{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMY   N PROFFITT","gend":1,"add":"717 ELM ST","city":"CHARLOTTESVILLE","state":"VA","zip":"22903-9998","dob":"1979-09-25","age":"","mstatus":"","insh":"1263868*01","cliId":"","pno":"434\/260-9684","cno":"","email":"","ename":"","eno":"","pphy":"RICHMOND, MICHAEL DO","ppno":"540\/967-9401","pcpadd":"SUITE 9 115 JEFFERSON HWY","pcpcity":"LOUISA","pcpstate":"VA","pcpzip":23093,"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":"540\/967-9405","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R05.","Z20.822","E53.8","G47.30","R73.03","E55.9","F32.9","D50.9","K21.9","E78.6","Z97.5","S13.9XXA","G47.33","Z87.891","Z88.0","Z91.013","M54.2","M25.552","Z90.49","Z87.442","Z83.3","NO DATA","D72.820","R53.82","E61.1","R53.81","M54.9","Z23.","Z87.898","Z71.89","Z71.3","J02.9","M70.62","Z68.41","R50.9","R07.9","R35.0","R51.9","N92.1","R68.89","D72.829","M19.90","R19.7","Z12.4","N89.8","Z12.39"],"date":["2021-09-27","2021-09-27","2021-09-14","2021-12-09","2021-09-14","2021-09-14","2020-11-11","2021-09-14","2020-02-12","2020-11-11","2021-09-14","2020-10-28","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2020-10-28","2021-08-19","2021-08-12","2021-08-12","2021-08-12","2021-08-12","2020-07-01","2021-12-09","2020-07-31","2021-08-30","2020-11-11","2020-11-11","2020-11-11","2020-11-11","2020-11-11","2021-04-08","2021-08-19","2021-08-19","2021-09-01","2021-09-01","2021-09-01","2021-09-14","2021-09-14","2019-12-26","2020-07-31","2021-09-01","2021-09-01","2019-09-05","2019-09-05","2019-09-05"],"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":[["","","SERTRALINE"," SERTRALINE ","30","Select","Select",""],["","","OMEPRAZOLE"," OMEPRAZOLE ","30","Select","Select",""],["","","OSELTAMIVIR"," OSELTAMIVIR ","10","Select","Select",""],["","","METFORMIN","TAB 500MG","","Select","Select",""],["","","CYCLOBENZAPR","TAB 5MG","","Select","Select",""],["","","BACLOFEN","TAB 10MG","","Select","Select",""],["","","NAPROXEN","TAB 500MG","","Select","Select",""],["","","FERROUS","TAB 325MG","","Select","Select",""],["","","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","","VITAMIN","CAP 50000UNT","","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00093005805","TRAMADOL","TAB 50MG","18","Select","Select",""],["","62756052069","SUMATRIPTAN","TAB 25MG","16","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","6","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","14","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":""}]}]}