{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LANEISHA  M BURLEY","gend":1,"add":"1141 TOMS ROAD","city":"BARBOURSVILLE","state":"VA","zip":"22923-9998","dob":"1993-07-18","age":"","mstatus":"","insh":"1514823*01","cliId":"","pno":4349064415,"cno":4349064415,"email":"","ename":"","eno":"","pphy":"KELLAMS, ANN MD","ppno":4349240123,"pcpadd":"1204 W MAIN ST","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":"22903-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B20.","Z47.89","S83.512D","F41.0","F90.9","V58.89","Z00.00","Z23.","Z34.81","Z3A.14","Z21.","Z34.83","Z3A.38","O10.013","O98.713","Z3A.39","O69.81X0","Z37.0","O26.841","Z3A.08","D57.3","O28.8","Z3A.36","R30.0","O10.919","Z34.90","O10.913","O99.820","Z3A.37","O99.013","D50.9","Z3A.00","M25.562","R53.1","R26.9","Z36.82","Z3A.13","O99.891","R10.9","Z3A.35","O98.719","O69.89X0","O10.02","O98.72","O99.824","S51.811A","S51.812A","S71.111A","S81.811A","Z3A.32","O99.019","Z36.3","Z3A.33","O36.8130","Z3A.34","F98.8","Z01.419","Z87.410","Z11.3","B00.2","Z30.41","N76.0","B37.3","Z13.1","Z13.29","Z71.85","Z86.39","Z68.32","Z3A.30","D64.9","Z91.89","B96.89","R87.610","Z03.818","Z20.822","O98.712","O98.312","A59.9","O10.012","Z3A.21","O99.210","Z86.79","Z87.898","O10.92","O99.02","Z87.891","Z39.2","Z3A.28","Z03.74","Z34.93","Z30.019","M25.531","O36.8190","Z34.80","O36.8330"],"date":["2023-03-13","2021-06-29","2021-06-29","2021-10-28","2021-10-28","2021-05-30","2021-08-02","2021-08-02","2022-09-26","2022-11-07","2023-03-12","2023-03-06","2023-03-06","2023-03-12","2023-03-13","2023-03-13","2023-03-13","2023-03-13","2022-08-10","2022-08-10","2023-03-12","2023-02-23","2023-02-23","2023-02-28","2023-03-06","2023-02-28","2023-03-06","2023-02-28","2023-02-28","2023-03-07","2023-03-12","2023-03-07","2021-05-04","2021-05-04","2021-05-04","2022-09-14","2022-09-14","2023-02-06","2023-02-06","2023-02-23","2023-03-09","2023-03-13","2023-03-13","2023-03-13","2023-03-13","2021-05-17","2021-05-17","2021-05-17","2021-05-17","2023-01-25","2023-01-26","2023-02-01","2023-02-01","2023-02-08","2023-02-08","2022-05-19","2022-05-23","2022-05-23","2022-05-23","2022-05-23","2022-05-23","2022-05-23","2022-05-23","2022-05-23","2022-05-23","2022-05-23","2022-05-23","2022-05-23","2023-01-11","2023-02-15","2023-03-09","2022-05-23","2022-05-23","2022-07-26","2023-03-12","2022-11-07","2022-09-26","2022-09-26","2022-11-07","2022-11-07","2022-11-07","2022-11-07","2022-11-07","2023-03-12","2023-03-12","2023-03-12","2023-03-14","2022-12-28","2023-01-11","2023-01-11","2021-09-27","2021-09-27","2023-02-08","2023-02-08","2023-02-23"],"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":[["","49702023113","TRIUMEQ","600-50-300","30","Select","Select",""],["","00527150537","AMPHET\/DEXTR","TAB 20MG","30","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","69452015120","VITAMIN D","CAP 50000UNT","4","Select","Select",""],["","00555902658","JUNEL FE","1MG-20(21)","84","Select","Select",""],["","69536010388","AFTERA","1.5 MG","1","Select","Select",""],["","65862004824","ZIDOVUDINE","10 MG\/ML","84","Select","Select",""],["","70700016406","LEVONORGESTREL","1.5 MG","1","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":""}]}]}