{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRITTANY GRINSTEAD","gend":1,"add":"2045 UNION GROVE ROAD","city":"SOUTH BOSTON","state":"VA","zip":"24592-9998","dob":"1989-11-22","age":"","mstatus":"","insh":"2069737*01","cliId":"","pno":"434\/222-4593","cno":"","email":"","ename":"","eno":"","pphy":"ROBERTS, MAURICE NP","ppno":"434\/835-4876","pcpadd":"3130 HALIFAX ROAD SUITE C","pcpcity":"SOUTH BOSTON","pcpstate":"VA","pcpzip":24592,"pcpcounty":"","pcpid":"","pcpname":"GODOCS SOUTH BOSTON LLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/835-4875","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Q21.1","R55.","F17.200","G90.1","B34.9","J02.9","M25.511","T14.8XXS","M75.51","F17.210","G89.29","E53.9","E55.9","E78.5","F32.9","F41.9","F60.3","G47.00","I95.1","F41.1","I49.8","R06.00","R00.2","E78.2","F41.8","J30.1","J30.81","J30.89","F41.0","R07.89","R09.82","R05.","N39.0","J06.9","R07.0","L02.422","K58.1","K21.9","R09.81","L02.412","R63.1","Z13.1","R35.8","R53.83","R63.5","R35.0","Z51.81","N64.4","J01.00","R59.0","M75.101","S46.011A","L29.8","D22.5","T88.7XXA","D48.5","J32.0","M54.9","R51.","R10.33","R11.0","S46.911A","F33.1","J30.0","J34.89","Z72.0","Z71.6","Z23.","L98.429","J00.","F43.23","R06.82","R10.84","R11.2","I47.1","J01.40","J10.89","J11.89","H93.13","S09.90XA","K42.0","R14.0","R19.4","S00.93XA","R06.02","I07.1","R21.","E53.8","Z83.3","K59.00","R59.9","N83.8","R10.9","H10.31","Z30.2","M62.08","N92.1","L50.9","H57.11","B30.2","Z01.419","Z11.3","Z15.01","K12.2","Z20.818","Z20.828","H60.501","H66.002","H60.391","J02.0","J20.9"],"date":["2022-05-16","2022-05-16","2020-02-10","2022-05-16","2020-03-18","2022-09-21","2020-06-29","2020-04-14","2020-06-29","2021-12-15","2020-06-29","2022-06-24","2022-06-24","2022-06-24","2022-03-25","2022-06-24","2022-03-25","2022-06-24","2022-06-24","2022-08-10","2021-12-15","2021-12-15","2021-12-15","2021-12-15","2021-01-06","2021-05-20","2021-05-20","2021-06-17","2021-09-09","2020-04-07","2020-04-07","2020-04-07","2020-04-07","2022-07-24","2020-04-07","2020-06-03","2021-01-28","2021-03-04","2021-03-04","2020-06-01","2021-03-08","2021-03-08","2021-03-08","2021-03-08","2021-03-08","2021-03-08","2020-01-30","2020-11-19","2021-10-05","2020-01-06","2020-05-05","2020-05-05","2020-01-29","2020-01-29","2020-03-04","2020-01-29","2021-04-14","2020-03-31","2020-03-31","2020-03-31","2020-03-31","2020-04-21","2020-05-27","2021-06-17","2021-07-27","2022-05-16","2021-06-17","2022-06-01","2020-03-04","2021-06-17","2019-08-05","2019-02-17","2019-10-23","2019-08-29","2019-11-12","2019-12-11","2019-01-01","2019-01-03","2019-01-28","2019-01-28","2019-02-15","2019-09-12","2019-10-23","2019-01-28","2019-10-30","2019-02-07","2019-06-13","2019-06-13","2019-08-21","2019-08-21","2019-08-21","2019-08-21","2019-09-12","2019-11-25","2019-02-01","2019-02-01","2019-02-15","2019-08-15","2019-09-16","2019-09-16","2022-04-14","2022-04-14","2022-04-14","2022-04-12","2022-06-10","2022-07-24","2022-07-24","2022-05-02","2022-05-02","2022-09-21","2022-09-27"],"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":[["","64764073030","TRINTELLIX","TAB 10MG","30","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","20","Select","Select",""],["","61314064610","NEO\/POLY\/HC","SOL 1% OTIC","10","Select","Select",""],["","00115703302","FLUDROCORT","TAB 0.1MG","30","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","14","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","00093005405","BUSPIRONE","TAB 10MG","30","Select","Select",""],["","00054418625","DEXAMETHASON","TAB 6MG","7","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","","AZITHROMYCIN"," AZITHROMYCIN ","6","Select","Select",""],["","60432060416","PROMETHAZINE","SYP DM","120","Select","Select",""],["","","VENLAFAXINE","TAB 225MG ER","","Select","Select",""],["","60505258008","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","64380073706","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","00781223410","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","65862069960","CEFUROXIME","TAB 250MG","20","Select","Select",""],["","59651021430","AZELASTINE","SPR 0.001","30","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","67877024910","QUETIAPINE","TAB 50MG","30","Select","Select",""],["","65862002106","MIRTAZAPINE","TAB 15MG ODT","30","Select","Select",""],["","00135057602","FLONASE","SPR 50MCG","10","Select","Select",""],["","54092054701","MOTEGRITY","TAB 2MG","30","Select","Select",""],["","65862019399","FLUOXETINE","CAP 20MG","90","Select","Select",""],["","33342002332","LEVOFLOXACIN","TAB 750MG","10","Select","Select",""],["","","MUPIROCIN","OIN 0.02","","Select","Select",""],["","","LEVOCETIRIZI","TAB 5MG","","Select","Select",""],["","","BETAMETH","CRE 0.0005","","Select","Select",""],["","42806031205","DOXYCYCL","TAB 100MG","14","Select","Select",""],["","","ALPRAZOLAM","TAB 0.25MG","","Select","Select",""],["","10702001001","HYDROXYZ","TAB 10MG","60","Select","Select",""],["","","BENZONATATE","CAP 200MG","","Select","Select",""],["","33342025866","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","","SMZ-TMP","TAB 800-160","","Select","Select",""],["","","CIPROFLOXACN","TAB 500MG","","Select","Select",""],["","","NABUMETONE","TAB 750MG","","Select","Select",""],["","","CLINDAMYCIN","CAP 150MG","","Select","Select",""],["","","BACLOFEN","TAB 10MG","","Select","Select",""],["","","FLUZONE","INJ 2020-21","","Select","Select",""],["","","TRULANCE","TAB 3MG","","Select","Select",""],["","","NICOTINE","DIS 21MG\/24H","","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":""}]}]}