{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SOPHIE   L TUGMAN","gend":1,"add":"239 VINE ST APT 202","city":"HARRISONBURG","state":"VA","zip":"22802-9998","dob":"1990-06-04","age":"","mstatus":"","insh":"20063777*01","cliId":"","pno":"540\/609-4385","cno":"","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":["M25.571","F43.21","F41.8","G43.809","H81.10","R07.9","F33.1","S20.212A","N83.201","D25.1","M25.512","R51.","F33.0","R42.","R10.32","E66.01","F17.200","Z79.899","J06.9","R05.","Z20.822","B34.9","Z11.59","R10.84","R30.0","R10.2","G89.29","N30.01","D21.9","R10.9","F32.9","R51.9","S99.911A","M89.8X1","S16.1XXA","R09.89","N30.00","G44.89","S93.491A","Z91.14","R52.","R59.1","S93.401A","N64.59","E66.9","Z68.31","M24.271","S86.311A","R11.0","H53.149","H53.8","Z68.42","R26.9","H65.92"],"date":["2021-01-22","2020-08-20","2020-08-20","2020-09-13","2020-09-13","2020-09-22","2021-12-14","2021-04-20","2021-06-06","2021-06-06","2021-12-23","2020-03-10","2020-08-19","2020-10-28","2021-05-26","2021-05-26","2021-05-26","2021-05-26","2021-08-17","2021-08-17","2021-08-17","2020-03-26","2020-03-26","2021-07-30","2020-11-07","2020-11-07","2021-12-23","2021-07-30","2021-07-30","2021-07-30","2020-02-24","2020-10-28","2020-12-07","2021-12-23","2021-12-23","2020-03-26","2020-08-25","2020-10-28","2021-01-26","2020-01-14","2021-07-30","2020-03-10","2020-09-03","2020-07-31","2021-01-22","2021-01-22","2021-01-26","2021-01-26","2021-07-30","2020-02-03","2020-02-03","2020-09-03","2020-09-03","2021-09-05"],"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":[["","62332002331","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","43547028111","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","00093100301","BUSPIRONE","TAB 15MG","60","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","5","Select","Select",""],["","45963014205","BUPROPN","TAB 300MG XL","30","Select","Select",""],["","57237002801","AMOXICILLIN","TAB 500MG","30","Select","Select",""],["","00456112030","VIIBRYD","TAB 20MG","30","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","40","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","42806031250","DOXYCYCL","TAB 100MG","20","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","68645056259","IBUPROFEN","TAB 600MG","20","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","65162019011","NAPROXEN","TAB 500MG","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":""}]}]}