{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AUTUMN   R FLETCHER","gend":1,"add":"16 LINCOLN CIR APT 4","city":"HARRISONBURG","state":"VA","zip":"22802-9998","dob":"2000-07-19","age":"","mstatus":"","insh":"7621167*01","cliId":"","pno":"540\/435-3461","cno":"","email":"","ename":"","eno":"","pphy":"ASHBY, JEFFREY A MD","ppno":"540\/433-9151","pcpadd":"1831 RESERVOIR ST","pcpcity":"HARRISONBURG","pcpstate":"VA","pcpzip":22801,"pcpcounty":"","pcpid":"","pcpname":"Harrisonburg Family Practice Associates","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/433-0547","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O60.03","Z3A.33","O70.0","O99.354","Z37.0","G40.909","Z3A.37","Z67.10","Z79.899","Z88.8","O47.1","G40.309","Z3A.28","O99.353","Z3A.34","S40.862A","R10.31","Z20.828","R43.9","R05.","R50.9","Z20.822","Z82.49","Z83.42","Z83.49","V23.9","O99.352","Z3A.30","Z3A.12","R11.10","E86.0","Z3A.32","R10.84","G40.409","R40.4","R56.9","R58.","R52.","M25.519","J02.9","R51.","J02.8","J34.89","R07.0","Z3A.35","Z3A.36","S29.019A","S39.012A","G43.909","N92.6","Z30.09","Z13.31","Z32.02","M25.511","G43.009","R29.898","G47.9","O99.89","R21.","L29.9","Z3A.26","O99.283","O99.345","NO DATA","M54.6","B34.9","K29.70","L25.5","O80.","Z03.818","Z30.42","K59.00","R43.8","G43.109","Z34.02","Z3A.18","Z34.90","Z34.01","L55.9","Z3A.14","L02.612","Z3A.17","R55.","H44.001","Z36.3","Z3A.21","L53.9"],"date":["2020-02-27","2020-02-27","2020-03-30","2020-03-30","2020-03-30","2021-12-13","2020-03-30","2020-03-30","2021-11-27","2021-11-27","2020-03-30","2021-12-13","2020-01-27","2020-03-24","2020-03-10","2020-11-12","2021-05-15","2021-03-09","2021-09-13","2021-09-13","2021-09-13","2021-09-13","2021-09-13","2021-09-13","2021-09-13","2020-02-24","2020-02-24","2020-02-10","2021-12-13","2020-02-18","2020-02-18","2020-02-24","2021-05-15","2021-11-27","2021-11-27","2021-11-27","2021-11-27","2021-11-27","2021-11-27","2020-06-22","2020-06-22","2021-11-23","2020-01-13","2020-01-13","2020-03-10","2020-03-24","2020-10-05","2020-10-05","2021-05-19","2021-06-28","2021-06-28","2021-06-28","2021-06-28","2021-11-27","2021-12-13","2021-12-13","2021-12-13","2020-01-07","2020-01-07","2020-01-07","2020-01-10","2020-02-18","2020-05-15","2020-05-15","2020-08-31","2021-03-09","2021-05-19","2021-07-21","2020-03-30","2020-06-20","2020-06-30","2021-03-12","2021-09-13","2019-01-16","2019-12-06","2019-11-15","2019-09-30","2019-10-07","2019-05-28","2019-10-18","2019-12-18","2019-11-08","2019-05-29","2019-10-01","2019-12-06","2019-12-06","2019-12-17"],"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":[["","69097086107","ZONISAMIDE","CAP 100MG","120","Select","Select",""],["","","XULANE","DIS 150-35","","Select","Select",""],["","45802086802","POLYETH","POW 3350 NF","238","Select","Select",""],["","68180089373","PIRMELLA","TAB 12785","28","Select","Select",""],["","65162035803","ZAFEMY","DIS 150\/35","3","Select","Select",""],["","21922001704","CLOBETASOL","OIN 0.0005","15","Select","Select",""],["","65162047810","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","59267100003","PFIZER","INJ COVID-19","0","Select","Select",""],["","","AMOXICILLIN","CAP 500MG","","Select","Select",""],["","11534016503","FOLIC","TAB 1MG","60","Select","Select",""],["","00781286810","OMEPRAZOLE","CAP 20MG","10","Select","Select",""],["","16729013616","CLONAZEPAM","TAB 0.5MG","20","Select","Select",""],["","","IBUPROFEN","TAB 600MG","","Select","Select",""],["","","STOOL","CAP 100MG","","Select","Select",""],["","","DOK","TAB 100MG","","Select","Select",""],["","","IRON","TAB 325MG","","Select","Select",""],["","","SERTRALINE","TAB 50MG","","Select","Select",""],["","","DICLOFENAC","GEL 0.01","","Select","Select",""],["","","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","","LIDOCAINE","PAD 0.05","","Select","Select",""],["","","ONDANSETRON","TAB 4MG ODT","","Select","Select",""],["","","MEDROXYPR","INJ 150MG\/ML","","Select","Select",""],["","","BACLOFEN","TAB 10MG","","Select","Select",""],["","00555901858","TRI-SPRINTEC","TAB ","28","Select","Select",""],["","43598021055","SSD","CRE 0.01","50","Select","Select",""],["","00054472825","PREDNISONE","TAB 5MG","20","Select","Select",""],["","61314070101","SULFACET","SOL 10% OP","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":""}]}]}