{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JANAJAWON N SUTPHIN","gend":0,"add":"700 NORTHPOINTE LN APT 202","city":"DANVILLE","state":"VA","zip":"24540-9998","dob":"2001-08-15","age":"","mstatus":"","insh":"20035818*01","cliId":"","pno":4344329494,"cno":4344329494,"email":"","ename":"","eno":"","pphy":"BAILEY, ALLISON R NP","ppno":4346562224,"pcpadd":"305 N MAIN ST,","pcpcity":"GRETNA","pcpstate":"VA","pcpzip":"24557-9998","pcpcounty":"","pcpid":"","pcpname":"Sovah Family Healthcare Gretna","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4346563988,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F32.2","R07.9","J45.998","K59.00","J45.909","R10.30","F90.9","F41.1","S16.1XXA","L98.9","F41.0","R07.1","R07.89","M94.0","Z11.3","Z20.2","H93.13","NO DATA","R06.00","F43.10","R06.83","H04.123","H52.13","H52.223","Z13.5","F41.9","Z72.51","R45.0","R00.2","J02.9"],"date":["2021-12-05","2021-12-08","2021-12-08","2022-12-08","2023-01-13","2022-12-08","2023-07-27","2023-07-27","2022-08-19","2022-08-19","2021-12-08","2023-01-13","2023-01-13","2023-01-13","2022-10-22","2022-10-22","2022-11-03","2023-07-27","2022-11-29","2023-07-27","2022-11-03","2023-03-01","2023-03-01","2023-03-01","2023-03-01","2023-03-07","2023-04-21","2021-11-02","2021-12-08","2023-04-13"],"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":[["","59267102504","PFIZER VACC","INJ ADLT RTU","0","Select","Select",""],["","59779045888","ALLERGY RLF","TAB 10MG","30","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","66993007996","FLUTICAS HFA","AER 110MCG","12","Select","Select",""],["","00173071920","FLOVENT HFA","AER 110MCG","12","Select","Select",""],["","00597014030","TRADJENTA","TAB 5MG","30","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","70010049110","METFORMIN","TAB 500MG ER","30","Select","Select",""],["","53191036212","D3-50","CAP 50000UNT","4","Select","Select",""],["","57237016199","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","45802048678","DOCUSATE SOD","CAP 100MG","14","Select","Select",""],["","13107015490","PAROXETINE","TAB 10MG","30","Select","Select",""],["","00093342210","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","53191036212","D","3-50 1250 MCG","12","Select","Select",""],["","00054001825","PREDNISONE","20 MG","18","Select","Select",""],["","70436005901","BUPROPION HCL SR","150 MG","30","Select","Select",""],["","59746000103","METHYLPREDNISOLONE","4 MG","21","Select","Select",""],["","27241009809","DULOXETINE HCL","30 MG","30","Select","Select",""],["","75834002001","VITAMIN D","3 1250 MCG","4","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":""}]}]}