{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LONDON   A SIMS","gend":1,"add":"PO BOX 21","city":"GORDONSVILLE","state":"VA","zip":"22942-9998","dob":"2004-01-15","age":"","mstatus":"","insh":"1457753*01","cliId":"","pno":"434\/465-5278","cno":"","email":"","ename":"","eno":"","pphy":"SCHINSTOCK, ELIZABETH C MD","ppno":"540\/661-3025","pcpadd":"661 UNIVERSITY LN STE A","pcpcity":"ORANGE","pcpstate":"VA","pcpzip":22960,"pcpcounty":"","pcpid":"","pcpname":"Orange Pediatrics: UVA","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/661-3021","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N94.6","N92.0","Z84.2","F64.9","F64.0","N80.9","E34.9","Z91.89","E55.9","Z78.9","E30.1","Z79.890","F41.9","N92.6","Z86.59","R62.51","F43.21","G47.00","H47.032","H44.21","R10.30","E83.39","H50.112","Z86.69","F41.8","F32.9","Z51.81","H44.23","J02.9","R13.10","R53.83","H54.62","L23.9","Z79.899","T78.49XA","S46.011A","N92.1","G47.9","F64.8","F32.1","R00.2","L23.4","T14.8XXA","Z00.121","R63.6","F64.2","J02.8"],"date":["2021-07-15","2020-04-14","2021-07-15","2021-11-10","2021-11-10","2021-10-08","2021-11-10","2021-10-08","2021-10-08","2021-11-10","2021-11-10","2020-04-27","2021-07-09","2020-04-27","2020-04-27","2020-04-27","2021-07-09","2021-08-06","2021-09-07","2021-09-07","2021-07-10","2020-01-21","2020-07-07","2020-07-07","2019-10-16","2019-10-16","2019-10-16","2019-06-18","2019-10-13","2019-10-13","2019-10-13","2019-10-13","2019-10-17","2019-10-17","2019-10-17","2019-12-02","2019-11-15","2019-11-15","2019-08-20","2019-09-19","2019-10-07","2019-10-17","2019-12-02","2019-09-10","2019-09-10","2019-09-10","2019-12-27"],"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":[["","","LUPRON","INJ 11.25MG","","Select","Select",""],["","","BD  HYPO NEED","MIS 18GX1\"","","Select","Select",""],["","08290309637","LUER-LOK","MIS 1ML\/20G","13","Select","Select",""],["","","3ML","MIS 25GX1\"","","Select","Select",""],["","08290305145","BD  NEEDLE","MIS 23GX1\"","12","Select","Select",""],["","","HYPO  NEEDLE  M","MIS 25GX1\"","","Select","Select",""],["","57664051083","MIRTAZAPINE","TAB 7.5MG","30","Select","Select",""],["","80681000900","VITAMIN","CAP 50MCG","90","Select","Select",""],["","","TESTOST","INJ 200MG\/ML","","Select","Select",""],["","08290328438","INSULIN","MIS 0.3\/31G","12","Select","Select",""],["","","NAPROXEN","TAB 250MG","","Select","Select",""],["","","CVS","CAP 2000UNIT","","Select","Select",""],["","","BACLOFEN","TAB 10MG","","Select","Select",""],["","","1ML","MIS 25GX5\/8\"","","Select","Select",""],["","","ONDANSETRON","TAB 4MG ODT","","Select","Select",""],["","00555901658","SPRINTEC","TAB 28 DAY","28","Select","Select",""],["","65162047505","NORETHIN","TAB 5MG","30","Select","Select",""],["","","LUPR","INJ 11.25MG","","Select","Select",""],["","50111064701","FLUOXETINE","CAP 10MG","30","Select","Select",""],["","69097083305","SERTRALINE","TAB 25MG","30","Select","Select",""],["","00093005805","TRAMADOL","TAB 50MG","10","Select","Select",""],["","50111043301","TRAZODONE","TAB 50MG","30","Select","Select",""],["","69097084507","CYCLOBENZAPR","TAB 5MG","10","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":""}]}]}