{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRIANNA   N MAYS","gend":1,"add":"105 RYAN CIR APT P","city":"SHIPMAN","state":"VA","zip":"22971-9998","dob":"2002-07-02","age":"","mstatus":"","insh":"8026254*01","cliId":"","pno":"434\/263-5083","cno":"434\/263-5083","email":"","ename":"","eno":"","pphy":"BROWN, BENJAMIN T MD","ppno":"434\/263-4000","pcpadd":"4038 THOMAS NELSON HIGHWAY","pcpcity":"ARRINGTON","pcpstate":"VA","pcpzip":22922,"pcpcounty":"","pcpid":671660,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/263-4160","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z34.03","Z3A.37","M54.5","G89.29","NO DATA","M53.3","Z34.02","Z3A.26","Z04.3","Z3A.27","Z39.2","O26.851","O26.891","R10.32","O20.0","Z3A.01","H72.92","M99.03","M99.02","M99.05","M99.04","M99.06","Z34.93","O99.891","O26.893","N89.8","Z3A.38","Z39.1","F33.1","Z3A.35","O99.213","E66.9","O76.","O99.52","J45.909","Z3A.39","Z37.0","O26.892","Z3A.22","M54.32","Z20.822","Z79.51","Z87.891","S06.9X9A","S22.41XA","S22.019A","S73.014A","R40.2413","S01.112A","S81.011A","S42.031A","Z23.","T14.90XA","F41.8","M25.551","M76.01","M25.511"],"date":["2021-07-08","2021-06-28","2021-07-02","2021-02-26","2021-11-04","2021-03-30","2021-04-08","2021-04-08","2021-04-17","2021-04-17","2021-07-11","2020-11-16","2020-12-23","2021-03-12","2020-11-16","2020-11-16","2020-12-21","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2021-06-01","2021-07-02","2021-07-02","2021-07-02","2021-07-02","2021-07-11","2020-01-03","2021-06-14","2021-06-22","2021-06-22","2021-07-09","2021-07-09","2021-09-18","2021-07-09","2021-07-09","2021-04-17","2021-03-12","2021-03-06","2021-07-08","2021-07-08","2021-07-08","2021-09-18","2021-09-18","2021-09-18","2021-09-18","2021-09-18","2021-09-18","2021-09-18","2021-09-18","2021-09-18","2021-09-18","2021-10-11","2021-11-04","2021-11-04","2021-11-04"],"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":[["","00406012305","HYDROCO\/APAP ","5-325MG","8","Select","Select",""],["","00143993905","AMOXICILLIN ","500MG","21","Select","Select",""],["","00116200116","CHLORHEX ","0.12%","473","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","30","Select","Select",""],["","52817033010","CYCLOBENZAPR ","5MG","30","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00591544305","PREDNISONE ","20MG","18","Select","Select",""],["","00904531346","PRENATAL ","27-0.8MG","90","Select","Select",""],["","00173071820","FLOVENT ","44MCG","32","Select","Select",""],["","00713075737","METRONIDAZOL ","0.75%","45","Select","Select",""],["","10135012310","ACETAMIN ","325MG","30","Select","Select",""],["","00472073063","MICONAZOLE ","2%","45","Select","Select",""],["","50228043605","NAPROXEN ","500MG","60","Select","Select",""],["","00406055201","OXYCODONE ","5MG","15","Select","Select",""],["","00363023820","STOOL ","100MG","30","Select","Select",""],["","00143993905","AMOXICILLIN","500MG","21","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","8","Select","Select",""],["","64380080707","IBUPROFEN","800MG","30","Select","Select",""],["","00054001829","PREDNISONE","20MG","18","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","00173071820","FLOVENT","44MCG","32","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00713075737","METRONIDAZOL","0.75%","45","Select","Select",""],["","00904531346","PRENATAL","27-0.8MG","90","Select","Select",""],["","49022008444","MICONAZOLE","2%","45","Select","Select",""],["","00406055201","OXYCODONE","5MG","15","Select","Select",""],["","50228043605","NAPROXEN","500MG","60","Select","Select",""],["","52817033010","CYCLOBENZAPR","5MG","30","Select","Select",""],["","00363023820","STOOL","100MG","30","Select","Select",""],["","49483008010","SENNA-TIME","8.6MG","30","Select","Select",""],["","10135012310","ACETAMIN","325MG","30","Select","Select",""],["","00904680940","ASPIRIN","325MG","45","Select","Select",""],["","57896090110","ASPIRIN ","TAB 325MG","45","Select","Select",""],["","49483008010","SENNA-TIME ","TAB 8.6MG","30","Select","Select",""],["","65862093574","AUROVELA ","TAB 1.5\/30","84","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":""}]}]}