{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CRYSTAL A SAMUELS","gend":1,"add":"817 HARDY DRIVE","city":"CHARLOTTESVILLE","state":"VA","zip":22903,"dob":"1985-03-25","age":"","mstatus":"","insh":4682890,"cliId":"","pno":4342027211,"cno":"","email":"","ename":"","eno":"","pphy":"KLECAN, ANN MARIE","ppno":4342027211,"pcpadd":"315 10TH ST NE,","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22902,"pcpcounty":"","pcpid":"","pcpname":"SENTARA MARTHA JEFFERSON FAMIL","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/CHARLOTTESVILLE","aligned":"","ano":"","add2":"817 HARDY DRIVE","add3":"","madd1":"218 PARADISE LANE","madd2":"APARTMENT A","madd3":"","mcity":"CHARLOTTESVILLE","mstate":"VA","mzip":"22903-4474","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N30.00","R07.81","R30.0","R07.9","F17.210","Z88.5","N10","M54.9","F15.90","R11.2","Z11.59","R10.9","R10.31","K80.20","F33.1","T43.624A","F10.920","R00.0","Y90.6","T43.604A","Y92.009","F10.929","R45.0","R45.1","F19.94","F41.1","T50.904A","K80.10","K80.12","K82.8","Z20.828","R93.2","K81.0","R10.11","N76.0","B96.89","F10.14","F10.180","F11.21","F41.9","R25.2","Z00.00","R07.0","F10.94","F41.8","F41.0","F10.980","M54.5","K08.89","R22.0","M79.604","R20.2","M41.86","M47.816","F10.24","G47.00","F51.01","M54.16","M47.26","M47.897","M51.27","M48.061","M47.27","R06.00","Z20.822","R91.8","J06.9","R06.02","R07.89","R53.83","R06.2","E66.9","Z82.49","M46.97","M54.17","R26.2","R53.1","R20.0","R29.898","R32","E11.22","N18.9","Z87.442","Z98.51","Z80.3","Z72.821","M54.50","N39.3","N60.01","N63.0","N64.4","M51.36","M79.606","J01.10","Z91.89","G47.9","Z53.21","Z72.0","D72.828","R39.15","S63.635A","S62.605A","M79.645","S62.615A"],"date":["2020-02-11","2020-02-11","2021-05-22","2021-09-12","2021-09-29","2021-09-29","2020-06-06","2020-06-06","2020-06-06","2020-06-06","2020-06-06","2020-12-25","2020-06-06","2020-12-25","2022-04-04","2020-12-24","2020-12-24","2020-12-24","2020-12-24","2020-12-24","2020-12-24","2020-12-24","2020-12-24","2020-12-24","2020-12-24","2020-12-24","2020-12-24","2020-12-25","2020-12-25","2020-12-25","2020-12-25","2020-12-25","2020-12-25","2020-12-25","2021-01-06","2021-01-06","2022-02-21","2022-02-21","2022-02-21","2022-02-21","2021-02-05","2021-02-05","2021-09-11","2022-02-21","2022-02-21","2022-03-18","2022-02-21","2021-09-29","2021-05-29","2021-05-29","2021-07-25","2021-07-25","2021-08-04","2022-01-06","2021-08-19","2022-04-04","2022-02-21","2022-01-13","2021-09-10","2021-09-10","2021-09-29","2021-09-10","2021-09-10","2021-09-11","2021-09-12","2021-09-11","2021-09-12","2021-09-12","2021-09-12","2021-09-12","2021-09-12","2021-09-12","2021-09-29","2021-09-29","2021-11-09","2021-11-09","2021-11-09","2021-09-29","2021-09-29","2021-09-29","2021-09-29","2021-09-29","2021-09-29","2021-09-29","2021-09-29","2021-10-21","2021-10-26","2021-12-03","2021-12-03","2021-12-27","2021-12-27","2022-01-06","2022-01-06","2022-01-18","2022-01-18","2022-02-21","2022-03-18","2019-02-19","2019-02-19","2019-05-13","2019-07-29","2019-07-29","2019-08-06","2019-08-06"],"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":[["","65862001501","AMOXICILLIN","65862001501 AMOXICILLIN ","20","Select","Select",""],["","00093005805","TRAMADOL","00093005805 TRAMADOL ","18","Select","Select",""],["","42858010201","OXYCOD\/APAP","42858010201 OXYCOD\/APAP ","21","Select","Select",""],["","69097094312","GABAPENTIN","69097094312 GABAPENTIN ","90","Select","Select",""],["","65862009620","CEFPODOXIME","TAB 200MG","20","Select","Select",""],["","00603188016","LIDOCAINE","00603188016 LIDOCAINE ","30","Select","Select",""],["","00378064205","PREDNISONE","00378064205 PREDNISONE ","10","Select","Select",""],["","60505025203","TIZANIDINE","60505025203 TIZANIDINE ","10","Select","Select",""],["","70710113908","FLUCONAZOLE","70710113908 FLUCONAZOLE ","1","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","65162019050","NAPROXEN","65162019050 NAPROXEN ","20","Select","Select",""],["","13668013701","ESCITALOPRAM","13668013701 ESCITALOPRAM ","30","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","10","Select","Select",""],["","00228212750","CLONIDINE","00228212750 CLONIDINE ","90","Select","Select",""],["","69097014260","ALBUTEROL","69097014260 ALBUTEROL ","6.7","Select","Select",""],["","59267100002","PFIZER","59267100002 PFIZER ","0.3","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","20.00","Select","Select",""],["","59779006200","CLOTRIMAZOLE","CRE 0.02","60.00","Select","Select",""],["","70436001002","BUPROPN","TAB 150MG XL","60.00","Select","Select",""],["","65862048901","QUETIAPINE","65862048901 QUETIAPINE ","30","Select","Select",""],["","50111033401","METRONIDAZOL","50111033401 METRONIDAZOL ","14","Select","Select",""],["","69097083412","SERTRALINE","69097083412 SERTRALINE ","30","Select","Select",""],["","16729008110","NALTREXONE","16729008110 NALTREXONE ","30","Select","Select",""],["","59746000103","METHYLPRED","59746000103 METHYLPRED ","21","Select","Select",""],["","47781030301","NITROFURANTN","47781030301 NITROFURANTN ","10","Select","Select",""],["","13668000705","ZOLPIDEM","13668000705 ZOLPIDEM ","17","Select","Select",""],["","00172392770","DIAZEPAM","00172392770 DIAZEPAM ","1","Select","Select",""],["","00185002201","ORPHENADRINE","TAB 100MG ER","20","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","14","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","",""],[""],[""],[""],[""]],"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":""}]}]}