{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARIA LORENZO","gend":1,"add":"1071 MEADOWLARD DR APT A","city":"HARRISONBURG","state":"VA","zip":"22802-9998","dob":"1967-07-04","age":"","mstatus":"","insh":"20040134*01","cliId":"","pno":"757\/656-1604","cno":"","email":"","ename":"","eno":"","pphy":"GIBSON, SARAH COLEMAN FNP","ppno":"540\/433-4913","pcpadd":"1380 LITTLE SORRELL DR STE 100","pcpcity":"HARRISONBURG","pcpstate":"VA","pcpzip":22801,"pcpcounty":"","pcpid":"","pcpname":"Healthy Community Health Center - Stone Port (HCHC-Stone Port)","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/433-4915","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["T43.014A","T50.902A","F33.3","F31.30","X83.8XXA","R40.2421","R06.9","E11.65","L65.9","L29.9","K21.9","R10.84","Z79.4","R42.","R53.81","V58.89","F33.9","F31.9","V62.84","E11.9","G47.00","F41.9","Z79.899","Z91.5","G43.009","G47.33","M51.9","M51.36","M54.16","Z01.810","M79.18","R94.31","E23.6","H25.13","H25.11","U07.1","R05.","Z96.1","R10.13","K59.00","R11.0","E78.5","R50.9","T50.B95A","H26.491","H25.12","J98.8","F32.9","G43.909","K59.04","R74.8","R07.89","R07.9","R40.4","G44.89","R41.0","R07.2","G93.2","M79.604","M54.42","G47.30","M79.605","M54.41","G89.29","R51.9","R20.2","R06.02","E78.00","K76.0","T43.594A","Z90.49","Z82.49","Z80.6","F32.0","D35.2","H40.003","T74.11XA","S00.83XA","S39.91XA","S09.8XXA","Z12.11","Z86.010","D17.5","D72.820","K29.50","R52.","Y04.8XXA","Z12.31","N93.9","N18.1","R23.2","D64.9","R03.0","B34.9","Z01.818","R00.2","N95.0","R93.89","F22.","R73.9","K29.80","E66.9","Z68.32","R10.32","E87.6","E16.2","Z76.89","Z79.1","I49.9","M54.9","NO DATA"],"date":["2020-03-01","2020-03-03","2022-09-01","2020-03-05","2020-03-05","2021-01-24","2021-01-24","2022-11-02","2021-06-23","2021-03-05","2022-09-27","2022-10-08","2022-10-08","2022-11-02","2021-09-29","2020-03-31","2020-03-03","2020-03-03","2020-03-03","2022-09-27","2022-07-26","2022-03-27","2022-10-08","2020-03-03","2022-01-28","2022-07-26","2022-07-26","2021-06-09","2021-06-09","2021-06-14","2021-06-14","2021-06-14","2020-06-18","2020-07-28","2020-08-26","2021-01-24","2021-01-24","2021-05-14","2022-10-08","2021-06-17","2022-03-27","2021-06-23","2021-04-11","2021-04-11","2022-03-11","2022-02-17","2021-01-24","2021-09-29","2021-09-29","2021-05-07","2021-05-07","2022-03-27","2022-03-27","2022-03-27","2021-09-05","2021-09-05","2021-09-29","2022-07-26","2021-06-23","2021-05-24","2021-06-23","2021-06-23","2021-05-24","2021-05-24","2021-09-29","2021-09-05","2022-03-27","2021-09-29","2021-09-29","2020-03-01","2022-10-08","2020-03-01","2020-03-01","2020-03-31","2020-05-22","2020-05-22","2021-08-08","2021-08-08","2021-08-08","2021-08-08","2021-06-17","2021-06-17","2021-06-17","2021-06-17","2021-06-17","2022-10-08","2021-08-08","2019-08-16","2019-05-07","2019-01-25","2019-01-25","2019-01-25","2019-01-25","2019-04-28","2019-04-26","2019-04-02","2019-05-06","2019-03-05","2022-01-30","2022-01-30","2022-03-27","2022-03-27","2022-03-27","2022-03-27","2022-01-20","2022-01-20","2022-01-18","2022-10-08","2022-10-08","2022-10-08","2022-10-08"],"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":[["","69097094312","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","","JANUMET"," JANUMET ","30","Select","Select",""],["","50458014190","INVOKANA","TAB 300MG","30","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","100","Select","Select",""],["","73070010315","INSULIN","INJ FLEXPEN","15","Select","Select",""],["","","QUETIAPINE"," QUETIAPINE ","60","Select","Select",""],["","","DULOXETINE"," DULOXETINE ","60","Select","Select",""],["","","BD  PEN NEEDL","MIS 31GX8MM","","Select","Select",""],["","","BUSPIRONE"," BUSPIRONE ","90","Select","Select",""],["","","LANTUS"," LANTUS ","15","Select","Select",""],["","","ZOLPIDEM"," ZOLPIDEM ","30","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","60","Select","Select",""],["","70377002711","ATORVASTATIN","TAB 10MG","30","Select","Select",""],["","00245531911","KLOR-CON","TAB 20MEQ ER","5","Select","Select",""],["","","ACETAZOLAMID","TAB 250MG","","Select","Select",""],["","16571066101","MECLIZINE","TAB 25MG","90","Select","Select",""],["","","VITAMIN","CAP 50000UNT","","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","15","Select","Select",""],["","94030000202","EMBRACE","TES BLD GLUC","30","Select","Select",""],["","00193731150","CONTOUR","TES NEXT","50","Select","Select",""],["","49483060350","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","","OMEPRAZOLE"," OMEPRAZOLE ","30","Select","Select",""],["","65862096901","ESZOPICLONE","TAB 3MG","30","Select","Select",""],["","55111014512","FLUCONAZOLE","TAB 150MG","4","Select","Select",""],["","67877026218","RIZATRIPTAN","TAB 10MG","9","Select","Select",""],["","69097012403","TOPIRAMATE","TAB 100MG","60","Select","Select",""],["","60505025203","TIZANIDINE","TAB 4MG","90","Select","Select",""],["","43547030303","ARIPIPRAZOLE","TAB 5MG","30","Select","Select",""],["","","LAMOTRIGINE","TAB 25MG","","Select","Select",""],["","","MOXIFLOXACIN","SOL HCL 0.5%","","Select","Select",""],["","","PREDNISOLONE","SUS 1% OP","","Select","Select",""],["","","DIVALPROEX","TAB 250MG ER","","Select","Select",""],["","","KETOROLAC","SOL 0.005","","Select","Select",""],["","","FLUCLVX","INJ 2020-21","","Select","Select",""],["","","FLUZONE","INJ 2020-21","","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":""}]}]}