{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TTOLRACRETEJ A","gend":1,"add":"REPMEK 1041201 TPA TS ","city":"LYNCHBURG","state":"VA","zip":"24501-9998","dob":"1973-03-15","age":"","mstatus":"","insh":"8691110*73","cliId":"","pno":"18\/4347523-8","cno":"434\/329-5566","email":"","ename":"","eno":"","pphy":"UPSHAW, SELESTE NP","ppno":"434\/947-5967","pcpadd":"320 FEDERAL ST","pcpcity":"LYNCHBURG","pcpstate":"VA","pcpzip":24504,"pcpcounty":"","pcpid":"","pcpname":"JOHNSON HEALTH CENTER","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","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":["N93.9","D25.9","R10.84","R10.2","M62.81","R27.8","R39.15","R35.0","N94.10","R10.13","R11.2","E66.01","R52.","N20.0","K85.90","N39.3","K59.00","Z12.4","Z23.","R10.9","I10.","J45.909","G47.30","J30.2","M62.89","R09.81","K57.30","E11.9","F17.210","Z71.9","K31.89","I49.9","R53.81","K64.8","R10.32","R06.9","R06.4","R11.11","E86.0","N92.0","N94.89","R68.89","E87.6","R03.0","R31.9","R07.9","R07.89","R06.2","F91.9","R16.0","R11.10","R06.02","R11.0","M54.9","R09.02","NO DATA","Z00.00","Z71.3","Z13.9","N92.1","E55.9","G43.909","G62.9","K57.92"],"date":["2021-08-06","2021-06-09","2022-10-23","2020-10-27","2020-10-27","2020-10-27","2020-10-27","2020-10-27","2020-10-27","2021-03-22","2021-11-12","2021-08-02","2021-11-12","2021-04-17","2021-04-19","2021-04-19","2021-06-01","2021-04-19","2021-06-22","2021-10-27","2022-09-30","2021-01-19","2021-01-19","2020-06-11","2020-06-11","2020-06-11","2021-10-26","2021-03-01","2020-11-03","2021-06-01","2021-08-19","2021-03-01","2021-03-01","2021-10-26","2022-10-23","2021-11-10","2021-11-10","2021-11-10","2021-03-12","2021-08-06","2021-10-27","2021-03-11","2021-03-12","2021-03-12","2021-11-12","2021-11-09","2021-11-09","2021-11-09","2021-03-20","2021-03-20","2021-03-20","2021-03-20","2021-10-27","2022-10-23","2022-10-23","2022-10-23","2019-06-18","2019-06-18","2019-06-18","2019-06-18","2019-06-18","2019-06-18","2019-06-18","2022-10-23"],"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":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","00781207410","TRIAMT\/HCTZ","CAP 37.5-25","30","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","67877032005","IBUPROFEN","TAB 600MG","120","Select","Select",""],["","00591565810","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","67877026218","RIZATRIPTAN","TAB 10MG","9","Select","Select",""],["","","BUDES\/FORMOT","AER 80-4.5","","Select","Select",""],["","00186037220","SYMBICORT","AER 80-4.5","10","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","","LEVOCETIRIZI","TAB 5MG","","Select","Select",""],["","00093742698","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","65862020190","LOSARTAN","TAB 25MG","30","Select","Select",""],["","74312030413","D3","CAP 25MCG","90","Select","Select",""],["","00173071520","ADVAIR","AER 45\/21","12","Select","Select",""],["","","AMOX\/K","TAB 875-125","","Select","Select",""],["","","ONDANSETRON","TAB 4MG","","Select","Select",""],["","45802057178","FEXOFENADINE","TAB 180MG","30","Select","Select",""],["","","MOMETASONE","SPR 50MCG","","Select","Select",""],["","00555077902","MEDROXYPR","TAB 10MG","20","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","00054023525","MORPHINE","TAB 15MG","10","Select","Select",""],["","51672401801","ETODOLAC","TAB 400MG","30","Select","Select",""],["","45802048678","DOCUSATE","CAP 100MG","20","Select","Select",""],["","65162052110","PROMETHAZINE","TAB 25MG","10","Select","Select",""],["","00143122701","DICYCLOMINE","TAB 20MG","20","Select","Select",""],["","00832154011","HALOPERIDOL","TAB 5MG","3","Select","Select",""],["","00121087316","LACTULOSE","SOL 10GM\/15","473","Select","Select",""],["","00456120230","LINZESS","CAP 290MCG","30","Select","Select",""],["","50428888489","CVS","TAB 180MG","90","Select","Select",""],["","55566670001","CLENPIQ","SOL ","320","Select","Select",""],["","65162018910","NAPROXEN","TAB 375MG","20","Select","Select",""],["","","TRIAMCINOLON","AER 55MCG\/AC","","Select","Select",""],["","","TRAMADOL","TAB 50MG","","Select","Select",""],["","00173088210","BREO","INH 200-25","60","Select","Select",""],["","70461031903","FLUCLVX","INJ 2019-20","0","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":""}]}]}