{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HEAVEN BRANCH","gend":1,"add":"11536 JAMES MADISON HWY","city":"PALMYRA","state":"VA","zip":"22963-9998","dob":"2004-09-17","age":"","mstatus":"","insh":"9615512*01","cliId":"","pno":"434\/714-5762","cno":"434\/969-4540","email":"","ename":"","eno":"","pphy":"KNIGHT, SARAH E MD","ppno":"434\/296-9161","pcpadd":"1011 E JEFFERSON ST","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22902,"pcpcounty":"","pcpid":"","pcpname":"Pediatric Associates of Charlottesville Downtown","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/977-6068","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["A49.02","R50.9","U07.1","R06.02","J02.0","L02.416","L03.116","Z30.017","S93.602A","M76.822","S80.02XA","S09.90XA","J06.9","H66.90","Z30.49","R43.8","NO DATA","K52.9","F32.9","G47.9","L02.91","V58.89","T50.901A","R04.0","R42.","R11.2","R07.89","T88.7XXA","J18.9","S19.9XXA","R51.","S63.501A","S60.212A","F43.10","F90.9","Z20.822","V62.84","F33.1","Z23."],"date":["2021-02-02","2021-02-02","2021-10-19","2021-10-19","2021-10-19","2021-01-31","2021-02-01","2021-06-04","2020-02-03","2020-02-05","2020-09-01","2020-09-01","2020-01-21","2020-01-21","2021-08-27","2021-10-19","2021-10-19","2021-10-17","2022-06-08","2021-02-08","2021-02-08","2019-05-06","2019-09-24","2019-09-24","2019-09-24","2019-09-24","2019-09-24","2019-09-24","2019-01-15","2019-03-07","2019-03-07","2019-04-29","2019-09-13","2022-06-06","2022-06-06","2022-06-06","2022-06-06","2022-06-14","2022-06-08"],"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":[["","68645052154","SERTRALINE","TAB 25MG","60","Select","Select",""],["","13668013601","ESCITALOPRAM","TAB 10MG","52","Select","Select",""],["","50428034138","MELATONIN","TAB 3MG","30","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","40","Select","Select",""],["","","SMZ\/TMP","TAB 800-160","","Select","Select",""],["","00052433001","NEXPLANON","IMP 68MG","1","Select","Select",""],["","59762453701","MEDROXYPR","INJ 150MG\/ML","1","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","30","Select","Select",""],["","50111064701","FLUOXETINE","CAP 10MG","30","Select","Select",""],["","70710122501","AMITRIPTYLIN","TAB 10MG","90","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":""}]}]}