{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LAURA CLARK","gend":1,"add":"205 BENNETT ST","city":"DANVILLE","state":"VA","zip":"24541-9998","dob":"1985-03-26","age":"","mstatus":"","insh":"2083431*01","cliId":"","pno":"434\/793-9429","cno":"","email":"","ename":"","eno":"","pphy":"ADAMS, ERICA W NP","ppno":"336\/694-6969","pcpadd":"1499 MAIN STREET","pcpcity":"YANCEYVILLE","pcpstate":"NC","pcpzip":27379,"pcpcounty":"","pcpid":"","pcpname":"TWO RIVERS PHYSICIAN PRACTICES LLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"336\/694-1266","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","L02.413","L03.113","F33.1","V58.89","Z48.01","F10.20","R55.","F12.10","F13.10","E87.6","F10.239","F19.10","R11.2","Z20.828","N39.0","K59.00","I96.","F17.210","K76.0","F10.10","R74.01","I10.","R10.11","R10.13","Z76.0","F11.23","L03.116","F10.229","D69.6","K70.9","K59.03","E03.9","Z90.49","Z98.890","Z88.5","Z88.8","Z91.030","S00.83XA","S70.12XA","S70.02XA","F10.929","R41.82","F11.10","R79.89","Y04.0XXA","Y92.89","Z87.898","G43.909","F32.9","Z00.00","G62.9","R68.89","J11.1","R11.0","R50.9","J02.9","S09.93XA","J06.9","F41.9","Z20.822","S89.92XA","M25.462","T40.0X1A","J96.01","R10.31","R56.9","R40.4","R40.20","R06.89","R00.0","R74.8","K64.8","K60.3","K62.89","M54.89","K64.9","K59.02","K62.5","E01.0","Z04.1","Z53.21","N20.0","M99.81","M50.30","R41.0","T40.601A","M54.2","N76.0","R31.9","N23.","K42.9","Z79.899","Z87.891","Z32.01","Z34.81","Z33.1"],"date":["2022-11-08","2021-03-12","2021-02-02","2022-09-26","2020-04-01","2020-04-01","2021-05-24","2021-07-24","2021-07-24","2021-07-24","2021-04-12","2021-03-13","2021-03-13","2021-03-13","2021-03-17","2020-04-24","2020-04-24","2021-02-02","2021-05-15","2021-04-12","2021-04-12","2021-04-12","2021-07-15","2021-04-12","2021-04-12","2021-04-12","2021-03-12","2021-03-12","2021-03-12","2021-03-12","2021-03-12","2021-03-12","2022-09-08","2021-03-12","2021-03-12","2021-03-12","2021-03-12","2021-03-12","2021-05-15","2021-05-15","2021-05-15","2021-05-15","2021-05-15","2021-05-15","2021-05-15","2021-05-15","2021-05-15","2021-07-15","2021-10-27","2021-10-27","2021-10-27","2021-10-27","2020-01-31","2020-01-31","2022-09-08","2020-04-26","2020-04-26","2021-05-15","2020-08-11","2021-02-02","2021-02-02","2021-11-17","2021-11-17","2019-12-22","2019-12-22","2019-01-03","2019-09-24","2019-09-24","2019-12-21","2019-09-24","2019-09-24","2019-08-15","2019-03-06","2019-03-06","2019-03-06","2019-01-03","2019-02-07","2019-02-07","2019-02-07","2019-02-07","2019-09-20","2019-09-20","2019-01-02","2019-02-08","2019-02-08","2019-12-21","2019-12-21","2019-12-27","2019-11-27","2019-11-27","2019-11-27","2019-11-27","2019-11-27","2019-11-27","2022-09-08","2022-09-29","2022-11-08"],"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":[["","12496120803","SUBOXONE","MIS 8-2MG","14","Select","Select",""],["","00378032701","HALOPERIDOL","TAB 5MG","14","Select","Select",""],["","69097012403","TOPIRAMATE","TAB 100MG","60","Select","Select",""],["","00228315303","BUPRENORPHIN","SUB 8MG","60","Select","Select",""],["","00115104101","PROMETHAZINE","TAB 25MG","15","Select","Select",""],["","16729044416","BUPROPN","TAB 300MG XL","30","Select","Select",""],["","00378181510","LEVOTHYROXIN","TAB 150MCG","30","Select","Select",""],["","65862069730","VENLAFAXINE","CAP 150MG ER","7","Select","Select",""],["","23155000810","HYDROCHLOROT","TAB 25MG","90","Select","Select",""],["","43598058230","BUPREN\/NALOX","MIS 8-2MG","70","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","00536589588","NICOTINE","DIS 14MG\/24H","28","Select","Select",""],["","68382056928","ACAMPRO","TAB 333MG","60","Select","Select",""],["","65862052305","GABAPENTIN","TAB 600MG","90","Select","Select",""],["","60505265401","TRAZODONE","TAB 100MG","60","Select","Select",""],["","00536408501","PRENATAL","TAB 28-0.8MG","30","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","12496131002","SUBUTEX","SUB 8MG","56","Select","Select",""],["","69315030630","NYSTATIN","POW 100000","30","Select","Select",""],["","55111012701","CIPROFLOXACN","TAB 500MG","28","Select","Select",""],["","57664037708","TRAMADOL","TAB 50MG","20","Select","Select",""],["","71858004004","TIROSINT","CAP 125MCG","30","Select","Select",""],["","00641604425","LORAZEPAM","INJ 2MG\/ML","3","Select","Select",""],["","55111029336","SUMATRIPTAN","TAB 100MG","9","Select","Select",""],["","52817018000","CLONIDINE","TAB 0.1MG","60","Select","Select",""],["","00555015902","CHLORDIAZEP","CAP 25MG","30","Select","Select",""],["","57664050083","MIRTAZAPINE","TAB 30MG","30","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","16","Select","Select",""],["","","OSELTAMIVIR","CAP 75MG","","Select","Select",""],["","16729020201","BUSPIRONE","TAB 10MG","180","Select","Select",""],["","","DOXYCYCL","CAP 100MG","","Select","Select",""],["","10572081005","POLYETH","POW 3350 NF","14","Select","Select",""],["","45802006535","TRIAMCINOLON","CRE 0.005","15","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","69097083412","SERTRALINE","TAB 50MG","30","Select","Select",""],["","00228299611","TAMSULOSIN","CAP 0.4MG","10","Select","Select",""],["","47781019605","OXYCOD\/APAP","TAB 5-325MG","10","Select","Select",""],["","50383093335","LIDOCAINE","OIN 0.05","35","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","30","Select","Select",""],["","43547038003","DULOXETINE","CAP 30MG","7","Select","Select",""],["","53746027201","SMZ\/TMP","TAB 800-160","1","Select","Select",""],["","00186037028","SYMBICORT","AER 160-4.5","6","Select","Select",""],["","68382085105","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","14539067401","HYDROXYZ","CAP 25MG","28","Select","Select",""],["","45802048678","DOCUSATE","CAP 100MG","14","Select","Select",""],["","42192080101","PHENAZOPYRID","TAB 100MG","6","Select","Select",""],["","57237023305","SMZ-TMP","TAB 800-160","14","Select","Select",""],["","00703680104","MEDROXYPR","INJ 150MG\/ML","1","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","63304069316","CLINDAMYCIN","CAP 300MG","80","Select","Select",""],["","00591544205","PREDNISONE","TAB 10MG","21","Select","Select",""],["","62175044214","GLYCOLAX","POW 3350 NF","14","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":""}]}]}