{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ASHLEY   N DOTSON","gend":1,"add":"PO BOX 28","city":"SUTHERLIN","state":"VA","zip":"24594-9998","dob":"1987-12-06","age":"","mstatus":"","insh":"2172814*01","cliId":"","pno":"434\/374-9975","cno":"","email":"","ename":"","eno":"","pphy":"BANE, MAGGIE NP","ppno":"434\/517-8627","pcpadd":"2206 WILBORN AVENUE","pcpcity":"SOUTH BOSTON","pcpstate":"VA","pcpzip":24592,"pcpcounty":"","pcpid":"","pcpname":"DOMINION HEALTH MEDICAL ASSOCIATES LTD","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/517-8080","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K92.1","K52.9","R19.4","N91.1","Z23.","Z34.93","N92.6","Z32.02","R10.32","Z30.42","Z30.09","K22.2","NO DATA","K29.70","K44.9","R10.9","M79.661","H92.02","R10.13","K21.9","N39.0","N85.00","O34.211","O61.0","O99.824","O66.41","Z3A.37","O99.02","D64.9","Z37.0","Z82.49","H00.011","R10.2","N89.8","Z01.89","M54.5","D50.9","Z20.822","R14.0","R68.81","Z83.79","R07.9","R30.0","Z34.92","V23.41","Z91.018","Z01.419","R19.7","R10.84","Z11.59","Z20.828","R11.0","Z90.49","Z01.810","Z01.812","R07.1","R06.02"],"date":["2019-03-20","2019-03-20","2019-03-20","2019-08-14","2019-12-09","2019-12-09","2020-11-02","2020-11-02","2020-11-02","2021-12-09","2021-12-09","2021-05-25","2021-05-25","2021-05-04","2021-05-25","2021-05-25","2019-03-16","2019-03-16","2021-04-22","2021-04-27","2019-05-02","2019-05-02","2020-01-26","2020-01-26","2020-01-25","2020-01-25","2020-01-26","2020-01-25","2021-04-30","2020-01-26","2020-01-25","2020-09-02","2021-04-12","2021-04-12","2021-04-30","2021-04-30","2021-04-30","2021-09-16","2021-05-11","2021-05-25","2021-05-25","2021-07-25","2021-07-25","2019-08-28","2019-11-15","2021-05-25","2021-06-04","2019-03-20","2019-03-05","2020-07-31","2020-07-31","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2020-01-31","2020-01-31"],"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":[["","","SUCRALFATE"," SUCRALFATE ","60","Select","Select",""],["","","CEFUROXIME"," CEFUROXIME ","20","Select","Select",""],["","","RANITIDINE"," RANITIDINE ","60","Select","Select",""],["","","DICYCLOMINE"," DICYCLOMINE ","60","Select","Select",""],["","","PHENAZOPYRID"," PHENAZOPYRID ","6","Select","Select",""],["","","CLINDAMYCIN"," CLINDAMYCIN ","14","Select","Select",""],["","","OMEPRAZOLE"," OMEPRAZOLE ","28","Select","Select",""],["","","IBUPROFEN","TAB 800MG","","Select","Select",""],["","","VITAMIN","TAB 500MG","","Select","Select",""],["","","OXYCOD\/APAP","TAB 5-325MG","","Select","Select",""],["","","METRONIDAZOL","TAB 500MG","","Select","Select",""],["","","MEDROXYPR","INJ 150MG\/ML","","Select","Select",""],["","","FERROUS","TAB 325MG","","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","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":""}]}]}