{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMANDA   M RODRIGUEZ","gend":1,"add":"6278 GEORGE WASHINGTON HIGHWA HWY","city":"KEYSVILLE","state":"VA","zip":"23947-9998","dob":"1969-02-15","age":"","mstatus":"","insh":"9648534*01","cliId":"","pno":"434\/390-3945","cno":"","email":"","ename":"","eno":"","pphy":"HAHESY-CALHOUN, MARIAN MD","ppno":"434\/542-5560","pcpadd":"165 LEGRANDE AVENUE","pcpcity":"CHARLOTTE COURT HOUSE","pcpstate":"VA","pcpzip":"23923","pcpcounty":"","pcpid":"","pcpname":"CENTRAL VIRGINIA HEALTH SERVICES INC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/542-4670","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S90.221A","E11.42","M79.674","M79.675","B35.1","M76.61","M76.62","M77.31","M77.32","M20.41","M20.42","R26.2","E11.9","H25.012","J02.0","J02.9","R35.0","N39.0","B34.9","Z20.822","U07.1","Z87.891","H25.812","H25.11","R69.","R05.","R50.9","J98.8","H25.12"],"date":["2020-10-22","2021-10-20","2021-10-20","2021-10-20","2021-10-20","2021-07-28","2021-07-28","2021-07-28","2021-07-28","2021-07-28","2021-10-20","2021-07-28","2021-02-19","2021-03-22","2021-10-02","2021-10-02","2021-10-02","2021-10-02","2021-10-02","2021-10-02","2021-08-22","2021-08-22","2021-02-19","2021-02-19","2020-01-30","2020-01-30","2020-11-17","2021-03-04","2021-03-22"],"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":[["","49035056311",""," ","30","Select","Select",""],["","80777027310","MODERNA","INJ COVID-19","0","Select","Select",""],["","00781207401","TRIAMT\/HCTZ","CAP 37.5-25","30","Select","Select",""],["","68645055354","LISINOPRIL","TAB 20MG","90","Select","Select",""],["","00093505898","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","68645058259","METFORMIN","TAB 500MG","60","Select","Select",""],["","69238106901","POT  CHLORIDE","TAB 20MEQ ER","60","Select","Select",""],["","49035056332","ASPIRIN","TAB 81MG EC","90","Select","Select",""],["","00832532511","POT  CL MICRO","TAB 20MEQ ER","60","Select","Select",""],["","68645056259","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","57237001930","DULOXETINE","CAP 60MG","30","Select","Select",""],["","68382002310","ATENOLOL","TAB 50MG","30","Select","Select",""],["","43598075205","BUPROPION","TAB 150MG SR","60","Select","Select",""],["","00069046903","CHANTIX","PAK 1MG","56","Select","Select",""],["","65862084003","MOXIFLOXACIN","SOL HCL 0.5%","3","Select","Select",""],["","49348098023","SM","TAB 81MG EC","30","Select","Select",""],["","24208050707","LOTEMAX","GEL 0.0038","5","Select","Select",""],["","24208060203","PROLENSA","SOL 0.0007","3","Select","Select",""],["","64380071206","BENZONATATE","CAP 100MG","42","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","65862050320","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":[]}]},{"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":""}]}]}