{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SANDRA SHAVER","gend":1,"add":"4400 BYRD MILL ROAD","city":"LOUISA","state":"VA","zip":"23093-9998","dob":"1961-03-09","age":"","mstatus":"","insh":"20068314*01","cliId":"","pno":"434\/242-1668","cno":"434\/242-1668","email":"","ename":"","eno":"","pphy":"CARVETH, BARRIE NP","ppno":"434\/654-1950","pcpadd":"315 10TH STREET NE","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22902,"pcpcounty":"","pcpid":"","pcpname":"SMJMG - Sentara Family Medicine at 5th Street Station","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/977-9808","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G40.901","I77.9","R93.0","R76.8","N95.0","R93.89","R19.09","E55.9","E11.22","F17.200","G89.29","I10.","K21.9","R56.9","J96.01","I16.1","E83.52","N17.9","R73.9","M54.5","M54.31","T80.1XXA","V58.89","Z01.810","N84.0","D25.0","Z86.73","Z11.51","Z12.4","G62.9","E78.2","H25.13","N18.3","Z01.818","I67.4"],"date":["2022-10-19","2022-10-19","2022-10-19","2022-10-19","2020-09-16","2020-09-16","2020-08-21","2020-08-21","2020-08-21","2020-08-21","2020-08-21","2020-08-21","2020-08-21","2022-10-24","2022-10-22","2022-10-22","2022-10-22","2022-10-22","2022-10-22","2020-08-10","2020-08-10","2022-10-21","2022-10-21","2020-09-09","2020-09-16","2020-09-16","2022-10-24","2020-08-21","2020-08-21","2020-08-21","2020-08-21","2020-08-21","2020-08-21","2020-08-27","2022-10-18"],"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":[["","65862024608","LEVETIRACETA","TAB 500MG","180","Select","Select",""],["","67877041301","METFORMIN","TAB 500MG ER","60","Select","Select",""],["","68645059090","CLOPIDOGREL","TAB 75MG","30","Select","Select",""],["","31722081360","LACOSAMIDE","TAB 100MG","120","Select","Select",""],["","42858000101","OXYCODONE","TAB 5MG","4","Select","Select",""],["","72205001290","PREGABALIN","CAP 50MG","90","Select","Select",""],["","00093505998","ATORVASTATIN","TAB 20MG","60","Select","Select",""],["","68645019059","METOPROL","TAB 50MG","180","Select","Select",""],["","00131247835","VIMPAT","TAB 100MG","120","Select","Select",""],["","65862069730","VENLAFAXINE","CAP 150MG ER","90","Select","Select",""],["","68645055254","LISINOPRIL","TAB 10MG","90","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","00093216568","NALOXONE","SPR 4MG","2","Select","Select",""],["","43598021055","SSD","CRE 0.01","50","Select","Select",""],["","31722094301","HYDROCO\/APAP","TAB 10-325MG","120","Select","Select",""],["","72205000390","ROSUVASTATIN","TAB 10MG","30","Select","Select",""],["","50580049660","TYLENOL","TAB 325MG","30","Select","Select",""],["","68645057290","GLIMEPIRIDE","TAB 2MG","90","Select","Select",""],["","43547040350","FUROSEMIDE","TAB 80MG","90","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":""}]}]}