{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MALIK   X CRAWFORD","gend":0,"add":"PO BOX 103","city":"RUCKERSVILLE","state":"VA","zip":"22968-9998","dob":"2003-05-08","age":"","mstatus":"","insh":"1283643*01","cliId":"","pno":"434\/459-9407","cno":"","email":"","ename":"","eno":"","pphy":"SAULS, CHARLES B NP","ppno":"434\/654-1850","pcpadd":"140 STONERIDGE DRIVE SOUTH SUITE 10","pcpcity":"RUCKERSVILLE","pcpstate":"VA","pcpzip":22968,"pcpcounty":"","pcpid":"","pcpname":"SMJMG - Sentara Greene Family Medicine","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/985-7848","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F34.1","F32.9","I10.","S83.92XA","S80.12XA","S89.92XA","R10.9","R50.9","V62.84","V62.85","F32.1","F12.10","E66.01","Z20.9","Z71.89","Z23.","I15.9","E66.9","Z68.54","R46.89","E78.1","T07.XXXA","W30.9XXA","B34.9","Z09.","J06.9","J11.1","R03.0","R94.5","K21.9","R11.0","R45.86","G47.00","R74.0","M54.9"],"date":["2021-05-15","2020-06-25","2020-06-25","2020-05-09","2020-05-09","2020-08-11","2020-08-11","2021-07-13","2020-01-16","2020-01-15","2020-01-18","2020-01-18","2020-01-18","2020-02-28","2020-02-28","2020-02-28","2020-01-15","2020-01-15","2020-01-15","2020-01-15","2020-01-16","2020-08-11","2020-08-11","2020-03-04","2020-01-24","2020-01-24","2020-02-03","2019-04-23","2019-04-23","2019-04-23","2019-04-23","2019-02-12","2019-02-12","2019-04-15","2019-11-18"],"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":[["","","ONDANSETRON","TAB 4MG","","Select","Select",""],["","68382054406","LANSOPRAZOLE","CAP 30MG DR","60","Select","Select",""],["","","FLUOXETINE","CAP 10MG","","Select","Select",""],["","","SERTRALINE","TAB 100MG","","Select","Select",""],["","68645055654","LISINOP\/HCTZ","TAB 10-12.5","30","Select","Select",""],["","","OSELTAMIVIR","CAP 75MG","","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","14","Select","Select",""],["","69097084507","CYCLOBENZAPR","TAB 5MG","5","Select","Select",""],["","68645056354","IBUPROFEN","TAB 800MG","90","Select","Select",""],["","00904027760","VITAMIN","CAP 1000UNIT","30","Select","Select",""],["","69452014320","BENZONATATE","CAP 100MG","20","Select","Select",""],["","60432060416","PROMETHAZINE","SYP DM","180","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":""}]}]}