{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JESSICA   L DIX","gend":1,"add":"145 HUNTERS RUN LOT 1","city":"DANVILLE","state":"VA","zip":"24540-9998","dob":"1989-06-02","age":"","mstatus":"","insh":"1788093*01","cliId":"","pno":"434\/247-1184","cno":"434\/228-6616","email":"","ename":"","eno":"","pphy":"BEACH, JACOB NP","ppno":"434\/857-3600","pcpadd":"414 PARK AVE","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"pcpcounty":"","pcpid":"","pcpname":"CENTRA MEDICAL GROUP LLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/857-3601","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O80.","O24.424","Z37.0","O32.1XX0","K64.9","Z72.0","D50.9","E55.9","K64.4","R10.9","K59.00","Z3A.38","Z39.1","Z34.82","Z34.83","O24.419","Z30.2","Z20.828","Z20.822","Z01.89","K64.8","K29.50","K62.5","F17.210","Z79.82","Z79.899","R11.2","R10.84","R19.4","R14.0","Z91.014","Z23.","S66.911A","R53.83","Z13.1","K92.1","K29.00","Z3A.00","D64.9","E87.6","E66.9","Z68.35"],"date":["2019-03-27","2019-03-27","2019-03-27","2019-03-27","2021-10-27","2021-06-22","2021-09-21","2021-09-21","2021-10-27","2021-10-05","2021-10-27","2019-03-26","2019-03-07","2019-03-07","2019-03-19","2019-03-19","2019-05-16","2020-07-28","2021-12-28","2021-09-17","2021-10-27","2021-09-21","2021-09-21","2021-10-27","2021-10-27","2021-09-21","2021-10-05","2021-10-05","2021-10-05","2021-10-05","2021-10-05","2019-01-29","2020-04-20","2021-02-12","2021-02-12","2021-09-21","2021-09-21","2019-03-26","2021-10-27","2021-10-27","2021-10-27","2021-10-27"],"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":[["","","LANTUS"," LANTUS ","1","Select","Select",""],["","","ACCU-CHEK"," ACCU-CHEK ","102","Select","Select",""],["","","BD  PEN NEEDL"," BD  PEN NEEDL","100","Select","Select",""],["","","OXYCOD\/APAP"," OXYCOD\/APAP ","20","Select","Select",""],["","","IBUPROFEN"," IBUPROFEN ","45","Select","Select",""],["","","PREDNISONE","TAB 10MG","","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":""}]}]}