{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SUSAN JEFFERSON","gend":1,"add":"720 SONGBIRD LN","city":"DANVILLE","state":"VA","zip":"24540-9998","dob":"1971-02-08","age":"","mstatus":"","insh":"1538293*01","cliId":"","pno":"434\/710-2229","cno":"434\/228-9744","email":"","ename":"","eno":"","pphy":"SMITH, DAVID B PA","ppno":"434\/835-0105","pcpadd":"2767 FRANKLIN TURNPIKE","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24540,"pcpcounty":"","pcpid":"","pcpname":"DANVILLE PHYSICIAN PRACTICES LLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":4344252503,"add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/835-0178","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J44.1","J18.9","Z32.02","N92.1","F31.9","F41.1","J44.9","F34.1","F17.200","F17.210","Z13.89","F11.20","M96.1","M54.17","N34.0","N36.8","N76.4","Z53.29","K21.9","F41.9","F32.9","R91.1","Z79.899","Z91.048","R94.31","Z20.822","R06.02","Z23.","G89.4","F43.10","F31.4","F33.0","R91.8","R93.89","J45.40","F11.21","G43.009","NO DATA","F48.2","T24.211A","Z68.27","F33.9","Z68.25","Z87.891","Z80.3","Z30.42","Z87.828","R30.0","Z80.41","E78.2","N75.0","F42.9","Z00.00","Z12.4","Z68.24","N90.7","R10.2","F41.0","F43.11","Z01.411","Z13.1","E07.9","E75.6","E55.9","R79.9","Z72.0","J20.9","J11.1","Z98.1","M54.6","M51.36","Z47.89","Z68.26","Z68.23","G43.709","L02.92","M54.5","T85.840A","N39.0","J44.0","I10.","F41.8","Z85.41","L30.9","Z68.30","Z71.3","N76.0","Z30.013","R09.02"],"date":["2021-10-04","2021-02-01","2021-05-03","2020-02-05","2021-11-22","2021-12-06","2021-07-19","2020-07-07","2021-07-01","2021-10-04","2021-02-04","2021-12-29","2021-12-14","2021-11-16","2021-07-28","2021-07-28","2021-07-28","2021-10-04","2021-10-04","2021-11-22","2021-10-04","2021-10-04","2021-10-19","2021-10-04","2021-10-04","2021-10-04","2021-10-04","2021-12-01","2021-10-19","2021-11-22","2021-12-06","2021-11-04","2021-01-18","2021-07-19","2021-01-18","2021-10-19","2021-04-01","2021-11-22","2021-11-22","2020-02-27","2020-02-27","2020-06-04","2021-07-01","2021-07-19","2021-10-28","2021-10-28","2021-04-09","2021-05-03","2021-08-11","2021-08-11","2021-08-11","2020-12-03","2021-02-04","2021-02-04","2021-02-04","2021-07-15","2021-07-15","2021-12-06","2021-12-06","2021-07-20","2021-07-20","2021-07-20","2021-07-20","2021-07-20","2021-07-20","2021-10-04","2019-11-19","2019-03-21","2019-10-07","2019-04-01","2019-10-07","2019-10-07","2019-11-27","2019-04-24","2019-03-08","2019-09-03","2019-10-07","2019-05-08","2019-09-10","2019-09-10","2019-09-10","2019-09-10","2019-09-10","2019-05-29","2019-01-28","2019-01-28","2019-01-18","2019-08-15","2019-09-10"],"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":[["","16714079904","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","61874014530","VRAYLAR","CAP 4.5MG","30","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","135","Select","Select",""],["","12496120803","SUBOXONE","MIS 8-2MG","18","Select","Select",""],["","55513084101","AIMOVIG","INJ 70MG\/ML","1","Select","Select",""],["","00173086910","ANORO","AER 62.5-25","60","Select","Select",""],["","62332042771","BENZONATATE","CAP 200MG","90","Select","Select",""],["","00536589671","NICOTINE","DIS 21MG\/24H","28","Select","Select",""],["","16714033202","GABAPENTIN","TAB 800MG","120","Select","Select",""],["","16714070001","LAMOTRIGINE","TAB 25MG","60","Select","Select",""],["","00085461001","DULERA","AER 200-5MCG","13","Select","Select",""],["","80777027310","MODERNA","INJ COVID-19","0","Select","Select",""],["","00173088710","TRELEGY","AER ELLIPTA","60","Select","Select",""],["","23155050110","HYDROXYZ","TAB 25MG","120","Select","Select",""],["","65862001901","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","31722072610","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","16714017402","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","70954002010","PRAZOSIN","CAP 2MG","60","Select","Select",""],["","00487950160","ALBUTEROL","NEB 0.00083","180","Select","Select",""],["","64597030160","NUEDEXTA","CAP 20-10MG","60","Select","Select",""],["","29300013905","DIVALPROEX","TAB 250MG DR","90","Select","Select",""],["","00378668910","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","55111029236","SUMATRIPTAN","TAB 50MG","9","Select","Select",""],["","00135050802","NICORETTE","LOZ 2MG MINT","72","Select","Select",""],["","60432060416","PROMETHAZINE","SYP DM","250","Select","Select",""],["","59762453802","MEDROXYPR","INJ 150MG\/ML","1","Select","Select",""],["","55111068301","IBU","TAB 600MG","60","Select","Select",""],["","59385002360","BELBUCA","MIS 300MCG","60","Select","Select",""],["","00143980350","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","63824017163","DELSYM","SUS 30MG\/5ML","120","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","33342032915","TRIAMCINOLON","CRE 0.001","45","Select","Select",""],["","00591544310","PREDNISONE","TAB 20MG","12","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":""}]}]}