{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DANIELLE   L CAMIRE","gend":1,"add":"258 WOODCHUCK DR","city":"APPOMATTOX","state":"VA","zip":"24522-9998","dob":"1990-07-28","age":"","mstatus":"","insh":"2227753*01","cliId":"","pno":"434\/710-0513","cno":"","email":"","ename":"","eno":"","pphy":"NEUMANN, MATTHEW NP","ppno":"434\/200-7210","pcpadd":"125 NATIONWIDE DR","pcpcity":"LYNCHBURG","pcpstate":"VA","pcpzip":24502,"pcpcounty":"","pcpid":"","pcpname":"CENTRA MEDICAL GROUP LLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/200-5948","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K21.9","G25.81","O24.113","F17.200","Z71.6","E11.319","Z13.32","Z23.","Z39.1","O80.","Z3A.36","Z37.0","O60.14X0","D62.","O62.3","O77.0","F17.210","O99.334","O99.62","O99.02","O60.10X0","Z3A.39","O60.03","Z3A.38","O71.4"],"date":["2020-11-10","2020-10-15","2020-10-15","2020-10-15","2020-10-15","2020-10-15","2020-08-17","2020-10-13","2019-12-17","2020-11-10","2020-11-10","2020-11-10","2020-11-10","2020-11-10","2020-11-10","2020-11-10","2020-11-10","2020-11-10","2020-11-10","2020-11-10","2020-11-10","2019-12-14","2019-12-13","2019-12-13","2019-12-14"],"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":[["","","LANSOPRAZOLE","CAP 15MG DR","","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","","SRONYX","TAB ","","Select","Select",""],["","","PREVACID","CAP 15MG DR","","Select","Select",""],["","","PENICILLN","TAB 250MG","","Select","Select",""],["","","PANTOPRAZOLE","TAB 20MG","","Select","Select",""],["","","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","00031871920","ROBIT","CAP 10-200MG","20","Select","Select",""],["","50428713423","PAIN","TAB 25-500MG","20","Select","Select",""],["","45802043262","PSEUDOEPHEDR","TAB 30MG","24","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":""}]}]}