{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMANDA TANNER","gend":1,"add":"377 JULESS ST","city":"DANVILLE","state":"VA","zip":24541,"dob":"1971-07-26","age":"","mstatus":"","insh":"1360830*01","cliId":"","pno":"434\/822-3226","cno":"","email":"","ename":"","eno":"","pphy":"Route,  barbara","ppno":"434\/799-4488","pcpadd":"5424 Discovery Park Blvd BLDB A STE 201","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":24541,"pcpcounty":"","pcpid":"","pcpname":"DANVILLE PHYSICIAN PRACTICES LLC","plan":"OHP","program":"Medicaid","lob":"M4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/773-6977","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["A41.9","I10.","R41.82","R26.2","R50.9","Z20.822","H66.92","M79.602","E11.9","Z79.4","Z91.030","G93.41","J18.9","J96.01","N39.0","Z68.41","E11.65","F31.9","E78.5","E66.01","B96.20","D50.9","Z79.84","Z79.899","Z82.49","S90.211A","S99.921A","Y99.9","M25.512","M79.632","E78.2","M25.519","B37.3","R30.0","B96.89"],"date":["2021-11-18","2021-12-12","2021-11-06","2021-11-22","2021-11-04","2021-11-04","2019-11-30","2019-11-30","2022-07-09","2022-07-09","2022-07-09","2021-11-08","2021-11-16","2021-11-16","2022-07-09","2021-11-04","2021-11-04","2021-11-04","2021-11-04","2021-11-04","2021-11-04","2021-11-04","2021-11-04","2021-11-04","2021-11-04","2021-12-12","2021-12-12","2021-12-12","2019-05-26","2019-05-26","2020-05-19","2019-06-19","2020-05-19","2022-07-09","2022-07-09"],"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":[["","65162027250","SMZ\/TMP","TAB 800-160","6","Select","Select",""],["","","LISINOP\/HCTZ"," LISINOP\/HCTZ ","30","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","15","Select","Select",""],["","60505257909","ATORVASTATIN","TAB 20MG","90","Select","Select",""],["","","PHENAZOPYRID","TAB 200MG","","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","65862007705","CIPROFLOXACN","TAB 500MG","10","Select","Select",""],["","86227012105","SURE","MIS 31GX3\/16","100","Select","Select",""],["","","ONETOUCH","TES VERIO","","Select","Select",""],["","","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","23155065205","METRONIDAZOL","TAB 500MG","21","Select","Select",""],["","73070010310","INSULIN","INJ FLEXPEN","15","Select","Select",""],["","23155010405","METFORMIN","TAB 1000MG","180","Select","Select",""],["","00378623305","CITALOPRAM","TAB 40MG","30","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","69097012715","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","68382009405","CARVEDILOL","TAB 12.5MG","28","Select","Select",""],["","65862017760","CEFDINIR","CAP 300MG","18","Select","Select",""],["","08222095831","PEN  NEEDLES","MIS 31GX8MM","100","Select","Select",""],["","","PROAIR","AER ","","Select","Select",""],["","10702000650","CYCLOBENZAPR","TAB 5MG","9","Select","Select",""],["","","LIDOCAINE","PAD 0.05","","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}