{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TERESA   E SHIFFLETT","gend":1,"add":"2511 MAYLAND ROAD","city":"BROADWAY","state":"VA","zip":"22815-9998","dob":"1978-12-27","age":"","mstatus":"","insh":"1400978*01","cliId":"","pno":"540\/214-9114","cno":"","email":"","ename":"","eno":"","pphy":"VONELTEN, CHRISTOPHER B MD","ppno":"434\/400-9668","pcpadd":"631 BERKMAR CIRCLE","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22901,"pcpcounty":"","pcpid":"","pcpname":"CHRISTOPHER B VONELTEN","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/381-4367","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z09.","Z47.89","F11.20","Z72.0","M25.511","M54.2","F41.1","F33.1","Z30.431","Z01.419","N30.00","Z48.02","NO DATA","M24.111","F41.9","T84.84XA","R30.0","J01.90","G89.29","S43.121A","G89.18","F33.0","F17.200","M75.41","Z47.2","S43.109A","Z30.433","Z32.02","M24.811","S43.101A","M67.811","N64.4","U07.1"],"date":["2019-07-09","2019-12-04","2021-05-09","2021-03-08","2019-12-24","2020-01-14","2021-03-16","2021-03-16","2021-02-17","2020-09-01","2019-08-30","2019-11-26","2020-07-15","2019-01-25","2019-04-22","2019-09-27","2019-10-21","2019-10-21","2021-03-08","2019-06-24","2019-11-11","2020-05-05","2019-04-23","2019-11-11","2019-11-11","2019-12-04","2021-01-20","2021-01-20","2019-02-22","2019-05-29","2019-02-22","2019-03-12","2021-03-09"],"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":[["","","LEVOTHYROXIN"," LEVOTHYROXIN ","30","Select","Select",""],["","","IBUPROFEN"," IBUPROFEN ","90","Select","Select",""],["","","SUBOXONE"," SUBOXONE ","42","Select","Select",""],["","","FLUTICASONE"," FLUTICASONE ","16","Select","Select",""],["","","BUPREN\/NALOX"," BUPREN\/NALOX ","42","Select","Select",""],["","","OXYCODONE"," OXYCODONE ","42","Select","Select",""],["","","ASPIRIN"," ASPIRIN ","28","Select","Select",""],["","","KETOROLAC"," KETOROLAC ","20","Select","Select",""],["","","SMZ-TMP"," SMZ-TMP ","10","Select","Select",""],["","","CEFUROXIME"," CEFUROXIME ","14","Select","Select",""],["","","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","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":""}]}]}