{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KHRISTOPHER   A THOMPSON","gend":0,"add":"170 UNION MILLS ROAD","city":"TROY","state":"VA","zip":"22974-9998","dob":"1978-01-24","age":"","mstatus":"","insh":"20053734*01","cliId":"","pno":"434\/293-2194","cno":"434\/293-2194","email":"","ename":"","eno":"","pphy":"HADA, MARIA S NP","ppno":"434\/227-5624","pcpadd":"800 PRESTON AVENUE","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22903,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/970-7700","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.2","F25.0","I10.","E78.2","Z71.3","Z71.89","F31.74","F17.200","G47.33","K76.0","L02.211","F17.210","L08.82","E66.01","R74.01","F29.","F10.99","Z23.","E78.5","R74.8","Z11.52","J34.89","F99.","R46.89","F20.9"],"date":["2020-09-29","2022-08-16","2021-12-22","2021-12-22","2021-12-22","2021-12-22","2021-12-22","2021-12-22","2021-12-22","2021-12-22","2020-07-30","2020-07-30","2020-08-13","2021-01-13","2021-01-18","2020-01-07","2020-01-07","2020-10-27","2020-10-27","2021-01-13","2022-02-09","2022-02-09","2020-01-07","2020-01-07","2020-01-07"],"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":[]},{"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":[["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","20","Select","Select",""],["","00187540008","JUBLIA","SOL 0.1","8","Select","Select",""],["","00093226301","AMOXICILLIN","TAB 500MG","21","Select","Select",""],["","31722070090","LOSARTAN","TAB 25MG","30","Select","Select",""],["","45802014167","CICLOPIROX","SOL 0.08","7","Select","Select",""],["","43547030403","ARIPIPRAZOLE","TAB 10MG","30","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","00603243921","BENZTROPINE","TAB 2MG","30","Select","Select",""],["","55111053401","DIVALPROEX","TAB 500MG ER","30","Select","Select",""],["","00832154011","HALOPERIDOL","TAB 5MG","60","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","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":""}]}]}