Select","Select",""],["","70000017803","ASPIRIN","81MG EC","90","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","28","Select","Select",""],["","63824000815","MUCINEX","600MG ER","20","Select","Select",""],["","50111078751","AZITHROMYCIN","250MG","6","Select","Select",""],["","00904531360","PRENATAL","27-0.8MG","90","Select","Select",""],["","10702001801","OXYCODONE","5MG","10","Select","Select",""],["","59762501701","FLUCONAZOLE","150MG","1","Select","Select",""],["","70000036502","STOOL","100MG","15","Select","Select",""],["","69618001001","ACETAMIN","325MG","30","Select","Select",""],["","59267100003","PFIZER","COVID-19","0","Select","Select",""],["","51862088603","ERRIN","0.35MG","84","Select","Select",""],["","68462019005","NAPROXEN","500MG","20","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","",""],["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":""}]}]}