{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"STEPHANIE BAYNES","gend":1,"add":"852 CORN TASSEL RD","city":"DANVILLE","state":"VA","zip":"24540-9998","dob":"1974-01-26","age":"","mstatus":"","insh":"9234322*01","cliId":"","pno":"434\/429-5975","cno":"","email":"","ename":"","eno":"","pphy":"WINFIELD, ALBERT C MD","ppno":"434\/791-4110","pcpadd":"173 EXECUTIVE DRIVE","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":"24541","pcpcounty":"","pcpid":"","pcpname":"PROVIDENCE FAMILY SPORTS MEDICINE INC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/791-4003","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","F33.2","F32.9","F41.9","F33.1","Z00.01","Z68.28","R10.2","R94.5","L98.9","Z13.89","F32.89","V62.84","R73.02","R63.5","D22.22","D22.0","D22.39","D22.5","D48.5","D22.61","D22.62","D22.72","D22.71","L82.1","Z12.83"],"date":["2021-12-30","2021-01-11","2021-12-29","2021-12-29","2021-08-20","2021-05-12","2021-05-12","2021-06-23","2021-06-23","2021-05-12","2021-05-12","2020-09-18","2020-09-30","2021-06-23","2021-06-23","2021-08-25","2021-08-25","2021-08-25","2021-08-25","2021-08-25","2021-08-25","2021-08-25","2021-08-25","2021-08-25","2021-08-25","2021-08-25"],"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":[["","00115180301","HYDROXYZ","CAP 25MG","90","Select","Select",""],["","69097082607","BENZTROPINE","TAB 0.5MG","30","Select","Select",""],["","67877025001","QUETIAPINE","TAB 100MG","30","Select","Select",""],["","00173071920","FLOVENT","AER 110MCG","12","Select","Select",""],["","61874011520","VRAYLAR","CAP 1.5MG","30","Select","Select",""],["","27241009903","DULOXETINE","CAP 60MG","180","Select","Select",""],["","60505265301","TRAZODONE","TAB 50MG","30","Select","Select",""],["","59310057922","PROAIR","AER ","26","Select","Select",""],["","13668021730","ARIPIPRAZOLE","TAB 5MG","30","Select","Select",""],["","43598044674","NICOTINE","DIS 7MG\/24HR","28","Select","Select",""],["","00093005401","BUSPIRONE","TAB 10MG","90","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","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":""}]}]}