{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BONNIE   S WELDON","gend":1,"add":"703 SELMA ROAD","city":"HOWARDSVILLE","state":"VA","zip":"24562-9998","dob":"1985-10-20","age":"","mstatus":"","insh":"2216534*01","cliId":"","pno":"434\/960-4053","cno":"","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":"CENTRAL VIRGINIA HEALTH SERVICES INC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","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":["F41.9","G47.00","Z88.9","F43.10","F32.0","Z00.8","R10.84","B86.","R21.","E55.9","T78.40XA","Z36.87","Z3A.01","K59.00","R30.0","M54.5","R10.2","N90.89","L28.0","L30.8","L29.9","N39.0","N73.9","Z30.09","Z71.3","Z71.89","R93.3","R10.30","R63.4","Z83.71","Z20.2","Z11.3","Z00.00","N76.0","A60.04","N91.2","N92.1","L25.9","N30.00","S46.811A","Z23.","Z30.46","R35.0","Z87.891","Z79.899","Z88.0","Z91.040","Z91.018","Z91.013","Z91.030","Z88.8","O42.00","O47.9","S80.02XA","N91.1","N92.6","F41.8","Z32.01","S93.422A","N93.9","Z53.21","Z12.4","Z30.40","Z12.39","T78.40XS","Z11.1"],"date":["2021-11-30","2021-01-05","2021-11-30","2020-08-31","2020-08-31","2021-09-15","2020-05-14","2020-12-30","2021-01-05","2021-11-30","2021-01-23","2021-02-25","2021-02-25","2020-03-04","2020-07-17","2020-04-20","2020-06-18","2021-01-11","2021-07-19","2021-01-12","2021-01-12","2021-01-16","2021-01-16","2021-07-19","2021-07-19","2021-07-19","2020-04-29","2020-04-29","2020-04-29","2020-04-29","2021-03-01","2021-03-01","2021-07-19","2021-02-22","2021-03-01","2021-03-22","2021-09-09","2020-11-23","2021-02-22","2021-05-29","2021-11-30","2021-08-06","2021-11-30","2019-09-08","2019-09-08","2019-09-08","2019-09-08","2019-09-08","2019-09-08","2019-09-08","2019-09-08","2019-11-15","2019-11-15","2019-08-28","2019-09-10","2019-09-10","2019-09-10","2019-09-10","2019-08-23","2019-11-15","2019-11-15","2019-09-25","2019-09-25","2019-09-25","2019-09-25","2019-09-25"],"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":[["","42806031250","DOXYCYCL","TAB 100MG","28","Select","Select",""],["","31722094101","HYDROCO\/APAP","TAB 5-325MG","8","Select","Select",""],["","","TRIAMCINOLON","OIN 0.001","","Select","Select",""],["","00555077902","MEDROXYPR","TAB 10MG","5","Select","Select",""],["","","HAILEY","TAB 43831","","Select","Select",""],["","","METRONIDAZOL","TAB 500MG","","Select","Select",""],["","","VALACYCLOVIR","TAB 1GM","","Select","Select",""],["","00093005405","BUSPIRONE","TAB 10MG","180","Select","Select",""],["","00406051201","OXYCOD\/APAP","TAB 5-325MG","12","Select","Select",""],["","43598075205","BUPROPION","TAB 150MG SR","180","Select","Select",""],["","42806054701","VITAMIN","CAP 1.25MG","4","Select","Select",""],["","68382080701","TRAZODONE","TAB 150MG","30","Select","Select",""],["","49502010202","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","","LEVONORGESTR","TAB 1.5MG","","Select","Select",""],["","","MUPIROCIN","OIN 0.02","","Select","Select",""],["","00555021110","NORETHIN","TAB 5MG","30","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","8","Select","Select",""],["","00904530660","BANOPHEN","CAP 25MG","24","Select","Select",""],["","","SMZ\/TMP","TAB 800-160","","Select","Select",""],["","10702000709","CYCLOBENZAPR","TAB 10MG","20","Select","Select",""],["","43386048026","ORPHENADRINE","TAB 100MG ER","20","Select","Select",""],["","","CLOBETASOL","OIN 0.0005","","Select","Select",""],["","","ALLERGY","TAB 10MG","","Select","Select",""],["","68645014059","FAMOTIDINE","TAB 20MG","28","Select","Select",""],["","","PHENAZOPYRID","TAB 200MG","","Select","Select",""],["","","NITROFURANTN","CAP 100MG","","Select","Select",""],["","","APAP\/CODEINE","TAB 300-30MG","","Select","Select",""],["","","LORATADINE","TAB 10MG","","Select","Select",""],["","","GAVILYTE-G","SOL ","","Select","Select",""],["","","PEG-3350","SOL ELECTROL","","Select","Select",""],["","","SUPREP","SOL PREP KIT","","Select","Select",""],["","","CIPROFLOXACN","TAB 500MG","","Select","Select",""],["","","ONDANSETRON","TAB 4MG","","Select","Select",""],["","","DICYCLOMINE","CAP 10MG","","Select","Select",""],["","","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","","FC2","MIS CONDOM","","Select","Select",""],["","","TAMSULOSIN","CAP 0.4MG","","Select","Select",""],["","","PERMETHRIN","CRE 0.05","","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":""}]}]}