{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMANDA L AHERRON","gend":1,"add":"317 WRENN DR","city":"DANVILLE","state":"VA","zip":"24540-9998","dob":"1992-05-11","age":"","mstatus":"","insh":"2119743*01","cliId":"","pno":4344296112,"cno":4344296112,"email":"","ename":"","eno":"","pphy":"NGUYEN, ELIZABETH PA","ppno":4347914122,"pcpadd":"705 MAIN STREET,","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":"24541-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4347914126,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K04.6","R07.0","Z79.899","F43.10","F41.1","F43.23","F94.1","K04.7","K02.9","Z88.5","Z88.8","Z88.2","K08.89","Z91.038","L50.9","R10.2","R19.04","R68.84"],"date":["2023-03-08","2022-05-06","2022-10-04","2022-12-20","2022-12-20","2022-12-20","2022-12-13","2022-12-24","2022-12-24","2022-12-24","2022-12-24","2022-12-24","2022-12-24","2022-04-13","2022-04-13","2021-02-10","2021-02-10","2022-02-21"],"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":[["","67877032105","IBUPROFEN","800 MG","12","Select","Select",""],["","57237002901","AMOXICILLIN","875 MG","20","Select","Select",""],["","67877025130","TRIAMCINOLON","CRE 0.001","30","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","10","Select","Select",""],["","68180035202","SERTRALINE","TAB 50MG","30","Select","Select",""],["","00172392560","DIAZEPAM","TAB 2MG","60","Select","Select",""],["","42806016105","HYDROXYZ HCL","TAB 50MG","90","Select","Select",""],["","00093117410","PENICILLN VK","TAB 500MG","28","Select","Select",""],["","00054350049","LIDOCAINE","SOL 2% VISC","100","Select","Select",""],["","27808003701","HYDROCODONE-ACETAMINOPHEN","10MG-325MG","6","Select","Select",""],["","00116200116","CHLORHEXIDINE GLUCONATE","0.12 %","473","Select","Select",""],["","49483060350","IBUPROFEN TAB","600MG","30","Select","Select",""],["","00781261305","AMOXICILLIN CAP","500MG","30","Select","Select",""],["","00378064205","PREDNISONE TAB","20MG","10","Select","Select",""],["","67877025130","TRIAMCINOLON CRE","0.1%","30","Select","Select",""],["","68180035202","SERTRALINE TAB","50MG","30","Select","Select",""],["","42806016105","HYDROXYZ HCL TAB","50MG","90","Select","Select",""],["","00172392560","DIAZEPAM TAB","2MG","60","Select","Select",""],["","00093117410","PENICILLN VK TAB","500MG","28","Select","Select",""],["","00054350049","LIDOCAINE SOL","2% VISC","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":""}]}]}