{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GEORGINA SIMS","gend":1,"add":"403 GARRETT ST APT E","city":"CHARLOTTESVILLE","state":"VA","zip":"22902-9998","dob":"1977-10-28","age":"","mstatus":"","insh":"20072328*01","cliId":"","pno":4342701614,"cno":4342701614,"email":"","ename":"","eno":"","pphy":"HEHIR, MONICA NP","ppno":4349245321,"pcpadd":"1204 W MAIN ST,","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":"22903-9998","pcpcounty":"","pcpid":"","pcpname":"UVA Teen & Young Adult Health ","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4342444412,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D50.0","R51.9","G43.909","H92.03","B35.3","G80.1","D56.3","NO DATA","F41.8","G89.29","R07.9","G47.9","F43.9","R29.6","R26.9","R29.898","M25.50","Z00.00","K59.00","R06.83","G47.8","R53.82","G47.00","G80.9","R20.0","R20.2","M65.841","G56.21","G56.01","M62.81","M79.641","M54.5","Z23.","E04.1","K64.9","S16.1XXA","M54.6","Z87.42","N92.0","R25.2","M47.816","M65.849","M25.521","R26.89","M40.50","G80.8","Z01.419","D64.9","N85.8","Z12.31"],"date":["2023-09-08","2022-08-30","2021-12-09","2022-02-10","2022-02-10","2023-09-01","2022-09-14","2023-08-28","2023-09-01","2023-08-28","2022-03-11","2022-07-18","2022-03-11","2023-09-01","2023-09-01","2023-09-01","2022-03-09","2021-09-16","2021-09-16","2022-08-30","2022-08-30","2022-08-30","2022-08-30","2022-08-30","2022-12-20","2022-12-20","2022-11-01","2022-12-20","2022-12-20","2022-12-20","2022-12-20","2021-07-08","2021-12-22","2022-04-25","2022-10-03","2021-06-14","2021-06-14","2023-09-08","2023-09-08","2023-04-11","2022-07-21","2022-11-01","2021-06-03","2023-04-11","2021-06-03","2021-06-03","2023-09-08","2023-09-08","2023-09-08","2023-09-08"],"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":[["","69097083412","SERTRALINE","TAB 50MG","90","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","69097015807","MELOXICAM","TAB 7.5MG","45","Select","Select",""],["","45802048678","DOCUSATE SOD","CAP 100MG","30","Select","Select",""],["","00093321915","KETOCONAZOLE","CRE 0.02","15","Select","Select",""],["","55111029236","SUMATRIPTAN","TAB 50MG","9","Select","Select",""],["","51991081701","PROPRANOLOL","CAP 60MG ER","30","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","51672404806","CLOTRIM\/BETA","CRE DIPROP","45","Select","Select",""],["","45802065078","LORATADINE","TAB 10MG","30","Select","Select",""],["","59267100001","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","00832105410","BACLOFEN","10 MG","90","Select","Select",""],["","62559043130","HYDROCORTISO","CRE 0.025","30","Select","Select",""],["","42002030268","TUCKS MEDICA","PAD ","40","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","69097083412","SERTRALINE HCL","50 MG","270","Select","Select",""],["","51991081701","PROPRANOLOL HCL ER","60 MG","90","Select","Select",""],["","69452034572","SUMATRIPTAN SUCCINATE","50 MG","9","Select","Select",""],["","69097015807","MELOXICAM TAB","7.5MG","45","Select","Select",""],["","00054327099","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","51672404806","CLOTRIM\/BETA CRE DIPROP","","45","Select","Select",""],["","45802065078","LORATADINE TAB","10MG","30","Select","Select",""],["","59267100001","PFIZER VACC INJ COVID-","19","0","Select","Select",""],["","51991081701","PROPRANOLOL CAP","60MG ER","30","Select","Select",""],["","69097083412","SERTRALINE TAB","50MG","270","Select","Select",""],["","59746000103","METHYLPRED TAB","4MG","21","Select","Select",""],["","00832105410","BACLOFEN TAB","10MG","90","Select","Select",""],["","62559043130","HYDROCORTISO CRE","2.5%","30","Select","Select",""],["","42002030268","TUCKS MEDICA PAD","","40","Select","Select",""],["","69097052444","DICLOFENAC GEL","1%","100","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":""}]}]}