{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMIRAH   K JONES","gend":1,"add":"716 FEDERAL ST APT 48","city":"LYNCHBURG","state":"VA","zip":"24504-9998","dob":"1999-06-16","age":"","mstatus":"","insh":"6532144*01","cliId":"","pno":"434\/420-0765","cno":"434\/363-6647","email":"","ename":"","eno":"","pphy":"CLAPP, SUSAN NP","ppno":"434\/200-3366","pcpadd":"800 5TH STREET","pcpcity":"LYNCHBURG","pcpstate":"VA","pcpzip":24504,"pcpcounty":"","pcpid":"","pcpname":"COMMUNITY ACCESS NETWORK","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/528-9101","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N76.0","B96.89","Z11.3","Z30.09","N92.6","R22.1","F33.1","F41.9","T78.40XA","O26.891","K59.00","R10.2","Z3A.09","M25.531","O60.00","F33.2","O80.","Z37.0","Z3A.38","F32.9","O99.340","Z3A.36","H65.03","R07.9","R79.89","O99.89","O26.90","S91.332A","O60.03","Z3A.28","Z87.891","O26.899","R74.8","R42.","R10.9","O76.","O99.344","O77.0","Z34.03","Z3A.00","Z39.2","Z34.93"],"date":["2021-10-11","2021-10-11","2021-10-11","2020-08-07","2021-09-20","2021-08-20","2021-04-28","2021-04-28","2021-04-28","2021-01-23","2021-01-23","2021-01-23","2021-01-23","2021-07-04","2019-04-12","2019-12-12","2019-06-18","2019-06-18","2019-06-18","2019-06-17","2019-05-30","2019-05-30","2019-06-14","2019-05-25","2019-05-25","2019-05-25","2019-06-16","2019-11-25","2019-04-12","2019-04-12","2019-06-17","2019-05-25","2019-05-25","2019-05-25","2019-05-25","2019-06-17","2019-06-17","2019-06-17","2019-06-17","2019-06-17","2019-06-19","2019-06-13"],"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":[["","68382003516","VENLAFAXINE","CAP 75MG ER","30","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","10","Select","Select",""],["","59762500801","MISOPROSTOL","TAB 200MCG","4","Select","Select",""],["","59779030603","CVS","POW ","510","Select","Select",""],["","41100082071","MIRALAX","POW 3350 NF","510","Select","Select",""],["","00378064110","PREDNISONE","TAB 10MG","10","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","30","Select","Select",""],["","65162052110","PROMETHAZINE","TAB 25MG","3","Select","Select",""],["","","METRONIDAZOL","TAB 500MG","","Select","Select",""],["","50428033106","GLYCERIN","SUP 2GM","10","Select","Select",""],["","","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","","XULANE","DIS 150-35","","Select","Select",""],["","45802048678","DOCUSATE","CAP 100MG","20","Select","Select",""],["","60432053716","NYSTATIN","SUS 100000","80","Select","Select",""],["","69097083412","SERTRALINE","TAB 50MG","15","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","14","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","16","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","30","Select","Select",""],["","50111064801","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","50111043301","TRAZODONE","TAB 50MG","30","Select","Select",""],["","68462056417","MUPIROCIN","CRE 0.02","15","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":""}]}]}