{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"STEPHANIE VANDEVANDER","gend":1,"add":"511 EAST AVE","city":"BROADWAY","state":"VA","zip":"22815-9998","dob":"1987-04-12","age":"","mstatus":"","insh":"20036603*01","cliId":"","pno":"540\/901-9412","cno":"540\/879-2848","email":"","ename":"","eno":"","pphy":"HILL, JORDAN L DO","ppno":"540\/564-5622","pcpadd":"13892 TIMBER WAY","pcpcity":"BROADWAY","pcpstate":"VA","pcpzip":"22815","pcpcounty":"","pcpid":"","pcpname":"SRMHMG - Sentara Timber Way Health Center","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/578-8547","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M32.14","I10.","D68.61","E78.9","E03.9","G40.909","R73.01","E55.9","L72.11","D18.01","L82.1","L91.8","D48.5","D22.5","L82.0","Z01.419","Z12.4","N92.6","M32.9","Z51.81","M79.662","Z86.718","G25.0","G40.309","G43.809","N19.","E66.3","R45.86","H61.23","H93.8X3","H93.13","R56.9","Z30.09","Z11.59","M79.605","Z79.01"],"date":["2021-11-23","2021-11-23","2021-12-21","2021-11-23","2021-11-23","2020-11-11","2020-08-10","2021-11-10","2021-07-21","2021-07-21","2021-07-21","2021-07-21","2021-07-21","2021-07-21","2021-07-21","2021-02-24","2021-02-24","2021-02-24","2021-11-10","2021-09-10","2021-09-30","2021-11-10","2021-07-21","2021-11-10","2021-11-10","2021-11-10","2021-11-10","2021-11-10","2021-08-04","2020-07-28","2020-07-28","2021-07-21","2021-02-24","2021-02-24","2021-09-30","2021-09-30"],"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":[["","00527411737","PROPRANOLOL","CAP 80MG ER","90","Select","Select",""],["","75834022101","CARBAMAZEPIN","TAB 200MG","75","Select","Select",""],["","67877022505","MYCOPHENOLAT","TAB 500MG","120","Select","Select",""],["","00378729189","NORETHIN","TAB 5MG","10","Select","Select",""],["","11534016503","FOLIC","TAB 1MG","30","Select","Select",""],["","00378180377","LEVOTHYROXIN","TAB 50MCG","30","Select","Select",""],["","51672403201","WARFARIN","TAB 5MG","135","Select","Select",""],["","43547035211","LISINOPRIL","TAB 5MG","90","Select","Select",""],["","70461032103","FLUCLVX","INJ 2021-22","0","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":""}]}]}