{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ELIZABETH   M WILLIAMS","gend":1,"add":"119 HARVEST ROAD","city":"WAYNESBORO","state":"VA","zip":"22980-9998","dob":"2004-04-29","age":"","mstatus":"","insh":"1554787*01","cliId":"","pno":"352\/602-9761","cno":"","email":"","ename":"","eno":"","pphy":"CRUTCHFIELD, RACHEL C MD","ppno":"540\/885-8143","pcpadd":"19 GREEN HILLS DR","pcpcity":"VERONA","pcpstate":"VA","pcpzip":24482,"pcpcounty":"","pcpid":"","pcpname":"VALLEY PEDIATRIC GROUP PLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/885-9809","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.2","N91.1","Z20.828","K21.9","H90.3","R63.5","N91.5","E28.2","E66.01","R10.84","H91.92","M25.532","G44.209","B07.9","J06.9","Z30.016","N94.6","J45.30","J30.9","J45.20","B34.9","J45.909","Z11.59","Z20.822","R09.81","R05.1"],"date":["2020-01-15","2020-01-15","2021-02-15","2019-05-17","2020-11-30","2020-04-09","2020-04-09","2019-12-30","2020-03-06","2020-03-06","2020-11-20","2020-11-20","2020-11-20","2020-11-20","2021-02-15","2021-07-29","2019-01-25","2019-01-25","2019-01-25","2019-04-22","2019-09-09","2019-09-09","2020-07-27","2021-10-14","2021-10-14","2021-10-14"],"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":[["","","LORATADINE"," LORATADINE ","30","Select","Select",""],["","","ALYACEN"," ALYACEN ","28","Select","Select",""],["","","MONTELUKAST"," MONTELUKAST ","30","Select","Select",""],["","","QVAR"," QVAR ","11","Select","Select",""],["","","PROAIR"," PROAIR ","8","Select","Select",""],["","","OPTICHAMBER"," OPTICHAMBER ","1","Select","Select",""],["","","ALBUTEROL"," ALBUTEROL ","18","Select","Select",""],["","","FLOVENT"," FLOVENT ","11","Select","Select",""],["","","PREDNISONE"," PREDNISONE ","12","Select","Select",""],["","","VENTOLIN"," VENTOLIN ","18","Select","Select",""],["","","OMEPRAZOLE"," OMEPRAZOLE ","30","Select","Select",""],["","","NORETHINDRON"," NORETHINDRON ","28","Select","Select",""],["","","ONDANSETRON","TAB 4MG ODT","","Select","Select",""],["","","XULANE","DIS 150-35","","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":""}]}]}