{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ELISHA GALLINORE","gend":1,"add":"2306 ARAGON ST","city":"LYNCHBURG","state":"VA","zip":"24501-9998","dob":"1989-12-12","age":"","mstatus":"","insh":"20027645*01","cliId":"","pno":4349841365,"cno":4349841365,"email":"","ename":"","eno":"","pphy":"PAGE, TERESA NP","ppno":4342003366,"pcpadd":"800 5TH STREET,","pcpcity":"LYNCHBURG","pcpstate":"VA","pcpzip":"24504-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4348472521,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["V62.84","F10.129","M79.621","M25.511","J45.909","G47.33","F17.210","Z79.899","Z88.8","Y04.8XXA","Y92.89","F31.75","F29.","F31.9","F10.929","F14.10","R52.","M25.519","I10.","F31.81","F10.10","F90.9","F33.2","F10.20","F15.10","Z72.0","Z72.51","Z11.3","Z20.2","T50.902A","F19.10","Z20.822","F31.4","F90.2","A59.01","R05.9","F31.61","K08.89","K04.7","R11.2","Y90.5","Z88.6"],"date":["2022-01-12","2021-08-18","2021-08-18","2021-08-18","2022-01-12","2022-01-11","2022-01-12","2021-10-16","2021-10-16","2021-08-18","2021-08-18","2021-09-15","2021-10-16","2022-01-11","2021-10-16","2022-01-12","2021-08-18","2021-08-18","2021-08-18","2021-10-19","2022-01-12","2021-10-19","2021-05-10","2021-05-10","2022-01-12","2021-01-30","2021-01-30","2021-12-09","2021-12-09","2022-01-12","2022-01-11","2022-01-11","2022-01-12","2022-01-12","2022-01-12","2022-01-12","2021-09-15","2021-09-27","2021-09-27","2021-01-28","2021-05-10","2021-05-10"],"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":[["","69097094312","GABAPENTIN CAP","300MG","60","Select","Select",""],["","50111033401","METRONIDAZOL TAB","500MG","9","Select","Select",""],["","43547030303","ARIPIPRAZOLE TAB","5MG","30","Select","Select",""],["","13668013701","ESCITALOPRAM TAB","20MG","30","Select","Select",""],["","57664049983","MIRTAZAPINE TAB","15MG","15","Select","Select",""],["","50111056001","TRAZODONE TAB","50MG","30","Select","Select",""],["","55111052830","ATOMOXETINE CAP","25MG","30","Select","Select",""],["","13668013701","ESCITALOPRAM","TAB 20MG","30","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","60","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","9","Select","Select",""],["","43547030303","ARIPIPRAZOLE","TAB 5MG","30","Select","Select",""],["","57664049983","MIRTAZAPINE","TAB 15MG","15","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","30","Select","Select",""],["","55111052830","ATOMOXETINE","CAP 25MG","30","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":""}]}]}