{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DESTINY   N HAWLEY","gend":1,"add":"57 WISEMAN LANE","city":"MOUNT SOLON","state":"VA","zip":"22843-2722","dob":"1998-09-07","age":"","mstatus":"","insh":6815154,"cliId":"","pno":5402808481,"cno":5404482735,"email":"","ename":"","eno":"","pphy":"LE, NGOC H","ppno":5402485110,"pcpadd":"3881 Churchville Ave, ","pcpcity":"Churchville","pcpstate":"VA","pcpzip":244212525,"pcpcounty":"","pcpid":"","pcpname":"AUGUSTA HEALTH FAMILY PRACTICE","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"LOT 19","add3":"","madd1":"57 WISEMAN LANE","madd2":"LOT 19","madd3":"","mcity":"MOUNT SOLON","mstate":"VA","mzip":"22843-2722","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R05","U07.1","E84.9","M25.512","M54.6","S39.012A","M54.50","X58.XXXA","N39.0","T83.9XXA","R10.2","K74.69","I85.00","K76.9","R10.9","M54.9","R31.9","R10.84","R10.31","K70.9","Z53.21","N93.9","M53.3","M95.8","M62.81","R07.89","S29.011A","S20.211A","K08.89","K74.60","I27.20","Z88.5","Z88.8","Z91.048","R23.8","J01.90","H60.91","R53.83","F41.8","J98.09","R50.9","K92.2","K76.6","I85.10","K64.9","K62.5","K92.0","N93.8","E84.8","D69.6","D68.4","K64.4","J45.909","R69","Z11.3","Z30.430","N83.201","A74.9","Z30.431","S09.90XA","R51","S19.9XXA","M54.2","S39.91XA","S39.93XA","S29.9XXA","S30.1XXA","R10.30","V89.2XXA","S13.4XXD","M62.838","V49.40XD","S20.219A","S49.91XA","K52.9","R16.1","N26.1","R11.2","R10.13","R04.2","R19.7","K92.1","R11.0","K63.3","K31.89","K76.89"],"date":["2021-09-16","2021-09-16","2021-12-03","2021-10-20","2022-01-04","2021-10-27","2022-01-18","2021-10-27","2021-10-29","2021-10-29","2021-10-29","2021-12-21","2021-10-29","2021-10-30","2021-10-30","2021-10-30","2021-10-30","2021-10-30","2021-10-30","2021-10-30","2021-10-30","2021-10-30","2021-11-05","2021-11-05","2021-11-05","2021-11-08","2021-11-08","2021-11-08","2021-12-03","2021-12-03","2021-12-03","2021-12-03","2021-12-03","2021-12-03","2021-12-21","2021-12-21","2021-12-21","2021-12-21","2022-01-18","2019-01-04","2019-01-04","2019-01-04","2019-08-16","2019-08-13","2019-01-04","2019-01-04","2019-07-20","2019-01-04","2019-08-13","2019-01-04","2019-01-04","2019-01-04","2019-01-04","2019-01-04","2019-02-14","2019-02-28","2019-02-20","2019-02-28","2019-02-28","2019-08-02","2019-07-20","2019-08-02","2019-07-20","2019-07-20","2019-07-20","2019-07-20","2019-07-20","2019-07-20","2019-08-02","2019-07-29","2019-07-29","2019-07-29","2019-08-02","2019-08-02","2019-08-13","2019-08-13","2019-08-13","2019-08-13","2019-08-15","2019-08-15","2019-08-15","2019-08-15","2019-08-16","2019-08-16","2019-08-16","2019-08-16"],"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":[["","68645013054","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","30","Select","Select",""],["","68645056354","IBUPROFEN","TAB 800MG","60","Select","Select",""],["","59746017210","PREDNISONE","TAB 5MG","20","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100.00","Select","Select",""],["","00378827052","ALBUTEROL","NEB 0.00083","300","Select","Select",""],["","50111078751","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","28","Select","Select",""],["","50111043301","TRAZODONE","TAB 50MG","60","Select","Select",""],["","55111015930","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","24208063110","NEO\/POLY\/HC","SOL 1% OTIC","10","Select","Select",""],["","66689000816","NYSTATIN","SUS 100000","200.00","Select","Select",""],["","62135030905","CIPROFLOXACN","TAB 500MG","10","Select","Select",""],["","65162019011","NAPROXEN","TAB 500MG","20","Select","Select",""],["","57237004101","PENICILLN","TAB 500MG","28","Select","Select",""],["","81131031251","IRON","TAB 325MG","30","Select","Select",""],["","00591315901","URSODIOL","CAP 300MG","30","Select","Select",""],["","00555088704","ESTRADIOL","TAB 2MG","14","Select","Select",""],["","49884028901","MEGESTROL","TAB 20MG","10","Select","Select",""],["","43386016006","MISOPROSTOL","TAB 100MCG","1","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","9","Select","Select",""],["","50419042401","KYLEENA","IUD 19.5MG","1","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","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":[]}},{"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":""}]}]}