{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MINDY WALUS","gend":1,"add":"138 GRANARY ROAD                                            ","city":"VERONA                        ","state":"VA","zip":"24482-2533","dob":"1978-07-23","age":"","mstatus":"","insh":4185578,"cliId":"","pno":5404481912,"cno":5402487526,"email":"","ename":"","eno":"","pphy":"ALEXANDER, KERRY A                                          ","ppno":5408866259,"pcpadd":"42 Lambert St                                               ,Ste 511                                                     ","pcpcity":"Staunton                      ","pcpstate":"VA","pcpzip":244012437,"pcpcounty":"","pcpid":"","pcpname":"STAUNTON MEDICAL ASSOCIATES","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"138 GRANARY ROAD                                            ","add3":"","madd1":"138 GRANARY ROAD                                            ","madd2":"                                                            ","madd3":"","mcity":"VERONA                        ","mstate":"VA","mzip":"24482-2533","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.2","M79.7","M54.16","M05.9","Z79.891","M54.5","M06.9","G62.9","R73.03","E03.9","E55.9","F34.1","F17.200","Z68.39","F11.20","J45.909","N76.0","M15.0","M05.79","M65.20","Z51.81","Z91.14","M54.6","M60.89","F11.23","G89.29","E11.9","F17.210","E07.9","Z88.1","Z88.0","R52","O99.320","M79.2","G56.03","G56.01","G56.02","F41.9","E28.2","G47.00","Z82.3","Z80.1","Z79.890","M89.49","Z79.899","K76.0","R05","F11.90","J22","N39.0","Z98.890","Z20.828","R00.2","F41.1","G44.009","I45.81","M25.512","M19.011","M19.012"],"date":["2020-08-31","2022-06-28","2020-02-26","2020-03-30","2020-05-01","2020-06-29","2021-12-06","2021-12-06","2021-03-17","2022-06-28","2022-06-28","2021-12-06","2021-12-06","2020-03-16","2022-12-05","2021-12-06","2020-03-16","2020-03-30","2022-08-02","2022-06-28","2022-08-02","2020-03-30","2021-12-08","2020-09-30","2020-05-01","2020-05-01","2021-12-06","2020-08-07","2020-05-01","2020-10-02","2020-10-02","2020-05-01","2020-05-05","2020-06-02","2022-06-28","2020-08-07","2020-10-02","2020-10-02","2020-10-02","2020-10-02","2020-08-07","2020-08-07","2020-08-07","2022-06-28","2020-10-02","2020-10-02","2020-10-02","2020-10-02","2020-10-26","2021-07-22","2020-10-07","2020-10-07","2021-01-13","2021-01-13","2021-12-06","2021-12-06","2021-07-22","2021-07-30","2021-07-30"],"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":[["","68382080510","TRAZODONE","TAB 50MG","60","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","90","Select","Select",""],["","49884015676","VARENICLINE","TAB 1MG","60","Select","Select",""],["","16729021716","SERTRALINE","TAB 100MG","30","Select","Select",""],["","57894007002","SIMPONI","INJ 50\/0.5ML","0.5","Select","Select",""],["","","MELOXICAM","TAB 15MG","30","Select","Select",""],["","59651018201","METHOTREXATE","TAB 2.5MG","12","Select","Select",""],["","65862014736","SUMATRIPTAN","TAB 50MG","9","Select","Select",""],["","00093317431","ALBUTEROL","FAT E","8.5","Select","Select",""],["","11534016503","FOLIC","TAB 1MG","30","Select","Select",""],["","00069046956","CHANTIX","TAB 1MG","60","Select","Select",""],["","00591079501","DICYCLOMINE","TAB 20MG","60","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","21","Select","Select",""],["","57237002801","AMOXICILLIN","TAB 500MG","21","Select","Select",""],["","64380080907","IBUPROFEN","TAB 400MG","16","Select","Select",""],["","00904672059","ACETAMIN","TAB 500MG","24","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","13811071910","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","69367016304","PHENAZOPYRID","TAB 200MG","15","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","16729031701","OXYBUTYNIN","TAB 5MG ER","30","Select","Select",""],["","69238183501","LEVOTHYROXIN","TAB 112MCG","30","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","20","Select","Select",""],["","70954005820","PREDNISONE","TAB 5MG","40","Select","Select",""],["","68462012605","GABAPENTIN","TAB 600MG","90","Select","Select",""],["","51224000150","BENZONATATE","CAP 200MG","30","Select","Select",""],["","11917014360","VITAMIN","CAP 5000UNIT","30","Select","Select",""],["","65162062711","TRAMADOL","TAB 50MG","56","Select","Select",""],["","60432060416","PROMETHAZINE","SYP DM","118","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","33332032001","AFLURIA","INJ 2020-21","0.5","Select","Select",""],["","59385002260","BELBUCA","MIS 150MCG","60","Select","Select",""],["","63824000832","MUCINEX","TAB 600MG ER","20","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":""}]}]}