{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CAMILLA   M CLAY","gend":1,"add":"1060 RIVERDALE DR","city":"SOUTH BOSTON","state":"VA","zip":"24592-9998","dob":"1987-11-06","age":"","mstatus":"","insh":"20036429*01","cliId":"","pno":"434\/222-0436","cno":"","email":"","ename":"","eno":"","pphy":"ROBERTS, MAURICE NP","ppno":"434\/835-4876","pcpadd":"3130 HALIFAX ROAD SUITE C","pcpcity":"SOUTH BOSTON","pcpstate":"VA","pcpzip":24592,"pcpcounty":"","pcpid":"","pcpname":"GODOCS SOUTH BOSTON LLC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/835-4875","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.31","R11.10","R19.7","Z98.51","R11.0","R10.84","R05.","J06.9","R11.2","R19.4","K30.","R10.9","K64.4","K62.1","N39.0","Z20.828","K29.70","R11.14","Z87.891","Z91.011","Z20.822","R68.83","M54.6","S89.92XA","S83.92XA","R07.9","S22.32XA","V54.19","I10.","Z82.49","M54.9","A08.4","M54.5","N30.00","J01.00","S92.534A","A09.","J30.9","G43.809","Z11.52","N91.2","S16.1XXA","S29.012A","V87.7XXA","M25.512","R12.","R00.2","I49.1","I87.2","R22.43","R07.89","R81.","E78.2","R06.00","R53.83","Z01.89","R10.13","K29.60","D64.9","M51.26","Z83.3","J01.90","R09.81","R50.9","R10.2","S92.901A","K29.00","R05.9","M54.2","V49.9XXA","V58.89","A56.02","M25.571","R51.","S40.012A","S10.93XA","M79.675","R42.","Z20.2","R51.9"],"date":["2019-03-20","2020-03-12","2020-04-23","2020-06-24","2021-10-05","2021-07-08","2021-09-29","2021-09-23","2021-07-08","2021-05-26","2021-05-26","2021-07-08","2020-06-30","2020-06-30","2020-06-30","2021-10-05","2021-09-29","2021-12-30","2021-12-30","2021-12-30","2021-12-30","2021-12-30","2019-10-21","2019-12-29","2019-12-29","2020-06-09","2020-06-24","2020-07-08","2021-03-31","2020-06-24","2020-06-24","2021-08-15","2021-09-09","2019-04-13","2021-10-11","2019-11-26","2020-03-16","2020-10-22","2021-02-03","2021-10-19","2020-01-23","2020-06-06","2020-06-06","2020-06-06","2020-06-10","2020-09-24","2021-03-31","2021-03-31","2021-03-31","2021-03-31","2021-03-31","2021-03-31","2021-03-31","2021-03-31","2021-07-08","2021-05-26","2021-07-05","2021-06-25","2021-09-29","2021-09-29","2021-09-29","2021-09-29","2021-10-11","2021-12-30","2019-11-04","2019-11-21","2021-07-05","2021-10-11","2020-06-06","2020-06-06","2020-07-08","2021-06-16","2019-10-31","2020-05-17","2020-06-16","2020-06-16","2021-10-13","2020-01-09","2021-08-12","2021-09-23"],"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":[["","","METRONIDAZOL"," METRONIDAZOL ","21","Select","Select",""],["","","PHENAZOPYRID"," PHENAZOPYRID ","6","Select","Select",""],["","","CEFUROXIME"," CEFUROXIME ","20","Select","Select",""],["","","PROMETHAZINE"," PROMETHAZINE ","30","Select","Select",""],["","","LOPERAMIDE"," LOPERAMIDE ","30","Select","Select",""],["","","ZYRTEC-D"," ZYRTEC-D ","12","Select","Select",""],["","","DICYCLOMINE"," DICYCLOMINE ","30","Select","Select",""],["","","TRAMADOL"," TRAMADOL ","20","Select","Select",""],["","","AZITHROMYCIN"," AZITHROMYCIN ","6","Select","Select",""],["","","CODEINE\/GG"," CODEINE\/GG ","240","Select","Select",""],["","","TYLENOL"," TYLENOL ","30","Select","Select",""],["","","IBUPROFEN"," IBUPROFEN ","30","Select","Select",""],["","","METHOCARBAM"," METHOCARBAM ","30","Select","Select",""],["","","DICLOFENAC"," DICLOFENAC ","100","Select","Select",""],["","","CETIRIZ\/PSE"," CETIRIZ\/PSE ","12","Select","Select",""],["","","KETOROLAC"," KETOROLAC ","15","Select","Select",""],["","","SUMATRIPTAN","TAB 50MG","","Select","Select",""],["","","VITAMIN","TAB 25MG","","Select","Select",""],["","","SLEEP","TAB 25MG","","Select","Select",""],["","","ONDANSETRON","TAB 4MG ODT","","Select","Select",""],["","","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","","NAPROXEN","TAB 500MG","","Select","Select",""],["","","ARTHRTS","TAB 650MG","","Select","Select",""],["","","CYCLOBENZAPR","TAB 5MG","","Select","Select",""],["","","ORPHENADRINE","TAB 100MG ER","","Select","Select",""],["","","LEVOCETIRIZI","TAB 5MG","","Select","Select",""],["","","RHINOCORT","SUS ALLERGY","","Select","Select",""],["","","DEXILANT","CAP 60MG DR","","Select","Select",""],["","","TOPIRAMATE","TAB 50MG","","Select","Select",""],["","","MECLIZINE","TAB 25MG","","Select","Select",""],["","","SMZ\/TMP","TAB 800-160","","Select","Select",""],["","","CIPROFLOXACN","TAB 500MG","","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":""}]}]}