{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KEJASHIA CREASY","gend":1,"add":"426 GARRETT ST APT D","city":"CHARLOTTESVILLE","state":"VA","zip":"22902-9998","dob":"1992-12-29","age":"","mstatus":"","insh":"7463707*01","cliId":"","pno":"434\/529-7143","cno":"","email":"","ename":"","eno":"","pphy":"POLLART, SUSAN P MD","ppno":"434\/924-5348","pcpadd":"1221 LEE ST","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22908,"pcpcounty":"","pcpid":"","pcpname":"UNIVERSITY OF VIRGINIA PHYSICIANS GROUP","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/982-4306","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G43.909","R51.9","G43.709","R51.","L30.1","D50.9","T83.89XA","D72.818","N92.0","F43.21","S16.1XXA","S29.011A","V43.62XA","K59.04","F32.9","G43.719","J02.9","J06.9","T14.90XA","R69.","M54.5","M54.9","R53.1","O99.345","NO DATA"],"date":["2021-09-18","2021-09-18","2019-10-10","2019-03-27","2019-04-22","2019-11-22","2019-11-22","2019-11-22","2019-11-22","2020-08-04","2019-06-10","2019-06-10","2019-06-10","2020-07-21","2020-07-21","2020-07-21","2020-02-13","2020-02-13","2019-06-10","2019-06-10","2020-01-24","2020-01-24","2020-02-12","2020-07-21","2020-07-21"],"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":[["","","TOPIRAMATE"," TOPIRAMATE ","120","Select","Select",""],["","","HYDROCORT"," HYDROCORT ","28","Select","Select",""],["","","CYCLOBENZAPR"," CYCLOBENZAPR ","15","Select","Select",""],["","","NAPROXEN"," NAPROXEN ","30","Select","Select",""],["","","VENLAFAXINE"," VENLAFAXINE ","60","Select","Select",""],["","","DEXAMETHASON"," DEXAMETHASON ","24","Select","Select",""],["","","BISACODYL","TAB 5MG EC","","Select","Select",""],["","","ESCITALOPRAM","TAB 20MG","","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":""}]}]}