{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WILLIAM   J LEED","gend":0,"add":"1409 W BAKER ST APT A","city":"CHARLOTTESVILLE","state":"VA","zip":"22903-9998","dob":"1980-10-03","age":"","mstatus":"","insh":"2149831*01","cliId":"","pno":"540\/566-2793","cno":"540\/566-2793","email":"","ename":"","eno":"","pphy":"HAMILTON, THOMAS FRANCIS MD","ppno":"540\/261-7421","pcpadd":"2252 MAGNOLIA AVE","pcpcity":"BUENA VISTA","pcpstate":"VA","pcpzip":24416,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/261-1952","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F32.9","B20.","F31.9","F63.81","F31.62","L03.119","E86.0","Z59.0","Z20.822","H04.129","H52.7","L29.9","L02.519","L02.419","F19.90","F33.1","G47.00","Z79.899","L08.9","F41.9","F42.4","NO DATA","B96.89","L02.821","L03.114","R53.83","Z23.","L30.9","L02.01","S05.02XA","Z91.19","R07.89","Z53.29","D72.829","L03.032","Z21.","R09.89","J34.0","L03.211","W57.XXXA"],"date":["2021-12-09","2022-09-29","2021-12-09","2021-12-16","2022-09-29","2021-05-13","2021-07-14","2021-07-14","2022-01-31","2020-05-29","2020-05-29","2021-06-02","2021-02-17","2021-05-13","2022-09-29","2021-12-09","2020-08-20","2021-03-04","2021-06-02","2021-06-02","2021-06-02","2021-06-02","2021-06-02","2021-01-05","2021-12-09","2022-01-14","2022-04-27","2020-07-29","2021-01-06","2020-03-07","2021-03-04","2021-05-29","2021-05-29","2021-07-20","2021-07-20","2020-05-12","2022-01-31","2022-08-21","2022-08-21","2022-08-21"],"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":[["","55111053401","DIVALPROEX","TAB 500MG ER","30","Select","Select",""],["","61958250101","BIKTARVY","TAB ","30","Select","Select",""],["","55111016330","OLANZAPINE","TAB 2.5MG","180","Select","Select",""],["","67877022310","GABAPENTIN","CAP 300MG","60","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","13668001005","CITALOPRAM","TAB 20MG","30","Select","Select",""],["","42571025201","CLINDAMYCIN","CAP 300MG","28","Select","Select",""],["","65862042001","SMZ\/TMP","TAB 800-160","30","Select","Select",""],["","00054418025","DEXAMETHASON","TAB 0.75MG","12","Select","Select",""],["","00143211205","DOXYCYCL","TAB 100MG","28","Select","Select",""],["","16714008210","HYDROXYZ","TAB 25MG","30","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","71930005552","APAP\/CODEINE","TAB 300-30MG","15","Select","Select",""],["","45802006003","BACITRACIN","OIN 500\/GM","28","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","6","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","69315030805","CIPROFLOXACN","SOL 0.3% OP","5","Select","Select",""],["","33342032980","TRIAMCINOLON","CRE 0.001","80","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":""}]}]}