{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ERICA   K WOOD","gend":1,"add":"16738 EVERGREEN VALLEY ROAD","city":"TIMBERVILLE","state":"VA","zip":"22853-9998","dob":"2004-09-13","age":"","mstatus":"","insh":"1335339*01","cliId":"","pno":"540\/271-7223","cno":"","email":"","ename":"","eno":"","pphy":"MCDORMAN, ASHLEY N NP","ppno":"540\/901-0800","pcpadd":"13892 TIMBER WAY","pcpcity":"BROADWAY","pcpstate":"VA","pcpzip":22815,"pcpcounty":"","pcpid":"","pcpname":"SRMHMG - Sentara Timber Way Health Center","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/578-8547","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J45.990","N93.9","R51.","G47.00","F84.0","J30.89","N94.6","F31.9","Z30.011","Z23.","M79.7","G44.229","R10.2","R10.9","N30.00","F41.1","M54.5","J06.9","R11.2","R43.0","Z30.8","S93.401A","S99.911A","M25.571","S99.921A","M79.671","Z30.013","B07.8","R30.0","R10.84","F32.9","R05.","G43.009","K29.70","Z30.41","M79.674","R35.0"],"date":["2020-09-08","2021-11-30","2019-04-09","2019-04-09","2020-09-08","2019-04-09","2019-04-09","2021-12-20","2020-09-08","2021-11-30","2020-09-08","2020-09-08","2021-07-16","2021-05-26","2020-09-28","2020-02-12","2020-01-02","2020-02-27","2021-10-04","2021-10-04","2020-02-19","2021-05-03","2021-05-03","2021-05-03","2021-05-03","2021-05-03","2020-03-05","2020-03-05","2020-09-28","2019-11-27","2019-03-06","2019-03-25","2021-11-30","2019-05-10","2021-07-16","2020-12-29","2020-09-28"],"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":[["","","ARIPIPRAZOLE","TAB 10MG","","Select","Select",""],["","","QUETIAPINE","TAB 100MG","","Select","Select",""],["","68462012605","GABAPENTIN","TAB 600MG","60","Select","Select",""],["","","AUROVELA","TAB 43831","","Select","Select",""],["","65862018730","ONDANSETRON","TAB 4MG","20","Select","Select",""],["","00527411737","PROPRANOLOL","CAP 80MG ER","30","Select","Select",""],["","33342008745","RIZATRIPTAN","TAB 5MG","9","Select","Select",""],["","","HYDROXYZ","TAB 25MG","","Select","Select",""],["","68180086613","BLISOVI","TAB 1.5\/30","28","Select","Select",""],["","","NEO\/POLY\/HC","SUS 1% OTIC","","Select","Select",""],["","68180029606","DULOXETINE","CAP 60MG","30","Select","Select",""],["","00703680101","MEDROXYPR","INJ 150MG\/ML","1","Select","Select",""],["","","DUOFILM","SOL 0.17","","Select","Select",""],["","","PALIPERIDONE","TAB ER 3MG","","Select","Select",""],["","13811071910","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","","RISPERIDONE","TAB 1MG","","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","","AMITRIPTYLIN","TAB 10MG","","Select","Select",""],["","","SF","CRE 0.011","","Select","Select",""],["","","NORETH\/ETHIN","TAB 43831","","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","65862037401","ESCITALOPRAM","TAB 10MG","45","Select","Select",""],["","68382013905","TOPIRAMATE","TAB 50MG","60","Select","Select",""],["","17772010301","TROKENDI","CAP 100MG","30","Select","Select",""],["","51293081101","PHENAZOPYRID","TAB 200MG","6","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","51862029206","MICROGESTIN","TAB FE1.5\/30","28","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","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":""}]}]}