{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SIDNEY HALL","gend":1,"add":"679 LEESVILLE RD APT 1104","city":"LYNCHBURG","state":"VA","zip":"24502-9998","dob":"1996-10-01","age":"","mstatus":"","insh":"1196202*01","cliId":"","pno":"434\/851-1947","cno":"","email":"","ename":"","eno":"","pphy":"JUN, JEAN NP","ppno":"434\/929-4357","pcpadd":"200 Amelon Square","pcpcity":"MADISON HEIGHTS","pcpstate":"VA","pcpzip":24572,"pcpcounty":"","pcpid":"","pcpname":"JOHNSON HEALTH CENTER","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/929-1093","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z30.42","Z11.3","L91.8","N89.8","Z30.09","N92.1","N94.6","R10.30","K59.09","K64.9","Z71.9","N87.9","N76.0","J45.901","Z68.30","K21.0","J01.30","Z91.09","B37.3","M25.562","G89.29","Z32.02","J01.00","J30.9","J32.9","B37.9","T36.95XA","J02.9","Z11.52","R10.2","Z30.41","Z11.1","M54.2","M54.6","M79.602","M79.605","J32.1"],"date":["2021-05-07","2021-12-08","2020-03-17","2021-10-21","2020-04-24","2021-02-03","2021-05-07","2021-10-26","2021-09-23","2021-09-23","2021-09-23","2021-04-08","2021-12-08","2021-10-06","2021-10-26","2019-04-18","2019-04-18","2019-04-18","2020-09-02","2019-10-11","2019-10-11","2019-10-11","2021-12-08","2021-12-08","2021-12-08","2021-12-08","2021-12-08","2021-12-08","2021-12-08","2021-12-08","2021-05-07","2019-05-13","2020-09-01","2020-09-01","2020-09-01","2020-09-01","2020-09-21"],"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":[["","","FLUCONAZOLE"," FLUCONAZOLE ","2","Select","Select",""],["","","PROCTOSOL"," PROCTOSOL ","28","Select","Select",""],["","","ALBUTEROL"," ALBUTEROL ","8","Select","Select",""],["","","OMEPRAZOLE"," OMEPRAZOLE ","28","Select","Select",""],["","","PREDNISONE"," PREDNISONE ","20","Select","Select",""],["","","CETIRIZINE"," CETIRIZINE ","30","Select","Select",""],["","","JUNEL"," JUNEL ","28","Select","Select",""],["","","IPRATROPIUM\/"," IPRATROPIUM\/ ","90","Select","Select",""],["","","METRONIDAZOL"," METRONIDAZOL ","14","Select","Select",""],["","","AMOX\/K"," AMOX\/K ","20","Select","Select",""],["","","PROAIR"," PROAIR ","8","Select","Select",""],["","","DICLOFENAC"," DICLOFENAC ","60","Select","Select",""],["","","NAPROXEN"," NAPROXEN ","30","Select","Select",""],["","","BACLOFEN","TAB 10MG","","Select","Select",""],["","","NIKKI","TAB 3-0.02MG","","Select","Select",""],["","","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","","AMOXICILLIN","CAP 500MG","","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":""}]}]}