{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DESTANEE   J DOUGLAS","gend":1,"add":"679 LEESVILLE ROAD APT 705","city":"LYNCHBURG","state":"VA","zip":"24502-9998","dob":"1996-10-30","age":"","mstatus":"","insh":"1243727*01","cliId":"","pno":"434\/832-0001","cno":"434\/426-2023","email":"","ename":"","eno":"","pphy":"PAGE, TERESA NP","ppno":"434\/200-3366","pcpadd":"800 5TH STREET","pcpcity":"LYNCHBURG","pcpstate":"VA","pcpzip":24504,"pcpcounty":"","pcpid":"","pcpname":"COMMUNITY ACCESS NETWORK","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/847-2521","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z30.46","Z01.419","A64.","S62.202A","G89.18","S62.512A","S90.821A","S90.822A","Y04.8XXA","Y92.89","S62.235A","M79.645","V54.12","S53.22XA","R05.9","J02.9","R53.83","N92.1","F41.8","Z13.39","F32.9","J45.909","F29.","Z01.812","S70.01XA","S16.1XXA","F41.9","V43.52XA","Y92.413","F33.9","F43.10","Z13.220","V62.84","Z78.9","Z13.31","Z91.14"],"date":["2020-08-24","2021-01-22","2021-01-22","2021-08-05","2021-08-05","2021-07-14","2021-07-14","2021-07-14","2021-07-14","2021-07-14","2021-07-23","2021-07-23","2021-08-05","2021-08-05","2021-12-02","2021-12-02","2021-12-02","2020-01-08","2021-01-12","2021-02-04","2021-02-04","2021-02-04","2021-02-03","2021-07-23","2020-08-18","2020-08-18","2020-08-18","2020-08-18","2020-08-18","2021-02-22","2021-02-22","2021-02-22","2019-10-03","2019-04-05","2019-04-05","2019-10-03"],"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":[["","00406051201","OXYCOD\/APAP","TAB 5-325MG","30","Select","Select",""],["","00904699860","DOCUSATE","CAP 100MG","100","Select","Select",""],["","68462015813","ONDANSETRON","TAB 8MG ODT","10","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","20","Select","Select",""],["","00121092716","PROMETHAZINE","SOL 6.25\/5ML","240","Select","Select",""],["","13107003134","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","68180035302","SERTRALINE","TAB 100MG","30","Select","Select",""],["","","SYEDA","TAB 3-0.03MG","","Select","Select",""],["","00093506001","HYDROXYZ","TAB 10MG","90","Select","Select",""],["","00781148601","AMITRIPTYLIN","TAB 10MG","60","Select","Select",""],["","64380073706","VITAMIN","CAP 50000UNT","4","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":""}]}]}