{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"REHPOTSIRHCSELBOR A   ","gend":0,"add":"BRAH ENIP 1002202 TPA NL RO","city":"HARRISONBURG","state":"VA","zip":"22801-9998","dob":"1968-10-05","age":"","mstatus":"","insh":"6968110*47","cliId":"","pno":"09\/0451186-8","cno":"540\/908-6811","email":"","ename":"","eno":"","pphy":"LEPLEY, SHAWN M MD","ppno":"540\/564-7300","pcpadd":"1661 S MAIN ST","pcpcity":"HARRISONBURG","pcpstate":"VA","pcpzip":22801,"pcpcounty":"","pcpid":"","pcpname":"SRMHMG - Sentara South Main Health Center","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":["A41.9","NO DATA","N17.9","K56.7","K29.70","K27.9","K29.80","K31.7","K21.9","Z20.828","G47.00","F41.9","F32.9","Z79.01","Z79.899","Z28.21","Z53.20","K59.00","R19.5","R10.13","R14.2","R14.0","I82.431","M25.561","R26.2","N18.9","K64.5","Z79.1","Z86.718","Z90.49","Z82.49","Z88.1","Z88.0","Z91.041","R05.9","R07.2","R93.1","R11.2","R10.84","K52.9","J18.9","K76.0","Z12.11","M24.661","V58.89","R19.4","R10.9","M25.551","H00.12","H00.014","M17.11","M54.5","I10.","Z20.822","Z87.19","M54.9","K64.8","S83.241A","G89.29","M51.36","M47.817","R10.33","K30.","D12.5","R19.7","J22.","R06.02","R94.31","I44.4","I51.7","R07.89","R94.4","I82.409","R07.9","R06.9","R09.02","Z12.5","D75.1","J98.8","Z86.16","Z59.41","Z59.6","R53.83","R51.9","R41.3","R09.1","M51.34","M19.90","M25.461","M54.16","M51.26","R12.","N18.2","M54.6"],"date":["2020-10-29","2022-10-03","2020-10-29","2020-10-29","2020-10-29","2020-10-29","2020-12-28","2020-11-01","2022-10-03","2020-10-29","2022-04-29","2022-04-29","2021-08-30","2022-04-29","2022-04-29","2020-10-29","2020-10-29","2021-02-03","2020-12-28","2022-03-18","2020-12-28","2020-12-28","2021-08-02","2021-09-01","2021-09-01","2021-11-03","2022-02-19","2022-04-29","2022-07-06","2022-02-19","2022-02-19","2022-04-29","2022-04-29","2022-04-29","2022-04-26","2022-07-20","2022-07-20","2022-08-30","2022-08-30","2022-09-15","2020-10-29","2020-10-29","2021-02-03","2021-11-05","2021-11-05","2022-09-15","2022-09-15","2020-02-14","2020-02-21","2020-02-21","2020-06-12","2020-09-11","2022-01-24","2022-01-24","2022-03-18","2022-04-29","2022-03-18","2020-06-12","2022-07-18","2021-12-14","2020-09-11","2020-11-01","2020-11-01","2021-02-03","2021-02-03","2022-04-29","2022-04-29","2022-07-06","2022-07-06","2022-07-06","2022-07-06","2022-07-06","2020-02-03","2022-04-29","2020-10-29","2020-10-29","2021-08-30","2021-10-20","2022-04-29","2022-04-29","2022-04-29","2022-04-29","2022-07-18","2022-07-18","2022-06-15","2020-03-05","2022-01-21","2022-04-28","2020-05-07","2020-07-24","2020-07-24","2020-11-01","2021-11-09","2021-12-14"],"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":[["","16714015901","ONDANSETRON","TAB 4MG","30","Select","Select",""],["","13668000801","ZOLPIDEM","TAB 10MG","30","Select","Select",""],["","27241006903","SILDENAFIL","TAB 100MG","30","Select","Select",""],["","57664037713","TRAMADOL","TAB 50MG","90","Select","Select",""],["","00093083201","CLONAZEPAM","TAB 0.5MG","60","Select","Select",""],["","65162010211","GABAPENTIN","CAP 300MG","30","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","60","Select","Select",""],["","24979070406","DEXLANSOPRAZ","CAP 60MG DR","30","Select","Select",""],["","69315031228","PROCTO-MED","CRE HC 2.5%","28","Select","Select",""],["","64764017590","DEXILANT","CAP 60MG DR","30","Select","Select",""],["","00713050324","ANUCORT-HC","SUP 25MG","12","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","69238110005","DOXYCYCL","CAP 100MG","28","Select","Select",""],["","50458058030","XARELTO","TAB 10MG","30","Select","Select",""],["","59746017310","PREDNISONE","TAB 10MG","6","Select","Select",""],["","50580022824","BENADRYL","CAP 25MG","1","Select","Select",""],["","72205002790","ROSUVASTATIN","TAB 5MG","30","Select","Select",""],["","00904530760","BANOPHEN","CAP 50MG","1","Select","Select",""],["","29300022701","METRONIDAZOL","TAB 500MG","9","Select","Select",""],["","42571012290","LEVOCETIRIZI","TAB 5MG","90","Select","Select",""],["","64380076921","PEG-3350\/KCL","SOL \/SODIUM","4000","Select","Select",""],["","62175013643","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","27241011403","TADALAFIL","TAB 20MG","12","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","10702000709","CYCLOBENZAPR","TAB 10MG","90","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","28","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","31722072250","LEVOFLOXACIN","TAB 500MG","4","Select","Select",""],["","57896044101","BISACODYL","TAB 5MG EC","30","Select","Select",""],["","49348001737","SM","SYP 100-10\/5","236","Select","Select",""],["","43386009019","GAVILYTE-G","SOL ","4000","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":""}]}]}