{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JALIYAH   L POOLE","gend":1,"add":"2516 BENNIE DR","city":"RINGGOLD","state":"VA","zip":"24586-9998","dob":"1997-07-20","age":"","mstatus":"","insh":"20033507*01","cliId":"","pno":"434\/429-9466","cno":"434\/228-5658","email":"","ename":"","eno":"","pphy":"CONDER, BRYAN DO","ppno":"434\/799-4488","pcpadd":"109 BRIDGE STREET SUITE 201","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":"24541","pcpcounty":"","pcpid":"","pcpname":"DANVILLE PHYSICIAN PRACTICES LLC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/773-6977","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.4","J06.9","G40.509","F41.9","F90.9","G44.219","R06.02","G40.89","E66.9","Z73.810","F91.1","G40.219","S09.90XA","R51.9","R56.9","F33.9","F33.1","R55.","F41.8","F31.81","Z11.59","G44.89","R40.20","E86.0","R30.0","F44.5","Z13.9","Z09.","Z20.828","F39.","L25.9","N30.00","F52.31","G40.909","L50.9","L29.9","R21.","Z76.0","J45.20","F32.9","N76.0","S40.811A","S13.9XXA","Z91.040","Z88.8","Z91.018","Z79.899","J45.909","Z87.820","NO DATA","F32.2","W57.XXXA","Z20.822","R00.0","R41.0","J18.0","R11.0","J45.40","R07.89","R06.2","Z87.2","Z72.89","R52.","J18.9","F10.20","B96.89"],"date":["2021-12-19","2021-03-09","2020-05-16","2021-05-25","2020-04-15","2020-04-15","2021-04-29","2021-12-05","2021-01-25","2021-01-25","2021-01-25","2021-01-25","2021-05-12","2021-05-12","2021-06-16","2021-09-13","2021-10-14","2021-06-28","2021-12-13","2021-12-13","2021-07-12","2021-03-12","2021-01-20","2021-04-29","2021-10-22","2020-01-29","2020-01-29","2020-05-15","2020-08-07","2020-10-26","2020-12-18","2020-12-18","2020-12-18","2021-06-22","2021-01-11","2021-01-11","2021-05-25","2021-06-22","2021-06-22","2021-06-22","2021-07-13","2021-07-13","2021-12-05","2021-12-05","2021-12-05","2021-12-05","2021-12-05","2021-12-05","2021-12-05","2021-12-05","2020-11-16","2020-07-02","2021-11-20","2020-06-09","2020-06-09","2020-05-16","2021-04-29","2021-07-12","2021-07-12","2021-07-12","2021-07-12","2021-07-12","2020-05-15","2020-05-15","2020-07-20","2021-03-09"],"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":[["","55111078401","FEXOFENADINE","TAB 180MG","30","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","20","Select","Select",""],["","51991074790","DULOXETINE","CAP 30MG","60","Select","Select",""],["","00310737220","BUDES\/FORMOT","AER 80-4.5","20","Select","Select",""],["","65862024708","LEVETIRACETA","TAB 750MG","60","Select","Select",""],["","65862007701","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","15","Select","Select",""],["","60505283303","ATOMOXETINE","CAP 40MG","30","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","16729020201","BUSPIRONE","TAB 10MG","60","Select","Select",""],["","60432056161","TRIAMCINOLON","LOT 0.001","60","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","45802091987","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","59779045806","CVS","TAB 10MG","30","Select","Select",""],["","00591565810","CYCLOBENZAPR","TAB 10MG","20","Select","Select",""],["","65862041901","SMZ-TMP","TAB 400-80MG","14","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","20","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","8","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":""}]}]}