{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LATASHA STANTON","gend":1,"add":"711 BUFFALO RD","city":"DILLWYN","state":"VA","zip":"23936-9998","dob":"1984-11-18","age":"","mstatus":"","insh":"1023562*01","cliId":"","pno":"434\/838-0600","cno":"","email":"","ename":"","eno":"","pphy":"MULLER, RICHARD A MD","ppno":"434\/654-8900","pcpadd":"29 JEFFERSON COURT","pcpcity":"ZION CROSSROADS","pcpstate":"VA","pcpzip":22942,"pcpcounty":"","pcpid":"","pcpname":"SMJMG - Sentara Spring Creek Family Medicine","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"844\/527-9358","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z30.09","G47.30","R06.83","G47.10","E66.01","Z68.45","G25.81","Z71.3","M25.562","B00.1","Z68.44","V58.89","M67.471","G47.33","S99.921A","Z79.899","E04.2","R40.0","M79.672","S97.82XA","E04.1","Z00.01","Z23.","G44.019","M25.561","R03.0","M17.0","S90.32XA"],"date":["2020-09-11","2019-05-01","2019-06-11","2019-08-08","2020-02-19","2019-07-17","2019-08-08","2019-07-17","2020-02-25","2020-02-25","2020-02-25","2021-06-02","2021-06-02","2021-03-17","2021-12-06","2019-06-09","2020-02-19","2019-07-03","2021-04-16","2021-04-16","2019-03-07","2020-01-29","2020-01-29","2020-01-29","2020-01-29","2020-01-29","2020-03-05","2021-04-22"],"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":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","","MEDROXYPR"," MEDROXYPR ","1","Select","Select",""],["","","PROMETH\/COD"," PROMETH\/COD ","120","Select","Select",""],["","","ALBUTEROL"," ALBUTEROL ","75","Select","Select",""],["","","SMZ\/TMP"," SMZ\/TMP ","14","Select","Select",""],["","","PHENTERMINE","TAB 37.5MG","","Select","Select",""],["","","VALACYCLOVIR","TAB 1GM","","Select","Select",""],["","","DICLOFENAC","TAB 75MG DR","","Select","Select",""],["","","TOPIRAMATE","TAB 50MG","","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":""}]}]}