{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SIOBHAN LINGENFELTER","gend":1,"add":"PO BOX 11032","city":"DANVILLE","state":"VA","zip":"24543-9998","dob":"1980-05-17","age":"","mstatus":"","insh":"20031152*01","cliId":"","pno":"434\/710-1848","cno":"","email":"","ename":"","eno":"","pphy":"SHIFFLETT, JEREMY PA","ppno":"434\/791-4793","pcpadd":"705 MAIN STREET","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"pcpcounty":"","pcpid":"","pcpname":"PIEDMONT ACCESS TO HEALTH SERVICES INC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/791-4048","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M65.341","F33.1","M65.30","F31.81","F31.31","F43.12","M20.012","S62.637S","B37.2","S62.637A","S69.92XA","L50.9","R21.","S02.401A","S40.011A","S80.11XA","S00.81XA","S02.40EA","M47.818"],"date":["2021-09-09","2020-10-11","2020-10-12","2020-03-08","2021-10-29","2021-10-29","2020-12-07","2020-12-07","2020-08-04","2020-11-23","2020-11-23","2019-01-16","2019-01-16","2019-10-01","2019-10-01","2019-10-01","2019-10-01","2019-10-14","2019-03-12"],"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":[["","55111016730","OLANZAPINE","TAB 15MG","30","Select","Select",""],["","55111029136","SUMATRIPTAN","TAB 25MG","18","Select","Select",""],["","00228255196","DICLOFENAC","TAB 75MG DR","14","Select","Select",""],["","","METRONIDAZOL","TAB 500MG","","Select","Select",""],["","","FISH","CAP 1000MG","","Select","Select",""],["","70010077005","METHOCARBAM","TAB 750MG","15","Select","Select",""],["","64380078706","BUSPIRONE","TAB 7.5MG","60","Select","Select",""],["","","ECONAZOLE","CRE 0.01","","Select","Select",""],["","40985022921","OMEGA-3","CAP 1000MG","90","Select","Select",""],["","00781261301","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","00054001829","PREDNISONE","TAB 20MG","10","Select","Select",""],["","50428047392","CVS","CAP 25MG","30","Select","Select",""],["","00093100501","NAPROXEN","TAB 375MG","60","Select","Select",""],["","64380080307","RANITIDINE","TAB 150MG","30","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","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":""}]}]}