{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LINDA BOTKINS","gend":1,"add":"169 W RIVERSIDE DR","city":"TIMBERVILLE","state":"VA","zip":"22853-9998","dob":"1966-04-28","age":"","mstatus":"","insh":"9526773*01","cliId":"","pno":"540\/896-5175","cno":"540\/208-8132","email":"","ename":"","eno":"","pphy":"SEE, JANE R NP","ppno":"540\/564-5622","pcpadd":"13892 TIMBER WAY","pcpcity":"BROADWAY","pcpstate":"VA","pcpzip":22815,"pcpcounty":"","pcpid":"","pcpname":"SRMHMG - Sentara Timber Way Health Center","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/578-8547","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R07.89","R07.9","I10.","E87.6","K21.9","E78.5","F41.9","E55.9","F32.9","Z13.220","Z00.00","K04.7","F32.4"],"date":["2021-02-21","2021-02-20","2022-03-18","2022-03-18","2022-03-18","2022-03-18","2022-03-18","2022-03-18","2021-06-18","2020-11-25","2020-11-25","2020-03-27","2022-03-18"],"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":[["","68645055654","LISINOP\/HCTZ","TAB 10-12.5","90","Select","Select",""],["","55111064530","OMEPRAZOLE","CAP 40MG","90","Select","Select",""],["","68645052354","SERTRALINE","TAB 100MG","90","Select","Select",""],["","68382032010","POT  CHLORIDE","TAB 10MEQ ER","180","Select","Select",""],["","00093005301","BUSPIRONE","TAB 5MG","60","Select","Select",""],["","72205000390","ROSUVASTATIN","TAB 10MG","90","Select","Select",""],["","00832532411","POT  CL MICRO","TAB 10MEQ ER","120","Select","Select",""],["","57237002801","AMOXICILLIN","TAB 500MG","21","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","20","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":""}]}]}