{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ARIANNA DALTON","gend":1,"add":"2984 SANDY CREEK ROAD","city":"DRY FORK","state":"VA","zip":"24549-9998","dob":"2000-03-05","age":"","mstatus":"","insh":"7705409*01","cliId":"","pno":"434\/250-4240","cno":"","email":"","ename":"","eno":"","pphy":"MCCORMICK, PHYLLIS NP","ppno":"434\/791-4122","pcpadd":"705 MAIN ST","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"pcpcounty":"","pcpid":"","pcpname":"PIEDMONT ACCESS TO HEALTH SERVICES INC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/791-4126","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N89.8","N73.9","N70.03","B99.8","V62.84","F33.2","F32.9","Z11.59","R10.13","D72.829","D64.9","Z20.828","Z88.6","R42.","Z13.1","Z86.2","Z86.69","R07.89","S93.401A"],"date":["2020-10-15","2020-10-15","2020-10-16","2020-10-16","2020-11-27","2020-12-17","2020-11-24","2020-08-07","2020-10-15","2020-10-15","2020-10-15","2020-10-15","2020-10-15","2019-07-26","2019-07-26","2019-08-06","2019-08-06","2019-08-06","2019-01-06"],"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":[["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","","GAVILAX","POW ","","Select","Select",""],["","","PROCTOSOL","CRE 0.025","","Select","Select",""],["","","NICOTINE","DIS 14MG\/24H","","Select","Select",""],["","","HYDROCORTISO","CRE 0.025","","Select","Select",""],["","","TRAZODONE","TAB 50MG","","Select","Select",""],["","","CITALOPRAM","TAB 20MG","","Select","Select",""],["","","DOXYCYCL","TAB 100MG","","Select","Select",""],["","","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","","NAPROXEN","TAB 500MG","","Select","Select",""],["","","HYDROCORT","SUP 25MG","","Select","Select",""],["","","IBUPROFEN","TAB 800MG","","Select","Select",""],["","","METRONIDAZOL","TAB 500MG","","Select","Select",""],["","","HYDROXYZ","CAP 25MG","","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":""}]}]}