{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMANDA   M JOHNSON","gend":1,"add":"25 BRIARWOOD ONE RD APT 103","city":"STAUNTON","state":"VA","zip":"24401-9998","dob":"1989-06-06","age":"","mstatus":"","insh":"20059076*01","cliId":"","pno":"540\/256-7250","cno":"540\/256-7250","email":"","ename":"","eno":"","pphy":"CARPENTER, SHAUN E DO","ppno":"540\/248-4487","pcpadd":"1 GREEN HILLS DR","pcpcity":"VERONA","pcpstate":"VA","pcpzip":24482,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/248-5312","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M22.2X2","E11.9","E78.2","E03.9","M54.5","E66.01","F17.210","N92.6","E66.9","N88.3","Z86.2","Z87.2","L02.229","Z87.891","Z20.822","M25.50","F41.8","F17.200","G47.33","R40.0","E28.2","K81.9","M25.562","M25.561","Z99.89","K21.9","G89.29","D72.829","K76.0","Z23.","M25.552","S72.352A","Z78.9","H93.8X1","R51.9","K80.20","R10.11","R19.7","Z68.38"],"date":["2020-04-16","2022-04-19","2021-09-22","2021-12-07","2020-06-15","2021-05-10","2020-06-15","2020-09-08","2022-01-13","2020-09-08","2020-12-09","2020-12-09","2020-12-09","2021-05-10","2021-10-14","2021-12-07","2021-12-07","2022-03-08","2021-09-22","2020-02-03","2021-09-22","2022-01-14","2021-05-10","2021-05-10","2021-09-22","2022-03-08","2021-03-08","2021-09-22","2022-01-13","2021-09-22","2020-05-05","2020-05-05","2021-09-22","2021-09-22","2021-09-22","2022-01-13","2022-01-13","2022-03-08","2022-03-08"],"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":[]},{"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":[["","43598086360","BUPROPION","TAB 150MG SR","60","Select","Select",""],["","00904645780","DOK","CAP 100MG","60","Select","Select",""],["","49035048462","ACETAMINOPHN","TAB 500MG","60","Select","Select",""],["","68645058259","METFORMIN","TAB 500MG","270","Select","Select",""],["","00169643810","LEVEMIR","INJ FLEXTOUC","6","Select","Select",""],["","53885027025","ONETOUCH","TES VERIO","25","Select","Select",""],["","49035020110","EQ","LOZ 2MG CINN","108","Select","Select",""],["","69618004410","DOCUSATE","CAP 100MG","60","Select","Select",""],["","68645056259","IBUPROFEN","TAB 600MG","20","Select","Select",""],["","42858000101","OXYCODONE","TAB 5MG","14","Select","Select",""],["","65162063609","PANTOPRAZOLE","TAB 20MG","30","Select","Select",""],["","00002143380","TRULICITY","INJ 0.75\/0.5","2","Select","Select",""],["","49884046665","CHOLESTYRAM","POW 4GM LITE","30","Select","Select",""],["","49035030890","PAIN","TAB 500MG","60","Select","Select",""],["","49348057308","SM","GUM 2MG","100","Select","Select",""],["","43598048672","NICOTINE","LOZ 2MG MINT","90","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","60","Select","Select",""],["","81131038679","RELION","MIS 32GX4MM","50","Select","Select",""],["","49502025175","SEMGLEE","INJ 100U\/ML","3","Select","Select",""],["","00002831501","HUMULIN","INJ U-100","10","Select","Select",""],["","16729044310","BUPROPN","TAB 150MG XL","30","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","68645057454","GLIPIZIDE","TAB 5MG","180","Select","Select",""],["","68382009810","PAROXETINE","TAB 20MG","90","Select","Select",""],["","00169413212","OZEMPIC","INJ 2\/1.5ML","2","Select","Select",""],["","68645014059","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","47781064090","LEVOTHYROXIN","TAB 25MCG","90","Select","Select",""],["","59676058015","JANSSEN","INJ COVID-19","0","Select","Select",""],["","00093505698","ATORVASTATIN","TAB 10MG","30","Select","Select",""],["","70700015010","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","72305002530","EUTHYROX","TAB 25MCG","90","Select","Select",""],["","49035078443","ALLERGY","TAB 180MG","90","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","00904705060","FEXOFENADINE","TAB 180MG","90","Select","Select",""],["","41167412003","ALLEGRA","TAB 180MG","90","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","30","Select","Select",""],["","31722094101","HYDROCO\/APAP","TAB 5-325MG","8","Select","Select",""],["","16714069211","FLUCONAZOLE","TAB 150MG","2","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":""}]}]}