{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHRISTINA CLINE","gend":1,"add":"1757 HAILEY LN","city":"BROADWAY","state":"VA","zip":"22815-9998","dob":"1970-12-15","age":"","mstatus":"","insh":"20039075*01","cliId":"","pno":"540\/901-2118","cno":"","email":"","ename":"","eno":"","pphy":"MAZER, TRENT W MD","ppno":"540\/564-5666","pcpadd":"13892 TIMBER WAY","pcpcity":"BROADWAY","pcpstate":"VA","pcpzip":22815,"pcpcounty":"","pcpid":"","pcpname":"SRMHMG - Sentara Timber Way Health Center","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/579-8594","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.65","J44.9","J30.9","I50.22","R60.9","I10.","E83.42","K21.9","E87.6","E11.69","E78.2","R19.00","Z11.59","R10.84","K91.2","R19.7","I36.1","I51.7","A41.9","I42.8","E11.9","E78.5","Z87.891","C56.2","R10.9","R11.2","R63.4","K64.9","K92.2","G89.18","R10.30","N13.6","Z96.0","N13.2","T36.1X5A","NO DATA","I11.0","N20.0","I50.9","I42.9","Z00.00","N85.8","K91.1","R50.9","R93.5","Z20.828","N20.1","B37.3","C56.9","K66.0","Z98.890","F41.9","F32.9","N20.2","R53.1","I50.23","A41.51","E66.9","Z68.37","I25.5","R19.07","Z28.21","N80.9","Z23.","Z79.84","Z79.899","E86.0","R52.","N92.2","M25.511","W19.XXXA","E66.01","K42.9"],"date":["2021-03-11","2022-04-11","2021-10-01","2022-04-11","2022-04-11","2022-10-17","2021-09-08","2021-10-01","2021-10-01","2022-10-17","2022-10-17","2020-11-24","2020-10-16","2021-03-13","2021-06-19","2021-10-01","2021-04-15","2021-04-15","2020-10-05","2021-09-08","2022-10-17","2022-04-06","2021-06-19","2022-04-11","2021-10-01","2021-10-01","2021-05-26","2021-03-11","2020-11-24","2020-11-26","2021-05-26","2020-10-05","2020-10-05","2021-06-19","2021-06-19","2021-06-19","2021-06-19","2021-06-19","2021-03-12","2020-11-24","2022-04-11","2020-10-23","2022-04-06","2020-10-03","2020-10-03","2020-11-24","2021-06-20","2020-10-12","2021-01-15","2020-11-24","2021-01-15","2021-01-15","2021-01-15","2021-06-19","2021-06-19","2021-09-08","2020-10-03","2020-10-03","2020-10-03","2020-10-03","2020-10-03","2020-10-03","2020-11-24","2022-10-17","2020-11-24","2020-11-24","2021-03-12","2021-06-19","2020-11-24","2019-09-30","2019-09-30","2022-10-17","2022-10-17"],"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":[["","00536352141","MAG","TAB 400MG","30","Select","Select",""],["","00173085910","BREO","INH 100-25","60","Select","Select",""],["","43547040211","FUROSEMIDE","TAB 40MG","60","Select","Select",""],["","16714068403","SIMVASTATIN","TAB 40MG","30","Select","Select",""],["","00781286810","OMEPRAZOLE","CAP 20MG DR","30","Select","Select",""],["","00832532511","POT  CL MICRO","TAB 20MEQ ER","30","Select","Select",""],["","64679092302","ENALAPRIL","TAB 2.5MG","30","Select","Select",""],["","50742061701","METOPROL","TAB 100MG ER","30","Select","Select",""],["","68180031406","IMIPRAM","CAP 75MG","30","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00597015230","JARDIANCE","TAB 10MG","30","Select","Select",""],["","66993013597","FLUTIC\/VILAN","INH 100-25","60","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","","NITROGLYCERN","SUB 0.4MG","","Select","Select",""],["","","OXYCODONE","TAB 5MG","","Select","Select",""],["","55111012705","CIPROFLOXACN","TAB 500MG","10","Select","Select",""],["","00527058601","DICYCLOMINE","CAP 10MG","120","Select","Select",""],["","49035022482","ANTI-DIARRHE","TAB 2MG","30","Select","Select",""],["","50580029512","IMODIUM","TAB 2MG","24","Select","Select",""],["","68382039801","POT  CHLORIDE","TAB 20MEQ ER","90","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","04142000024","FLORASTOR","CAP 250MG","90","Select","Select",""],["","66758019092","KLOR-CON","TAB 20MEQ ER","30","Select","Select",""],["","60432053716","NYSTATIN","SUS 100000","300","Select","Select",""],["","68645058259","METFORMIN","TAB 500MG","60","Select","Select",""],["","68645055354","LISINOPRIL","TAB 20MG","30","Select","Select",""],["","","ACETAMINOPHE","TAB 325MG","","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","","LEVOFLOXACIN","TAB 750MG","","Select","Select",""],["","","FLUCONAZOLE","TAB 100MG","","Select","Select",""],["","","IBUPROFEN","TAB 600MG","","Select","Select",""],["","","POLYETH","POW 3350 NF","","Select","Select",""],["","","ONDANSETRON","TAB 8MG","","Select","Select",""],["","","ELIQUIS","TAB 2.5MG","","Select","Select",""],["","59746021106","CYCLOBENZAPR","TAB 5MG","30","Select","Select",""],["","68382005005","MELOXICAM","TAB 7.5MG","30","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}