{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CRYSTAL TWYMAN","gend":1,"add":"7247 HAPPY CREEK ROAD","city":"GORDONSVILLE","state":"VA","zip":"22942-9998","dob":"1983-05-17","age":"","mstatus":"","insh":"1506620*01","cliId":"","pno":"540\/832-2623","cno":"540\/406-7695","email":"","ename":"","eno":"","pphy":"COX, DAVID B MD","ppno":"540\/832-2211","pcpadd":"501 N MAIN STREET","pcpcity":"GORDONSVILLE","pcpstate":"VA","pcpzip":22942,"pcpcounty":"","pcpid":"","pcpname":"Gordonsville Area Medical Center","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/832-2293","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G43.109","F41.0","G47.00","F32.2","M54.5","G89.29","V58.89","F32.9","E53.8","E55.9","D50.8","Z30.42","N93.8","F41.9","M25.562","M23.52","S83.412A","G43.119","M54.42","NO DATA","N92.1","D50.9","Z98.84","E66.01","Z83.3","Z00.00","Z68.41","J20.9","J45.909","I10.","F51.01","E56.9","J45.41","R11.0","Z11.59","B36.9","N83.201","N83.202","N93.9","S60.222A","J11.1","B37.2","E65.","N39.0","R30.9","J40.","Z86.19","R03.0","N92.0"],"date":["2019-10-01","2019-02-13","2021-08-23","2019-06-25","2019-02-13","2019-11-12","2019-05-20","2019-05-14","2020-10-15","2021-08-23","2020-10-15","2020-03-17","2021-09-09","2021-08-23","2019-05-01","2019-05-20","2019-05-20","2019-11-12","2019-11-12","2021-08-23","2021-10-19","2020-10-15","2020-10-15","2020-10-15","2020-10-15","2021-08-23","2020-10-15","2021-11-03","2021-11-03","2021-08-23","2019-05-01","2019-05-01","2021-01-27","2021-01-27","2021-08-23","2021-08-23","2021-09-09","2021-09-09","2021-09-10","2019-09-25","2019-02-15","2019-02-15","2019-02-15","2020-05-18","2020-05-18","2020-09-28","2020-03-17","2020-03-17","2021-06-01"],"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":[["","","MEDROXYPR","TAB 5MG","","Select","Select",""],["","","VITAMIN"," VITAMIN ","4","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","","PROMETHAZINE"," PROMETHAZINE ","240","Select","Select",""],["","","ZOLPIDEM"," ZOLPIDEM ","30","Select","Select",""],["","","CLONAZEPAM"," CLONAZEPAM ","90","Select","Select",""],["","","PREGABALIN"," PREGABALIN ","90","Select","Select",""],["","","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","","HYDROCHLOROT","TAB 25MG","","Select","Select",""],["","","OMEPRAZOLE"," OMEPRAZOLE ","60","Select","Select",""],["","00121092816","PROMETH\/COD","SOL 6.25-10","473","Select","Select",""],["","","RIZATRIPTAN"," RIZATRIPTAN ","10","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","60","Select","Select",""],["","68001036103","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","","PROAIR"," PROAIR ","8","Select","Select",""],["","","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","","VIRTUSSIN","SOL 100-10\/5","","Select","Select",""],["","","SMZ\/TMP","TAB 800-160","","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":""}]}]}