{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"THOMAS WALTERS","gend":0,"add":"2003 INDIAN TRAIL ROAD","city":"KEEZLETOWN","state":"VA","zip":"22832-9998","dob":"1968-12-23","age":"","mstatus":"","insh":"20036881*01","cliId":"","pno":"540\/269-2054","cno":"","email":"","ename":"","eno":"","pphy":"JOHNSTON, PAUL T PA","ppno":"540\/564-7300","pcpadd":"1661 S MAIN STREET","pcpcity":"HARRISONBURG","pcpstate":"VA","pcpzip":22801,"pcpcounty":"","pcpid":"","pcpname":"SRMHMG - Sentara South Main Health Center","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/431-7100","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I47.1","E11.65","I10.","E78.5","R60.0","R07.89","F45.42","G89.29","M54.5","M51.36","M51.26","NO DATA","E88.2","M46.96","M54.2","M50.30","M47.812","M25.78","M25.561","M25.562","M54.16","M54.12","E11.40","M79.7","R07.9","E11.9","Z79.4","M47.817","M43.00","M48.061","B35.1","L85.1","R09.89","E11.42","Z51.81","I45.19","E08.65","H52.13","H52.223","H52.4","H35.033","R52.","M54.89","R09.02","R00.0","K59.00","M47.814","M25.569","Z00.00","Z12.5","Z11.59","Z79.891","E66.01","Z12.11","R21.","M79.604","G89.4","Z13.89","I45.10","M71.21","H40.013","K63.5","M79.661","M79.89","M54.9","Z79.899","Z88.8","M17.11","Z28.21","Z71.89","B35.3","E10.42"],"date":["2021-06-03","2021-12-06","2021-12-06","2021-04-14","2020-12-03","2020-07-08","2021-12-01","2021-12-30","2021-09-01","2021-12-30","2020-06-17","2021-12-30","2020-06-17","2021-12-30","2020-06-17","2020-06-17","2021-10-08","2020-06-17","2021-12-30","2021-12-30","2021-12-30","2021-12-30","2020-07-07","2021-12-30","2020-03-06","2021-06-07","2021-06-03","2021-12-30","2021-12-30","2021-07-08","2020-12-03","2020-12-03","2020-09-23","2020-12-03","2020-01-29","2020-07-08","2021-04-14","2021-06-07","2021-06-07","2021-06-07","2021-06-07","2020-01-20","2020-01-20","2020-01-20","2020-01-20","2020-05-29","2020-05-29","2020-05-29","2021-06-03","2021-06-03","2021-06-03","2019-08-30","2019-03-26","2019-08-07","2019-06-11","2019-09-03","2020-05-29","2020-05-29","2019-08-06","2019-09-11","2019-01-23","2019-08-07","2019-08-30","2019-08-30","2019-08-30","2019-08-30","2019-08-30","2019-09-11","2019-10-21","2019-10-21","2019-03-20","2019-04-17"],"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":[["","","MORPHINE","TAB 15MG ER","","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","100","Select","Select",""],["","08290328203","BD  PEN NEEDL","MIS 29GX12.7","6","Select","Select",""],["","00169406012","VICTOZA","INJ 18MG\/3ML","6","Select","Select",""],["","08470385001","UNIFINE","MIS 31GX5MM","100","Select","Select",""],["","42858000201","OXYCODONE","TAB 10MG","120","Select","Select",""],["","65862001005","METFORMIN","TAB 1000MG","75","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","15","Select","Select",""],["","31722088490","ROSUVASTATIN","TAB 20MG","30","Select","Select",""],["","43547035110","LISINOPRIL","TAB 2.5MG","30","Select","Select",""],["","65862052301","GABAPENTIN","TAB 600MG","180","Select","Select",""],["","00002879959","HUMALOG","INJ 100\/ML","30","Select","Select",""],["","16714049602","CLOTRIM\/BETA","CRE 1-0.05%","45","Select","Select",""],["","00002822259","INSULIN","INJ 100\/ML","90","Select","Select",""],["","","BUPRENORPHIN","DIS 10MCG\/HR","","Select","Select",""],["","","BUTRANS","DIS 10MCG\/HR","","Select","Select",""],["","","BELBUCA","MIS 150MCG","","Select","Select",""],["","65597030210","MORPHABOND","TAB 30MG ER","60","Select","Select",""],["","64764008060","AMITIZA","CAP 8MCG","60","Select","Select",""],["","00832046560","NYAMYC","POW 100000","60","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","51672530200","CICLOPIROX","SOL 0.08","7","Select","Select",""],["","10572010001","PEG-3350","SOL ELECTROL","4000","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","52268001201","SUPREP","SOL PREP KIT","354","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":""}]}]}