{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KHADIJA BROWN","gend":1,"add":"PO BOX 78","city":"FISHERSVILLE","state":"VA","zip":"22939-9998","dob":"2002-10-23","age":19,"mstatus":"","insh":"8251266*01","cliId":"","pno":"540\/942-4294","cno":"","email":"","ename":"","eno":"","pphy":"KOCKLER, VIRGINIA MD","ppno":"540\/932-0980","pcpadd":"57 BEAM LANE SUITE 202","pcpcity":"FISHERSVILLE","pcpstate":"VA","pcpzip":22939,"pcpcounty":"","pcpid":"","pcpname":"Augusta Pediatrics: UVA","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/932-0979","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":{"indx":["","","",""],"comment":["","","",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z00.01","Z13.31","I10.","E11.9","Z91.89","R03.0","J06.9","R07.89","Z20.822","S16.1XXA","S46.911A","S40.011A","M54.2","S29.012A","M25.511"],"date":["2021-06-23","2021-06-23","2022-07-24","2021-11-05","2020-12-04","2021-07-09","2022-09-23","2022-09-23","2022-09-23","2022-06-27","2022-06-27","2022-06-27","2022-06-27","2022-07-24","2022-07-24"],"priorHcc":["","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]}]}]},{"t":"Self-Assessment and Social History","q":[{"a":{"indx":["","","",""],"comment":["","","",""],"sub":[]}},{"a":{"indx":["","","",""],"comment":["","","",""],"sub":[]}},{"a":{"indx":["","","",""],"comment":["","","",""],"sub":[]}},{"a":{"indx":["","","",""],"comment":["","","",""],"sub":[]}},{"a":{"indx":["","","",""],"comment":["","","",""],"sub":[]}},{"a":{"indx":["","","",""],"comment":["","","",""],"sub":[]}},{"a":{"indx":["","","","","",""],"comment":["","","","","",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["","","","","","",""],"comment":["","","","","","",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"score":[0,0,0,0]}},{"a":{"index":-1,"commentTxt":"","arr":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":[false,false,false,false,false,false,false,false],"comment":["","","","","","","",""],"score":["","","","","","","",""]}}]},{"t":"Activities of Daily Living","q":[{"a":[{"indx":["","",""],"comment":["","",""],"sub":[]},{"indx":["","",""],"comment":["","",""],"sub":[]},{"indx":["","",""],"comment":["","",""],"sub":[]},{"indx":["","",""],"comment":["","",""],"sub":[]},{"indx":["","",""],"comment":["","",""],"sub":[]},{"indx":["","",""],"comment":["","",""],"sub":[]},{"indx":["","",""],"comment":["","",""],"sub":[]},{"indx":["","",""],"comment":["","",""],"sub":[]}]}]},{"t":"Medical History","q":[{"a":{"indx":[],"comment":[],"sub":{"indx":["","","","","","","",""],"comment":[""],"sub":[],"textValue":""}}},{"index":-1,"comment":"","sub":[]},{"a":[{"indx":["","","","","",""],"comment":["","","","","",""],"sub":[]},{"indx":["","","","","",""],"comment":["","","","","",""],"sub":[]},{"indx":["","","","","",""],"comment":["","","","","",""],"sub":[]},{"indx":["","","","","",""],"comment":["","","","","",""],"sub":[]},{"indx":["","","","","",""],"comment":["","","","","",""],"sub":[]}]},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":[{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]}]},{"a":[{"indx":["","",""],"comment":["","",""],"sub":[]},{"indx":["","",""],"comment":["","",""],"sub":[]},{"indx":["","",""],"comment":["","",""],"sub":[]},{"indx":["","",""],"comment":["","",""],"sub":[]},{"indx":["","",""],"comment":["","",""],"sub":[]},{"indx":["","",""],"comment":["","",""],"sub":[]}]}]},{"t":"Family History","q":[{"index":-1,"comment":"","sub":[]}]},{"t":"Preventive Care","q":[{"a":[["","","","",false],["","","","",false],["","","N\/A","",false],["","","N\/A","",false],["","","N\/A","",false],["","","N\/A","",false],["","","N\/A","",false],["","","N\/A","",false],["","","N\/A","",false],["","","N\/A","",false],["","","N\/A","",false],["","","N\/A","",false],["","","","",false],["","","N\/A","",false],["","","N\/A","",false],{"comment":""}]},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}}]},{"t":"Allergies \/ Medications","q":[{"a":{"index":-1,"commentTxt":"","arr":[]}},{"a":{"comment":"","sub":[["","69097084507","CYCLOBENZAPR","TAB 5MG","15","Select","Select",""],["","72819015110","DICLOFEN","TAB 50MG","20","Select","Select",""],["","76385012350","METHOCARBAM","TAB 500MG","24","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","20","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","","ONETOUCH","TES VERIO","","Select","Select",""],["","","METFORMIN","TAB 500MG","","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","10","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","49483060350","IBUPROFEN","TAB 600MG","20","Select","Select",""],["","00169430313","RYBELSUS","TAB 3MG","30","Select","Select",""],["","68180051303","LISINOPRIL","TAB 5MG","30","Select","Select",""],["","","CVS","CAP 2000UNIT","","Select","Select",""],["","","FLUBLOK","INJ 2020-21","","Select","Select",""]]}},{"a":{"index":-1,"commentTxt":"","arr":[]}},{"a":{"indx":[],"comment":[],"sub":{"indx":["","","","","","","",""],"comment":[""],"sub":[],"textValue":""}}},{"a":[{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]}]},{"a":{"indx":[false,false,false],"comment":["","",""],"score":["","",""]}},{"a":{"indx":[false],"comment":[""],"score":[""]}}]},{"t":"Review of Systems and