{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SKYLER CASH","gend":1,"add":"275 FISHERSVILLE ROAD","city":"FISHERSVILLE","state":"VA","zip":"22939-9998","dob":"2003-09-08","age":"","mstatus":"","insh":"1299349*01","cliId":"","pno":"540\/241-6009","cno":"540\/430-9014","email":"","ename":"","eno":"","pphy":"PUMPHREY, SARAH B MD","ppno":"540\/932-0980","pcpadd":"57 BEAM LANE SUITE 202","pcpcity":"FISHERSVILLE","pcpstate":"VA","pcpzip":22939,"pcpcounty":"","pcpid":"","pcpname":"Augusta Pediatrics: UVA","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/932-0979","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E28.2","Z68.54","E78.1","R74.01","K76.0","R74.0","E66.9","R11.10","R51.9","R51.","R05.","Z20.828","U07.1","J02.9","J02.0","Z68.41","Z00.01","Z13.31","Z23.","NO DATA","R43.9","Z88.0","Z00.121","N93.9","R94.5","L83.","L98.8","L70.0","H66.003","J30.2","H69.83","Z86.69","E66.8"],"date":["2021-12-02","2021-10-06","2021-03-31","2021-10-06","2020-09-29","2020-09-29","2021-03-31","2021-05-14","2021-12-02","2020-09-08","2020-12-08","2020-12-08","2021-12-16","2020-01-27","2020-01-27","2021-10-06","2021-12-02","2021-12-02","2021-12-02","2021-12-16","2021-12-16","2021-12-16","2019-06-20","2019-06-20","2019-06-20","2019-06-20","2019-06-20","2019-05-02","2019-04-16","2019-05-02","2019-05-02","2019-05-02","2019-09-25"],"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 ODT","","Select","Select",""],["","","RIZATRIPTAN","TAB 10MG","","Select","Select",""],["","00555901058","NORTREL","TAB 12785","28","Select","Select",""],["","","METFORMIN","TAB 750MG ER","","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","68180089313","PIRMELLA","TAB 12785","28","Select","Select",""],["","51672138104","CLINDAMY\/BEN","GEL 1-5%","50","Select","Select",""],["","42806031250","DOXYCYCL","TAB 100MG","30","Select","Select",""],["","00472011745","TRETINOIN","CRE 0.00025","45","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","68001036206","CEFDINIR","CAP 300MG","20","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":""}]}]}