{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"FRANCES TIBBS","gend":1,"add":"840 RUNNEL CT APT 8","city":"CHARLOTTESVILLE","state":"VA","zip":"22901-9998","dob":"1980-08-28","age":"","mstatus":"","insh":"1251559*01","cliId":"","pno":4342135522,"cno":4342135522,"email":"","ename":"","eno":"","pphy":"LANDEN, DONNA A MD","ppno":4342434660,"pcpadd":"4916 Plank Rd","pcpcity":"NORTH GARDEN","pcpstate":"VA","pcpzip":"22959-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4349248335,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E89.0","Z86.39","Z30.42","Z32.02","NO DATA","F31.9","F31.70","R46.89","E05.00","L29.9","L28.2","R87.610","K42.9","E66.9","F19.10","K43.9","Z68.37","Z12.4","Z11.3","E03.9","Z86.59","L03.211","K04.7","Z00.00","R23.3","L30.1","L84."],"date":["2023-05-23","2021-05-24","2023-02-01","2022-02-02","2022-06-14","2023-05-23","2022-10-18","2022-06-14","2022-06-14","2022-06-14","2022-06-27","2022-06-27","2021-10-18","2021-05-03","2021-10-18","2021-10-18","2021-05-03","2021-04-19","2021-04-19","2022-03-07","2021-04-19","2021-02-14","2021-02-14","2022-03-07","2022-03-07","2022-08-22","2022-08-22"],"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":[]},{"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":[["","00378180910","LEVOTHYROXIN","TAB 100MCG","90","Select","Select",""],["","50428043400","ONE DAILY","TAB ESSENTL","30","Select","Select",""],["","80777027399","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","00074455290","SYNTHROID","TAB 50MCG","60","Select","Select",""],["","70461032103","FLUCLVX QUAD","INJ 2021-22","0","Select","Select",""],["","65862022701","LAMOTRIGINE","TAB 25MG","120","Select","Select",""],["","65862059401","DIVALPROEX","TAB 250MG ER","30","Select","Select",""],["","42806016005","HYDROXYZ HCL","TAB 25MG","90","Select","Select",""],["","68462018135","CLOTRIMAZOLE","CRE 0.01","30","Select","Select",""],["","65862001401","AMOXICILLIN","500 MG","21","Select","Select",""],["","49483060450","IBUPROFEN","800 MG","20","Select","Select",""],["","43386009663","CLOBETASOL","OIN 0.0005","45","Select","Select",""],["","54629111301","MULTI VITAMN","TAB MINERALS","90","Select","Select",""],["","43547030203","ARIPIPRAZOLE","TAB 2MG","30","Select","Select",""],["","29300014801","QUETIAPINE FUMARATE","50 MG","90","Select","Select",""],["","00378180310","LEVOTHYROXINE SODIUM","50 MCG","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":""}]}]}