Diagnoses","q":[{"a":{"indx":["",""],"comment":["",""],"sub":[{"indx":[],"comment":[],"sub":[]}],"subgroup":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[{"indx":[],"comment":[],"sub":[]}],"subgroup":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[{"indx":[],"comment":[],"sub":[]}],"subgroup":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[{"indx":[],"comment":[],"sub":[]}],"subgroup":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[{"indx":[],"comment":[],"sub":[]}],"subgroup":[]}},{"a":{"indx":[false,false,false,false,false,false],"comment":["","","","","",""],"score":["","","","","",""]}},{"a":{"indx":["",""],"comment":["",""],"sub":[{"indx":[],"comment":[],"sub":[]}],"subgroup":[]}},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"a":{"indx":["",""],"comment":["",""],"sub":[{"indx":[],"comment":[],"sub":[]}],"subgroup":[]}},{"a":{"indx":[false,false,false,false,false],"comment":["","","","",""],"score":["","","","",""]}},{"a":{"indx":["",""],"comment":["",""],"sub":[{"indx":[],"comment":[],"sub":[]}],"subgroup":[]}},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"a":{"indx":["",""],"comment":["",""],"score":[0,0,0,0]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[{"indx":[],"comment":[],"sub":[]}],"subgroup":[{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]}]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":["",""]},{"a":[{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["","",""],"comment":["","",""],"sub":[]}]},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":[{"indx":["","","",""],"comment":["","","",""],"sub":[]},{"indx":["","","",""],"comment":["","","",""],"sub":[]},{"subGroup":[{"indx":["","","",""],"comment":["","","",""]},{"indx":["","","",""],"comment":["","","",""]},{"indx":["","","",""],"comment":["","","",""]},{"indx":["","","",""],"comment":["","","",""]},{"indx":["","","",""],"comment":["","","",""]},{"indx":["","","",""],"comment":["","","",""]},{"indx":["","","",""],"comment":["","","",""]},{"indx":["","","",""],"comment":["","","",""]},{"indx":["","","",""],"comment":["","","",""]},{"indx":["","","","","",false],"comment":[""]}]}]},{"a":{"indx":["","","",""],"comment":["","","",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":["","","","","","","","","",""],"comment":["","","","","","","","","",""],"sub":[]}},{"a":{"indx":["","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"a":{"indx":["",""],"comment":["",""],"sub":[{"indx":[],"comment":[],"sub":[]}],"subgroup":[]}},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"a":{"indx":["",""],"comment":["",""],"sub":[{"indx":[],"comment":[],"sub":[]}],"subgroup":[{"indx":["",""],"comment":["",""],"sub":[]}]}},{"a":{"indx":[false,false,false],"comment":["","",""],"score":["","",""]}},{"a":{"indx":["",""],"comment":["",""],"sub":[{"indx":[],"comment":[],"sub":[]}],"subgroup":[]}},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"a":{"indx":["",""],"comment":["",""],"sub":[{"indx":[],"comment":[],"sub":[]}],"subgroup":[]}},{"a":{"indx":[false,false,false],"comment":["","",""],"score":["","",""]}},{"a":{"indx":["",""],"comment":["",""],"sub":[{"indx":[],"comment":[],"sub":[]}],"subgroup":[]}},{"a":{"indx":[false,false,false,false],"comment":["","","",""],"score":["","","",""]}},{"a":[{"indx":["",""],"comment":["",""],"sub":[]}]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}}]},{"t":"Pain","q":[{"a":{"indx":["",""],"comment":["",""],"sub":[[{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]}]]}}]},{"t":"Vital Signs","q":[{"a":["","","","","",""]},{"a":["","","","",{"txt":""},{"malnutrition":{"indx":["","","",""],"sub":{"indx":[],"comment":[],"sub":[]}}}]},{"a":{"indx":["","","","","","","","",""],"comment":["","","","","","","","",""],"sub":[]}},{"a":{"indx":["","","","","",""],"comment":["","","","","",""],"sub":[]}},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}}]},{"t":"Exam Review","q":[{"a":[{"indx":["",""],"comment":["",""],"sub":[]}]},{"a":[{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]}]},{"a":[{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]}]},{"a":[{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]}]},{"a":[{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]}]},{"a":[{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]}]},{"a":[{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]}]},{"a":[{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]}]},{"a":[{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]}]},{"a":[{"indx":["",""],"comment":["",""],"sub":[]}]},{"a":[{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]}]},{"a":[{"indx":["",""],"comment":["",""],"sub":[]}]},{"a":[{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]}]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":[false],"comment":[""],"score":[""]}}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}}]},{"t":"Home Safety & Personal Goals","q":[{"a":{"indx":["","","","",""],"comment":["","","","",""],"score":[0,0,0,0]}},{"a":[{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]},{"indx":["",""],"comment":["",""],"sub":[]}]},{"a":[""]},{"a":[""]},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"select","a10":[],"a11":"","a12":"","a13":""}]}]}