{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"VERUCA   J WOOD","gend":1,"add":"527 N SKYLINE AVE APT 11","city":"DANVILLE","state":"VA","zip":"24540-9998","dob":"2001-04-28","age":"","mstatus":"","insh":"7544065*01","cliId":"","pno":"434\/835-3012","cno":"434\/429-1679","email":"","ename":"","eno":"","pphy":"OMOJI, BASSEY MD","ppno":"434\/793-7745","pcpadd":"SUITE B 140 PINEY FOREST RD","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24540,"pcpcounty":"","pcpid":"","pcpname":"PIEDMONT PEDIATRICS INC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/793-7805","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.9","Z33.1","J06.9","Z30.430","N93.9","R10.30","Z97.5","Z53.20","Z20.828","F33.2","T50.901A","N39.0","F33.1","J02.9","R50.9","Z20.822","O99.89","R10.13","Z3A.00","O23.591","Z3A.11","Z23.","T42.4X1A","T42.8X1A","F41.9","Z81.8","Z79.899","Z91.030","Z91.013","Z39.1","O99.344","Z37.0","Z3A.40","F32.9","S93.401A","J03.90","R11.0","M62.838","Z04.3","T42.4X2A","T42.8X2A","O62.2","O99.02","D50.9","O80.","R20.2","M79.602","J30.9","B35.4","K04.99"],"date":["2019-06-11","2019-06-11","2019-11-05","2020-01-27","2021-01-20","2021-01-20","2021-01-20","2021-01-20","2021-01-29","2019-04-16","2019-04-16","2019-04-16","2020-05-07","2021-10-13","2021-10-13","2021-10-13","2019-05-04","2019-05-04","2019-05-04","2019-06-11","2019-06-11","2019-04-14","2019-04-14","2019-04-14","2021-12-09","2019-04-14","2019-04-14","2019-04-14","2019-04-14","2019-12-02","2020-01-01","2020-01-01","2020-01-01","2020-01-01","2020-02-27","2021-12-09","2021-12-09","2019-04-05","2019-04-05","2019-04-14","2019-04-14","2020-01-01","2020-01-01","2020-01-01","2020-01-01","2021-09-23","2021-09-23","2019-05-21","2019-05-21","2020-06-04"],"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":[["","","AMOXICILLIN","TAB 875MG","","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","16571020210","DICLOFENAC","TAB 50MG DR","14","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","40","Select","Select",""],["","16714008210","HYDROXYZ","TAB 25MG","30","Select","Select",""],["","","DOK","CAP 100MG","","Select","Select",""],["","","IBUPROFEN","TAB 800MG","","Select","Select",""],["","","FEROSUL","TAB 325MG","","Select","Select",""],["","","EQ","CAP SOFTENER","","Select","Select",""],["","","IRON","TAB 325MG","","Select","Select",""],["","","BUPROPN","TAB 150MG XL","","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":""}]}]}