{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DESTINY   N LOGAN","gend":1,"add":"107 WATERFORD LOOP APT 203","city":"STAUNTON","state":"VA","zip":"24401-9998","dob":"1999-03-30","age":"","mstatus":"","insh":"20031227*01","cliId":"","pno":"434\/728-6315","cno":"","email":"","ename":"","eno":"","pphy":"BLOSSER, JENNIFER NP","ppno":"540\/942-1200","pcpadd":"1850 ROSSER AVE","pcpcity":"WAYNESBORO","pcpstate":"VA","pcpzip":22980,"pcpcounty":"","pcpid":"","pcpname":"UNIVERSITY OF VIRGINIA PHYSICIANS GROUP","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/942-0151","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N76.0","Z20.828","N83.201","L70.8","L66.1","L21.9","F32.1","F90.0","Z13.21","Z76.89","E28.2","E28.1","R63.5","Z68.41","E66.01","E66.9","N92.6","B34.9","Z79.1","Z72.0","R19.7","R51.9","F17.200","Z00.00","J06.9","U07.1","J02.9","Z03.818","L21.8","B96.89"],"date":["2020-05-21","2021-08-10","2021-01-29","2021-05-04","2021-05-04","2021-05-04","2020-05-21","2020-02-18","2020-02-18","2020-02-18","2021-09-02","2021-11-10","2021-11-10","2020-05-21","2020-05-21","2021-06-04","2021-06-04","2020-12-26","2020-12-26","2021-12-05","2020-12-26","2021-01-04","2021-01-04","2021-01-04","2021-08-10","2021-12-05","2021-12-05","2020-12-26","2019-09-23","2019-05-30"],"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":[["","70156011118","SELENIUM","SHA 0.0225","180","Select","Select",""],["","43386002860","CLOBETASOL","SOL 0.0005","50","Select","Select",""],["","00168009960","KETOCONAZOLE","CRE 0.02","60","Select","Select",""],["","67877056105","METFORMIN","TAB 500MG","180","Select","Select",""],["","","SAXENDA","INJ 18MG\/3ML","","Select","Select",""],["","","VITAMIN","CAP 50000UNT","","Select","Select",""],["","00472082902","FLUOCINONIDE","SOL 0.0005","60","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","6","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","00713072853","BETAMETH","LOT 0.0005","60","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":""}]}]}