{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KELSEY EDWARDS","gend":1,"add":"2462 HAWKSBILL ROAD","city":"MCGAHEYSVILLE","state":"VA","zip":"22840-9998","dob":"2000-04-17","age":"","mstatus":"","insh":"20057322*01","cliId":"","pno":"540\/289-7903","cno":"540\/289-7903","email":"","ename":"","eno":"","pphy":"PRIEUR, TARA H MD","ppno":"540\/434-3007","pcpadd":"1947 MEDICAL AVE","pcpcity":"HARRISONBURG","pcpstate":"VA","pcpzip":22801,"pcpcounty":"","pcpid":"","pcpname":"UVA Pediatrics Harrisonburg","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/434-3659","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F50.2","F31.81","F50.02","F51.05","F41.0","F41.1","H10.31","Z79.899","L63.8","F32.9","F10.10","F12.10","Z76.89","Z11.59","F31.12","V62.84","Z72.89","F12.90","H10.11","H53.9","H01.133","F31.32","J01.90","F33.0","Z20.828","F33.41","F33.2","Z00.01","Z13.31","L63.9","Z13.39","N92.6","N94.6","Z11.3","NO DATA","H10.9","Z03.818"],"date":["2022-08-01","2022-10-24","2022-10-24","2021-09-08","2022-03-16","2022-10-24","2021-01-17","2022-10-24","2022-06-13","2020-09-24","2020-09-21","2020-09-21","2020-09-21","2020-09-21","2020-09-23","2021-01-17","2020-09-24","2020-09-24","2021-01-09","2021-01-09","2021-01-09","2021-01-17","2022-08-23","2020-08-17","2021-01-11","2020-04-07","2020-09-14","2021-11-09","2021-11-09","2021-11-09","2021-11-09","2021-11-09","2021-11-09","2021-11-09","2021-01-06","2021-01-17","2021-01-17"],"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":[]},{"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":[["","43547030303","ARIPIPRAZOLE","TAB 5MG","30","Select","Select",""],["","00054002025","LITHIUM","TAB 450MG ER","30","Select","Select",""],["","00555901658","SPRINTEC","TAB 28 DAY","84","Select","Select",""],["","50111043401","TRAZODONE","TAB 100MG","30","Select","Select",""],["","65862022801","LAMOTRIGINE","TAB 100MG","60","Select","Select",""],["","42571038519","TRIAMCINOLON","LOT 0.001","60","Select","Select",""],["","51672127901","FLUOCINONIDE","GEL 0.0005","30","Select","Select",""],["","59148001971","ABILIFY","INJ 400MG","1","Select","Select",""],["","27241009809","DULOXETINE","CAP 30MG","30","Select","Select",""],["","54879000460","BETAMETH","LOT 0.001","60","Select","Select",""],["","69238207707","PROPRANOLOL","TAB 10MG","90","Select","Select",""],["","68180016011","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","17478071131","LIDOCAINE","GEL 2% JELLY","100","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","20","Select","Select",""],["","31722070530","VALACYCLOVIR","TAB 1GM","20","Select","Select",""],["","50428047857","EYE","DRO 0.025%OP","5","Select","Select",""],["","60505056000","OFLOXACIN","DRO 0.3% OP","5","Select","Select",""],["","42806016005","HYDROXYZ","TAB 25MG","60","Select","Select",""],["","24208091055","ERYTHROMYCIN","OIN 5MG\/GM","4","Select","Select",""],["","65862084003","MOXIFLOXACIN","SOL HCL 0.5%","3","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","69097083412","SERTRALINE","TAB 50MG","30","Select","Select",""],["","68180059306","DESVENLAFAX","TAB 100MG ER","30","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":""}]}]}