{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DEREK   T HALL","gend":0,"add":"901 4TH ST APT 614","city":"WAYNESBORO","state":"VA","zip":"22980-9998","dob":"1975-08-22","age":"","mstatus":"","insh":"20058282*01","cliId":"","pno":"540\/471-9536","cno":"540\/471-9536","email":"","ename":"","eno":"","pphy":"FORTIN, KELSEY C NP","ppno":"540\/261-7421","pcpadd":"2252 MAGNOLIA AVE","pcpcity":"BUENA VISTA","pcpstate":"VA","pcpzip":24416,"pcpcounty":"","pcpid":"","pcpname":"Radford Student Health Center","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/261-1952","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L30.4","S99.921A","M25.561","Z79.899","F25.0","F31.10","F41.1","F31.70","F43.12","NO DATA","F31.62","R07.81","F31.77","F33.2","F32.89","Z13.41","M10.9","V58.89","X58.XXXD","R10.32","F12.20","R41.0","R42.","B34.9","R07.9","Z86.73","R06.09","R00.2","M79.89","R11.2","R20.2","F31.61","F31.32","H04.123","M10.071","M77.51","M79.671","K59.4","F11.20","Z68.38","K43.9","R10.13","K12.1","G47.00","L03.111","F17.210","Z88.0","K60.2","R35.0","R73.01","R35.8","F41.9","J06.9","R29.818","R09.89","R22.41","B35.6","K92.1","K43.2","R15.1","K64.8","I63.9","R51.9","R53.83","Z20.828","R00.0","F31.9","Z79.82"],"date":["2020-05-12","2020-05-12","2020-10-20","2022-07-26","2021-02-25","2021-02-25","2022-10-19","2022-02-17","2022-10-19","2022-01-10","2022-09-21","2022-06-13","2022-10-19","2021-11-01","2020-06-24","2020-06-24","2020-06-24","2020-07-08","2020-07-08","2021-02-24","2021-11-01","2021-10-14","2021-10-14","2021-10-14","2021-10-30","2021-12-09","2021-12-09","2021-12-09","2022-01-15","2022-01-15","2022-01-15","2022-09-16","2022-08-10","2020-07-08","2020-07-15","2020-07-15","2020-07-15","2021-01-14","2021-11-01","2022-01-17","2020-11-04","2021-02-26","2022-04-29","2021-12-03","2020-04-28","2020-04-28","2021-12-03","2021-03-03","2021-05-25","2021-05-25","2021-05-25","2021-10-30","2021-12-31","2022-01-16","2022-01-16","2022-01-16","2022-07-25","2020-10-01","2020-11-04","2021-01-07","2021-01-07","2021-01-07","2021-02-24","2021-02-24","2021-02-24","2021-12-03","2021-12-03","2021-12-03"],"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":[]},{"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":[["","49281072210","FLUBLOK","INJ 2022-23","0","Select","Select",""],["","65862070360","ZIPRASIDONE","CAP 40MG","60","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","61442010305","DICLOFENAC","TAB 75MG DR","28","Select","Select",""],["","49884003201","TRANYLCYPROM","TAB 10MG","210","Select","Select",""],["","43547040710","CLONAZEPAM","TAB 1MG","90","Select","Select",""],["","00093406901","PRAZOSIN","CAP 5MG","30","Select","Select",""],["","68382000601","LAMOTRIGINE","TAB 25MG","42","Select","Select",""],["","65862016001","ZOLPIDEM","TAB 10MG","30","Select","Select",""],["","16729013401","ALLOPURINOL","TAB 100MG","90","Select","Select",""],["","00115180401","HYDROXYZ","CAP 50MG","120","Select","Select",""],["","00603548232","PROPRANOLOL","TAB 10MG","90","Select","Select",""],["","45802006435","TRIAMCINOLON","CRE 0.001","30","Select","Select",""],["","00527293341","PREDNISONE","TAB 10MG","30","Select","Select",""],["","51672129802","KETOCONAZOLE","CRE 0.02","30","Select","Select",""],["","68462022301","LITHIUM","TAB 300MG ER","60","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","60","Select","Select",""],["","68462010340","FLUCONAZOLE","TAB 150MG","7","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","14","Select","Select",""],["","00536106229","STOOL","CAP 100MG","60","Select","Select",""],["","59762040105","SUCRALFATE","TAB 1GM","60","Select","Select",""],["","69315090505","LORAZEPAM","TAB 1MG","90","Select","Select",""],["","47781057172","LIDOCAINE","CRE 0.05","45","Select","Select",""],["","68752001545","LC-5","CRE 0.05","45","Select","Select",""],["","00832030200","CHLORPROMAZ","TAB 50MG","60","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","43386036021","PHENELZINE","TAB 15MG","120","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","30","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","00713067831","NYSTATIN","CRE 100000","45","Select","Select",""],["","00254200801","COLCHICINE","TAB 0.6MG","3","Select","Select",""],["","29300012401","MELOXICAM","TAB 7.5MG","60","Select","Select",""],["","60505005501","SELEGILINE","CAP 5MG","30","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","00536116401","ACETAMIN","TAB 325MG","60","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":""}]}]}