{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KAYLA   M TERRY","gend":1,"add":"126   PARK  BOULEVARD                                       ","city":"STAUNTON                      ","state":"VA","zip":"24401-3056","dob":"2002-02-23","age":"","mstatus":"","insh":6846026,"cliId":"","pno":5402949479,"cno":"","email":"","ename":"","eno":"","pphy":"FARLEY, BENJAMIN GATES                                      ","ppno":5408866259,"pcpadd":"42 Lambert St                                               ,Ste 511                                                     ","pcpcity":"Staunton                      ","pcpstate":"VA","pcpzip":244012437,"pcpcounty":"","pcpid":"","pcpname":"AUGUSTA HEALTH URGENT CARE","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"126   PARK  BOULEVARD                                       ","add3":"","madd1":"126   PARK  BOULEVARD                                       ","madd2":"APT 101                                                     ","madd3":"","mcity":"STAUNTON                      ","mstate":"VA","mzip":"24401-3056","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z30.017","Z30.432","Z32.02","J02.9","B34.9","F17.210","R07.89","R06.02","R07.9","R00.2","F17.200","Z97.5","Z82.49","Z88.8","Z30.46","Z11.59","R19.7","Z20.828","N83.201","N83.202","R10.2","R10.31","R11.0","Z87.891","S20.229A","F43.12","Z79.899","R11.2","S09.90XA","R27.0","R05","Z72.0","R10.10","R10.32","Z53.29","R93.89","N83.12","I86.8","R10.9","Z11.52","N94.89","Z30.42","Z01.812","Z20.822","Z01.818","N80.3","N80.9","F41.9","F32.9","Z53.21","G89.29","R10.30","B37.3","Z87.42","Z98.890","S23.3XXA","I63.9","R09.89","R20.0","E04.2","I77.89","G93.0","R51.9","Z86.73","R42","R47.81","R53.1","G45.9","G40.89","R56.9","R25.9","G40.909","G93.89","J02.0","E04.1","R68.89","Z13.6","R41.82","M25.512","N93.8","N93.9","R63.0","J01.90","J06.9","R03.0","J20.8","Z11.3","N30.00","N83.209","R30.0","N83.292","J03.90","R59.0","T36.8X5A","T88.7XXA"],"date":["2020-02-14","2020-02-14","2021-04-30","2022-11-19","2020-03-05","2020-03-05","2020-03-27","2020-12-15","2022-04-02","2020-03-27","2021-07-08","2020-03-27","2020-03-27","2022-11-19","2020-04-16","2020-04-13","2020-07-05","2020-12-15","2020-08-03","2022-11-16","2022-11-14","2021-04-19","2022-08-27","2022-11-16","2020-09-11","2020-10-29","2020-10-29","2022-11-22","2020-12-26","2020-12-26","2021-02-05","2022-01-02","2021-04-19","2022-11-14","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2022-11-22","2021-05-11","2021-07-08","2021-04-30","2021-07-03","2022-11-19","2021-07-06","2021-07-08","2022-11-22","2021-07-08","2021-07-08","2021-07-10","2022-01-02","2022-11-16","2022-01-02","2022-11-14","2022-11-14","2022-02-02","2022-09-23","2022-04-02","2022-04-02","2022-04-02","2022-04-02","2022-04-02","2022-04-02","2022-11-16","2022-04-02","2022-04-02","2022-04-02","2022-04-02","2022-04-03","2022-09-23","2022-04-03","2022-09-01","2022-05-20","2022-04-11","2022-04-21","2022-04-19","2022-04-19","2022-04-19","2022-06-02","2022-07-10","2022-07-10","2022-09-01","2022-09-23","2022-10-29","2022-10-27","2022-10-29","2022-11-10","2022-11-16","2022-11-16","2022-11-16","2022-11-16","2022-11-19","2022-11-19","2022-11-22","2022-11-22"],"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":[["","65162047810","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","10","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","63304069205","CLINDAMYCIN","CAP 150MG","42","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","5","Select","Select",""],["","31722053301","METHOCARBAM","TAB 500MG","30","Select","Select",""],["","50024042902","ALAVERT","TAB 5-120MG","24","Select","Select",""],["","42192060716","BROM\/PSE\/DM","SYP 2\/30\/10","120","Select","Select",""],["","42806040021","METHYLPRED","TAB 4MG","21","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","6.7","Select","Select",""],["","65862024608","LEVETIRACETA","TAB 500MG","60","Select","Select",""],["","59762453701","MEDROXYPR","INJ 150MG\/ML","1","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","20","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0.3","Select","Select",""],["","49483060350","IBUPROFEN","TAB 600MG","20","Select","Select",""],["","42806031250","DOXYCYCL","TAB 100MG","28","Select","Select",""],["","70710101002","OSELTAMIVIR","CAP 75MG","10","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":""}]}]}