{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HANNAH   M PETRILLO","gend":1,"add":"122 JACKSON ST","city":"BROADWAY","state":"VA","zip":"22815-9998","dob":"2003-01-20","age":"","mstatus":"","insh":"20055581*01","cliId":"","pno":5402088497,"cno":5409012182,"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":"OHCC","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":["J06.9","Q03.9","R63.6","R11.2","R05.","Z93.1","R32.","J01.00","R11.11"],"date":["2020-02-24","2021-10-04","2021-08-09","2020-02-22","2021-09-02","2020-04-06","2021-10-04","2021-09-02","2021-09-02"],"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":[["","54838055840","LORATADINE ","5MG\/5ML","300","Select","Select",""],["","00143988915","AMOXICILLIN ","250\/5ML","150","Select","Select",""],["","29300022010","MONTELUKAST ","10MG","30","Select","Select",""],["","00378801593","LANSOPRAZOLE ","15MG DR","30","Select","Select",""],["","47469004408","MELATONIN ","2.5MG","237","Select","Select",""],["","76204020025","ALBUTEROL ","0.08%","75","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","16","Select","Select",""],["","00363013830","SENNA ","8.6MG","4","Select","Select",""],["","68462039710","OMEPRAZOLE ","40MG","30","Select","Select",""],["","45802086866","POLYETH ","3350 NF","2","Select","Select",""],["","00143988915","AMOXICILLIN","250\/5ML","150","Select","Select",""],["","29300022010","MONTELUKAST","10MG","30","Select","Select",""],["","76204020025","ALBUTEROL","0.08%","75","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","16","Select","Select",""],["","51672213108","LORATADINE","5MG\/5ML","360","Select","Select",""],["","00378801593","LANSOPRAZOLE","15MG DR","30","Select","Select",""],["","47469004408","MELATONIN","2.5MG","237","Select","Select",""],["","45802086866","POLYETH","3350 NF","2","Select","Select",""],["","00363013830","SENNA","8.6MG","4","Select","Select",""],["","68462039710","OMEPRAZOLE","40MG","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","",""],["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":""}]}]}