{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TANIKA DAY","gend":1,"add":"1440 N MAIN ST APT B","city":"DANVILLE","state":"VA","zip":"24540-9998","dob":"1995-12-08","age":"","mstatus":"","insh":"8656193*01","cliId":"","pno":"434\/709-0177","cno":"","email":"","ename":"","eno":"","pphy":"WATERS, MICHAEL MD","ppno":"434\/797-2828","pcpadd":"125 EXECUTIVE DRIVE","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"pcpcounty":"","pcpid":"","pcpname":"DANVILLE PHYSICIAN PRACTICES LLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/773-6833","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R07.9","L03.116","G43.909","G43.009","O26.892","R10.9","Z3A.15","R60.0","N76.0","F12.10","G44.89","R09.02","R06.89","A08.4","Z79.899","Z11.3","O99.824","O66.0","Z20.822","O98.32","A56.8","Z59.0","Z87.891","Z3A.38","Z37.0","O26.893","V23.9","O23.42","O23.592","N92.6","Z3A.14","O99.511","J09.X2","Z3A.09","M25.561","M25.562","O23.593","B96.89","L25.8","V23.7","Z3A.29","R55.","O98.811","A74.9","Z3A.01","O99.820","O99.323","F29.","O47.9"],"date":["2019-07-05","2019-08-13","2020-07-16","2020-07-16","2021-01-25","2021-01-25","2021-01-25","2019-05-31","2020-04-22","2021-09-08","2019-08-23","2019-08-23","2019-08-23","2020-03-02","2020-07-16","2020-10-01","2021-09-08","2021-09-08","2021-09-08","2021-09-08","2021-09-08","2021-09-08","2021-09-08","2021-09-08","2021-09-08","2021-09-08","2021-08-03","2019-11-08","2019-11-08","2019-11-08","2019-11-08","2019-03-07","2019-03-07","2019-03-07","2020-02-14","2020-02-14","2021-07-05","2021-07-05","2021-07-05","2021-09-08","2021-07-05","2019-08-23","2021-02-05","2021-02-05","2021-02-05","2021-09-08","2021-09-08","2021-09-08","2021-09-08"],"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":[["","","DOXYCYCL"," DOXYCYCL ","20","Select","Select",""],["","","OSELTAMIVIR"," OSELTAMIVIR ","10","Select","Select",""],["","","RANITIDINE"," RANITIDINE ","20","Select","Select",""],["","","METRONIDAZOL"," METRONIDAZOL ","14","Select","Select",""],["","","TAMIFLU"," TAMIFLU ","10","Select","Select",""],["","","PAIN"," PAIN ","50","Select","Select",""],["","","IBUPROFEN"," IBUPROFEN ","30","Select","Select",""],["","","ONDANSETRON"," ONDANSETRON ","12","Select","Select",""],["","","SPRINTEC"," SPRINTEC ","28","Select","Select",""],["","","AFLURIA"," AFLURIA ","0","Select","Select",""],["","","NAPROXEN"," NAPROXEN ","10","Select","Select",""],["","","BUT\/APAP\/CAF","CAP ","","Select","Select",""],["","","AZITHROMYCIN","TAB 500MG","","Select","Select",""],["","","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","","BUT\/ASA\/CAFF","CAP ","","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":""}]}]}