{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CYRAH   L JONES","gend":1,"add":"6472 CROSSROADS LN APT A","city":"TIMBERVILLE","state":"VA","zip":"22853-9998","dob":"2004-03-23","age":"","mstatus":"","insh":"20030210*01","cliId":"","pno":"540\/448-0620","cno":"","email":"","ename":"","eno":"","pphy":"CODDING, HEATHER L NP","ppno":"540\/901-0800","pcpadd":"13892 TIMBER WAY","pcpcity":"BROADWAY","pcpstate":"VA","pcpzip":22815,"pcpcounty":"","pcpid":"","pcpname":"SRMHMG - Sentara Timber Way Health Center","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/578-8547","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.8","S60.946A","R07.89","R06.02","Z23.","Z00.129","F41.9","F32.1","B34.9","R50.9","Z30.09","N39.0","N76.0","R51.9","Z20.822","Z30.42"],"date":["2021-12-15","2020-08-25","2021-01-27","2021-01-27","2021-11-04","2021-11-04","2021-11-04","2021-11-04","2020-02-10","2020-02-10","2021-07-27","2021-06-14","2021-06-14","2021-09-07","2021-09-07","2021-07-27"],"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":[["","00093506001","HYDROXYZ","TAB 10MG","15","Select","Select",""],["","70710111001","CYPROHEPTAD","TAB 4MG","30","Select","Select",""],["","","SERTRALINE","TAB 25MG","","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","","AMOXICILLIN","TAB 875MG","","Select","Select",""],["","00054418425","DEXAMETHASON","TAB 4MG","6","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","70461032103","FLUCLVX","INJ 2021-22","0","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","8","Select","Select",""],["","59651036105","IBUPROFEN","TAB 600MG","24","Select","Select",""],["","00548540000","MEDROXYPR","INJ 150MG\/ML","1","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","15","Select","Select",""],["","","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","58160088752","FLUARIX","INJ 2021-22","0","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","","ESCITALOPRAM","TAB 5MG","","Select","Select",""],["","","NITROFURANTN","CAP 100MG","","Select","Select",""],["","","ONDANSETRON","TAB 4MG","","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":""}]}]}