{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SANDRA HUNT","gend":1,"add":"596 EADES LN","city":"LOVINGSTON","state":"VA","zip":"22949-9998","dob":"1974-12-06","age":"","mstatus":"","insh":"2235236*01","cliId":"","pno":"434\/826-0183","cno":"","email":"","ename":"","eno":"","pphy":"BROWN, BENJAMIN T MD","ppno":"434\/263-4000","pcpadd":"4038 THOMAS NELSON HIGHWAY","pcpcity":"ARRINGTON","pcpstate":"VA","pcpzip":22922,"pcpcounty":"","pcpid":"","pcpname":"BLUE RIDGE HEALTH CENTER INC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/263-4160","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G93.5","R51.9","G89.18","G89.29","Z48.02","G97.82","Q07.00","Q05.5","Z88.0","Z88.5","Z88.6","S93.492A","M79.672","F15.10","S93.402A","M54.12","F32.9","F41.0","F17.200","Z20.828","Z79.899","NO DATA","M54.2","M75.02","M25.512","M62.838","F41.9","G89.4"],"date":["2021-05-07","2020-12-04","2020-12-04","2020-12-02","2021-05-07","2021-05-07","2021-05-07","2021-04-14","2021-04-14","2021-04-14","2021-04-14","2020-06-24","2020-06-24","2020-02-19","2020-06-10","2020-11-02","2020-12-01","2020-12-01","2020-12-01","2020-12-01","2020-12-01","2021-03-26","2019-11-14","2019-11-14","2019-11-03","2019-11-18","2019-12-05","2019-12-05"],"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":[["","55111017915","TIZANIDINE","TAB 2MG","6","Select","Select",""],["","","OXYCODONE","TAB 5MG","","Select","Select",""],["","65162062711","TRAMADOL","TAB 50MG","2","Select","Select",""],["","","GABAPENTIN","CAP 100MG","","Select","Select",""],["","76329336901","NALOXONE","INJ 1MG\/ML","4","Select","Select",""],["","00172392670","DIAZEPAM","TAB 5MG","7","Select","Select",""],["","43547022650","METHOCARBAM","TAB 750MG","20","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","52817031910","BACLOFEN","TAB 5MG","30","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","40","Select","Select",""],["","10702000710","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","","DICLOFENAC","TAB 75MG DR","","Select","Select",""],["","","DOK","CAP 100MG","","Select","Select",""],["","","KETOROLAC","TAB 10MG","","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","6","Select","Select",""],["","00378247401","DICLOFEN","TAB 50MG","90","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","15","Select","Select",""],["","00228202796","ALPRAZOLAM","TAB 0.25MG","2","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":""}]}]}