{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANTHONY MONDRAGON","gend":0,"add":"610 LOWER BREMO LN","city":"BREMO BLUFF","state":"VA","zip":"23022-9998","dob":"2004-10-25","age":"","mstatus":"","insh":"1006655*01","cliId":"","pno":"434\/842-5151","cno":"","email":"","ename":"","eno":"","pphy":"SHIVARAM, VIDYULLATHA MD","ppno":"434\/581-3271","pcpadd":"25892 N JAMES MADISON HIGHWAY","pcpcity":"NEW CANTON","pcpstate":"VA","pcpzip":23123,"pcpcounty":"","pcpid":"","pcpname":"CENTRAL VIRGINIA HEALTH SERVICES INC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/581-1105","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N31.9","Q05.9","G93.5","Z23.","Q36.9","Q35.9","R33.9","H91.90","R62.51","R21.","L30.9","L01.00","H72.93","Q04.9","G95.0","Q37.8","Z00.8","Z86.69","G43.009","G43.709","R51.","G47.09","N36.44","H65.493","Q10.0","H52.03","H52.203","H52.4","B35.4","L29.9","R62.52","Z00.121","Q07.03","Q89.7","M41.116","Q07.00","Q37.9","M26.51","M27.8","Q30.2","Z87.730","M26.31","M26.211","Z68.51","R51.9","L03.019","Z71.89","Z71.3","Z71.82","Z02.89","G91.9","H69.83","H90.0","Q06.8","Q75.9","Q04.8"],"date":["2022-10-10","2022-10-20","2022-10-20","2022-01-19","2022-04-20","2022-04-20","2022-04-20","2022-10-20","2022-10-20","2022-04-20","2022-03-24","2022-04-07","2022-06-06","2020-11-12","2021-11-04","2022-10-20","2021-07-21","2021-11-02","2020-03-13","2020-03-13","2020-03-13","2020-03-13","2020-10-06","2021-06-07","2022-03-02","2022-03-02","2022-03-02","2022-03-02","2022-04-20","2022-04-20","2022-10-20","2022-01-19","2022-01-19","2022-01-19","2022-01-19","2021-11-04","2021-11-15","2021-11-15","2021-11-15","2021-11-15","2021-11-15","2021-11-15","2021-11-15","2022-04-07","2021-03-15","2021-08-26","2021-08-26","2021-08-26","2021-08-26","2022-03-02","2021-11-04","2020-05-29","2020-05-29","2021-11-04","2021-11-04","2021-11-04"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","68462018135","CLOTRIMAZOLE","CRE 0.01","30","Select","Select",""],["","33342033315","TRIAMCINOLON","OIN 0.001","60","Select","Select",""],["","87701040750","GNP","TAB 1000UNIT","180","Select","Select",""],["","35046000105","VITAMIN","TAB 1000UNIT","60","Select","Select",""],["","64980043101","OXYBUTYNIN","TAB 5MG","90","Select","Select",""],["","68001043804","LORATADINE","TAB 10MG","30","Select","Select",""],["","68462029817","CLOTRIM\/BETA","CRE DIPROP","30","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","20","Select","Select",""],["","45802046564","KETOCONAZOLE","SHA 0.02","120","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","00228277811","PROPRANOLOL","CAP 60MG ER","30","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}