{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LLEHCIMGNOL E","gend":1,"add":"NALREBMIT 573402 TPA NL D","city":"CHARLOTTESVILLE","state":"VA","zip":"22903-9998","dob":"1990-08-13","age":"","mstatus":"","insh":"0521110*64","cliId":"","pno":"32\/4345557-4","cno":"434\/234-7555","email":"","ename":"","eno":"","pphy":"KELLAMS, BRYCE S L MD","ppno":"434\/923-4600","pcpadd":"3263 PROFFIT RD STE 101","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22911,"pcpcounty":"","pcpid":"","pcpname":"SMJMG - Sentara Forest Lakes Family Medicine","plan":"OHP","program":"MEDICAID","lob":"M4","region":"","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":["F43.25","V58.89","E87.2","K72.00","G47.00","F33.2","F12.99","F15.99","R10.12","R10.32","R11.0","Z87.891","Z88.3","S00.01XA","V43.62XA","Y92.410","K71.9","T39.1X4A","F06.30","R10.9","G92.","I45.10","T39.1X2A","T42.4X2A","T39.312A","T43.592A","K71.2","F31.9","F42.9","F60.3","Z91.410","F32.9","F41.9","T50.901A","R40.0","T14.91XA","Z65.9","S69.91XA","F31.81","R21.","Z30.46","V89.2XXA","B17.9","J02.9","R42.","R55.","K76.9","X83.8XXA","E87.1","R00.1"],"date":["2020-10-01","2020-09-28","2020-09-28","2020-09-28","2021-12-23","2022-10-18","2022-10-18","2022-10-18","2022-09-29","2022-09-29","2022-09-29","2022-09-29","2022-09-29","2020-09-21","2020-09-21","2020-09-21","2020-10-01","2020-10-01","2020-10-01","2020-09-25","2020-09-27","2020-09-28","2020-09-27","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2020-11-04","2022-08-03","2020-09-25","2020-09-26","2020-10-22","2022-08-03","2021-05-14","2021-05-28","2022-06-14","2021-04-23","2020-09-21","2020-11-04","2022-07-22","2020-04-22","2020-04-22","2020-09-28","2020-09-28","2020-09-27","2020-09-27"],"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":[["","00093321205","CLONAZEPAM","TAB 1MG","60","Select","Select",""],["","31722070530","VALACYCLOVIR","TAB 1GM","20","Select","Select",""],["","00904773445","MICONAZOLE","CRE 0.02","45","Select","Select",""],["","00093117410","PENICILLN","TAB 500MG","30","Select","Select",""],["","68382003416","VENLAFAXINE","CAP 37.5 ER","30","Select","Select",""],["","59779073041","CVS","CRE 7","45","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","60","Select","Select",""],["","69097084507","CYCLOBENZAPR","TAB 5MG","30","Select","Select",""],["","00093816201","QUETIAPINE","TAB 100MG","90","Select","Select",""],["","42806016005","HYDROXYZ","TAB 25MG","90","Select","Select",""],["","55111029236","SUMATRIPTAN","TAB 50MG","9","Select","Select",""],["","00555904358","APRI","TAB ","28","Select","Select",""],["","68180059206","DESVENLAFAX","TAB 50MG ER","30","Select","Select",""],["","43547030403","ARIPIPRAZOLE","TAB 10MG","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":""}]}]}