{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SALLY  E TAYLOR","gend":1,"add":"603 KNIGHTING RD 33","city":"GORDONSVILLE","state":"VA","zip":22942,"dob":"1964-10-01","age":"","mstatus":"","insh":"20036029*01","cliId":"","pno":"434\/906-9016","cno":"","email":"","ename":"","eno":"","pphy":"Route,  barbara","ppno":"540\/672-3010","pcpadd":"5424 Discovery Park Blvd BLDB A STE 201","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":22942,"pcpcounty":"","pcpid":"","pcpname":"AHG - Orange Family Physicians","plan":"OHP","program":"Medicaid","lob":"OHCC","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/672-5713","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K08.89","J06.9","E11.65","E78.2","J45.21","J01.00","Z78.9","H00.015","K04.7","L02.811","L03.221","R59.0","L03.011","S01.512A","M54.12","V89.2XXS","M47.14","M25.561","H00.011","R42.","Z79.4","M79.604","M25.40","S83.241A","L03.317","I25.10","Z20.828","L03.313","E66.01","Z68.42"],"date":["2021-09-04","2021-01-12","2022-11-01","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2020-12-10","2021-08-27","2021-03-02","2021-03-03","2021-03-03","2021-06-18","2021-07-01","2019-02-22","2019-02-22","2019-02-22","2022-07-25","2022-03-09","2022-05-20","2022-05-20","2022-06-03","2022-06-03","2022-06-03","2022-05-02","2022-11-01","2022-11-01","2022-11-01","2022-11-01","2022-11-01"],"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":[["","00088221905","LANTUS","INJ 100\/ML","15","Select","Select",""],["","","ERYTHROMYCIN","OIN 5MG\/GM","","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","56151210401","PEN  NEEDLES","MIS 32GX4MM","100","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","53746017801","METFORMIN","TAB 500MG ER","90","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","08290320550","BD  PEN NEEDL","MIS 32GX5\/32","100","Select","Select",""],["","59651005290","EZETIMIBE","TAB 10MG","30","Select","Select",""],["","21922000909","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","00169430713","RYBELSUS","TAB 7MG","30","Select","Select",""],["","00093005805","TRAMADOL","TAB 50MG","15","Select","Select",""],["","00603533932","PREDNISONE","TAB 20MG","10","Select","Select",""],["","55111015330","ONDANSETRON","TAB 4MG","20","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","14","Select","Select",""],["","65162027250","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","29300011516","TOPIRAMATE","TAB 25MG","30","Select","Select",""],["","00085720601","DULERA","AER 100-5MCG","13","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","58160088752","FLUARIX","INJ 2021-22","0","Select","Select",""],["","10702000709","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","00006027754","JANUVIA","TAB 100MG","30","Select","Select",""],["","16729017117","AMITRIPTYLIN","TAB 10MG","30","Select","Select",""],["","55111015834","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","","FLUBLOK","INJ 2020-21","","Select","Select",""],["","","AFLURIA","INJ 2020-21","","Select","Select",""],["","10370074605","GLIPIZIDE","TAB 10MG","60","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","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":""}]}]}