{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHASE   T FARTHING","gend":0,"add":"5137 US HIGHWAY 29","city":"BLAIRS","state":"VA","zip":"24527-9998","dob":"2003-11-10","age":"","mstatus":"","insh":"1243777*01","cliId":"","pno":"434\/836-5464","cno":"","email":"","ename":"","eno":"","pphy":"STANFIELD, AMY L NP","ppno":"434\/791-3009","pcpadd":"SUITE 1100 201 SOUTH MAIN STREET","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"pcpcounty":"","pcpid":"","pcpname":"DANVILLE PHYSICIAN PRACTICES LLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/791-3228","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.1","L70.0","Z23.","F32.1","F90.0","Z01.89","Z20.822","K21.9","R10.9","R11.14","K20.0","K22.2","J11.1","R11.0","K29.70","F90.2","F32.9","R10.13","R11.2","R12.","Z20.828","E55.9","R11.11","B34.9","R53.83","F41.9","F90.1","R42.","G43.019","G47.00","A08.4","Z63.4","J10.1","R50.9","Z76.89","R05.9","R13.19","G47.21","H61.21","R19.7","K29.00"],"date":["2021-12-14","2019-07-10","2021-04-28","2021-12-14","2021-12-14","2021-05-14","2021-05-14","2021-06-03","2021-06-03","2021-06-03","2021-06-03","2021-06-03","2019-11-13","2019-12-04","2021-05-19","2021-03-25","2021-05-20","2021-05-19","2021-05-19","2021-05-19","2021-10-19","2019-01-18","2019-01-18","2019-01-18","2019-02-04","2020-11-12","2019-05-30","2019-02-25","2019-05-30","2019-05-30","2019-09-17","2019-09-17","2019-11-07","2019-11-07","2019-03-04","2021-10-19","2021-05-19","2019-05-30","2019-12-04","2019-12-04","2021-05-19"],"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":[["","","VYVANSE"," VYVANSE ","30","Select","Select",""],["","","VITAMIN"," VITAMIN ","4","Select","Select",""],["","","SERTRALINE"," SERTRALINE ","15","Select","Select",""],["","","ONDANSETRON"," ONDANSETRON ","15","Select","Select",""],["","","CLINDAMY\/BEN"," CLINDAMY\/BEN ","45","Select","Select",""],["","","DOXYCYCL"," DOXYCYCL ","30","Select","Select",""],["","","RETIN-A"," RETIN-A ","45","Select","Select",""],["","","TRETINOIN"," TRETINOIN ","45","Select","Select",""],["","","CLINDAMYCIN"," CLINDAMYCIN ","60","Select","Select",""],["","","PREDNISONE"," PREDNISONE ","12","Select","Select",""],["","","CULTURELLE"," CULTURELLE ","30","Select","Select",""],["","","OMEPRAZOLE"," OMEPRAZOLE ","10","Select","Select",""],["","","PROMETHAZINE"," PROMETHAZINE ","140","Select","Select",""],["","","CIPROFLOXACN"," CIPROFLOXACN ","14","Select","Select",""],["","","OSELTAMIVIR","CAP 75MG","","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":""}]}]}