{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LYNN   S TIPTON","gend":1,"add":"33 SHADY GROVE CIR PO BOX 646","city":"RUCKERSVILLE","state":"VA","zip":"22968-9998","dob":"1993-10-21","age":"","mstatus":"","insh":"1897637*01","cliId":"","pno":"434\/990-1250","cno":"434\/990-1250","email":"","ename":"","eno":"","pphy":"BOSTIC, BROOKE A MD","ppno":"434\/654-1850","pcpadd":"140 STONERIDGE DR SUITE 100","pcpcity":"RUCKERSVILLE","pcpstate":"VA","pcpzip":22968,"pcpcounty":"","pcpid":145513,"pcpname":"SMJMG - Sentara Greene Family Medicine","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/985-7848","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.2","F41.1","F41.0","R51.","G43.009","F41.8","S01.511A","F43.9","F17.210","F32.9","Z79.899","M79.604","L23.7","F51.04","G47.30","NO DATA","N30.00","R10.2","F41.9","Z87.42","M54.2","V58.89","F33.1","R19.7","M54.9","K08.89","Z30.46"],"date":["2020-07-15","2020-07-15","2020-09-04","2020-03-16","2021-07-11","2020-02-18","2020-02-16","2020-09-04","2020-09-04","2020-09-04","2020-09-04","2020-09-04","2020-09-16","2020-07-07","2020-07-07","2020-07-15","2021-02-21","2021-02-21","2020-03-09","2020-03-09","2020-09-04","2020-02-22","2020-04-08","2020-03-16","2020-04-24","2020-04-24","2021-07-14"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","13668000905","CITALOPRAM ","10MG","30","Select","Select",""],["","55111029136","SUMATRIPTAN ","25MG","9","Select","Select",""],["","65862039110","ONDANSETRON ","8MG ODT","12","Select","Select",""],["","43547030203","ARIPIPRAZOLE ","2MG","30","Select","Select",""],["","49884030802","CLONAZEP ","0.5MG","14","Select","Select",""],["","00093083205","CLONAZEPAM ","0.5MG","8","Select","Select",""],["","13107008305","LORAZEPAM ","0.5MG","12","Select","Select",""],["","68382003516","VENLAFAXINE ","75MG ER","30","Select","Select",""],["","10702001150","HYDROXYZ ","25MG","90","Select","Select",""],["","65862001501","AMOXICILLIN ","875MG","10","Select","Select",""],["","16571020210","DICLOFENAC ","50MG DR","12","Select","Select",""],["","69097084615","CYCLOBENZAPR ","10MG","20","Select","Select",""],["","65862050320","AMOX\/K ","875-125","20","Select","Select",""],["","00093117410","PENICILLN ","500MG","30","Select","Select",""],["","51991090990","L-METHYLFOLA ","FORTE 15","30","Select","Select",""],["","00525110290","DEPLIN ","","30","Select","Select",""],["","69097094312","GABAPENTIN ","300MG","30","Select","Select",""],["","00378064110","PREDNISONE ","10MG","15","Select","Select",""],["","50111033401","METRONIDAZOL ","500MG","14","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","6","Select","Select",""],["","59746011506","PROCHLORPER ","10MG","20","Select","Select",""],["","49483060350","IBUPROFEN ","600MG","40","Select","Select",""],["","55111029136","SUMATRIPTAN","25MG","9","Select","Select",""],["","49884030802","CLONAZEP","0.5MG","14","Select","Select",""],["","43547030203","ARIPIPRAZOLE","2MG","30","Select","Select",""],["","10702001150","HYDROXYZ","25MG","90","Select","Select",""],["","13107008305","LORAZEPAM","0.5MG","12","Select","Select",""],["","68382003516","VENLAFAXINE","75MG ER","30","Select","Select",""],["","65862001501","AMOXICILLIN","875MG","10","Select","Select",""],["","00093083205","CLONAZEPAM","0.5MG","10","Select","Select",""],["","16571020210","DICLOFENAC","50MG DR","12","Select","Select",""],["","13668000905","CITALOPRAM","10MG","30","Select","Select",""],["","65862039110","ONDANSETRON","8MG ODT","12","Select","Select",""],["","00093117410","PENICILLN","500MG","30","Select","Select",""],["","69097084615","CYCLOBENZAPR","10MG","20","Select","Select",""],["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","51991090990","L-METHYLFOLA","FORTE 15","30","Select","Select",""],["","00525110290","DEPLIN","","30","Select","Select",""],["","00378064110","PREDNISONE","10MG","15","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","14","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","6","Select","Select",""],["","59746011506","PROCHLORPER","10MG","20","Select","Select",""],["","49483060350","IBUPROFEN","600MG","40","Select","Select",""],["","53746010901","HYDROCO\/APAP","5-325MG","8","Select","Select",""],["","69097094312","GABAPENTIN","300MG","30","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","12","Select","Select",""],["","64980030550","DENTA ","CRE PLUS","102","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}