{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOYCE   M MAURER","gend":1,"add":"83 PINEWOOD CT","city":"RUCKERSVILLE","state":"VA","zip":"22968-9998","dob":"1952-06-04","age":"","mstatus":"","insh":"20031685*01","cliId":"","pno":"434\/985-6206","cno":"434\/227-1960","email":"","ename":"","eno":"","pphy":"KELLAMS, BRYCE S L MD","ppno":"434\/923-4600","pcpadd":"3263 PROFFIT RD STE 101","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22911,"pcpcounty":"","pcpid":"","pcpname":"SMJMG - Sentara Forest Lakes Family Medicine","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/975-1384","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.65","N20.0","F41.9","E78.5","F11.90","N23.","N18.4","R52.","I10.","K81.0","R10.13","NO DATA","R60.9","F32.1","N17.9","I12.9","N18.3","E11.22","F41.1","F32.9","Z79.82","Z79.84","Z79.899","Z87.442","Z28.21","Z83.3","Z82.3","Z82.49","Z51.89"],"date":["2021-07-15","2021-08-26","2021-07-15","2021-07-15","2020-05-15","2021-08-26","2021-07-15","2021-08-26","2021-08-26","2019-09-10","2019-09-06","2019-09-16","2019-09-16","2019-08-16","2019-09-06","2019-09-06","2019-09-06","2019-09-06","2019-09-06","2019-09-06","2019-09-06","2019-09-06","2019-09-06","2019-09-06","2019-09-06","2019-09-06","2019-09-06","2019-09-06","2019-10-09"],"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":[["","","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","","HYDROMORPHON"," HYDROMORPHON ","10","Select","Select",""],["","","POT  CITRATE"," POT  CITRATE ","90","Select","Select",""],["","00093727198","PIOGLITAZONE","TAB 15MG","90","Select","Select",""],["","","CLONAZEPAM"," CLONAZEPAM ","60","Select","Select",""],["","","ACETAMINOPHN","TAB 500MG","","Select","Select",""],["","00904673080","ACETAMIN","TAB 500MG","150","Select","Select",""],["","","GLIPIZIDE"," GLIPIZIDE ","120","Select","Select",""],["","","PAIN"," PAIN ","96","Select","Select",""],["","00245007111","POT  CITRA ER","TAB 1080MG","90","Select","Select",""],["","","NYSTATIN","POW 100000","","Select","Select",""],["","","GLUCOCOM","MIS MONITOR","","Select","Select",""],["","","ALCOHOL","MIS 0.7","","Select","Select",""],["","","ONETOUCH","KIT ULTRA 2","","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}