{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MICHAELA   L EVANS","gend":1,"add":"11046 LUNENBURG COUNTY ROAD 15843 RICHMOND HIGHWAY","city":"KEYSVILLE","state":"VA","zip":"23947-9998","dob":"2003-02-21","age":"","mstatus":"","insh":"2083575*01","cliId":"","pno":"434\/454-0920","cno":"","email":"","ename":"","eno":"","pphy":"INGE, MARGARET DO","ppno":"434\/696-2165","pcpadd":"1508 K V RD","pcpcity":"VICTORIA","pcpstate":"VA","pcpzip":23974,"pcpcounty":"","pcpid":"","pcpname":"SOUTHERN DOMINION HEALTH SYSTEM INC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/696-1557","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L03.213","H57.12","T36.8X5A","S52.351C","Z48.89","Z89.021","M25.541","R07.9","Z74.3","R10.9","K62.5","S01.412A","S01.81XA","F17.210","W54.0XXA","S52.91XB","S52.501B","R51.9","H53.8","R42.","F32.9","F41.9","G47.00","S81.811A","S00.03XA","S27.0XXA","S81.011A","S52.201B","V89.2XXA","G89.18","M79.641","R07.89","J45.909","F33.9","N92.6","Z80.3","S01.80XA","Z68.52","S52.251A","V49.50XA","S52.301B","S52.591C","S62.626B","S52.601B","D62.","T81.31XA","S06.0X1A","V72.85","S52.579B","S61.206A","Z20.822","N83.209","F43.23","K92.1","R11.2","R19.7","R68.84","L29.9","Z79.3","Z88.5","Z91.040","Z82.49","Z82.3","R55.","M21.922","R60.9","V54.12","S62.609A","S61.401S","B34.9","S00.551A","X58.XXXA","R51.","R94.6","N92.1","H02.844","S52.571B","S52.601A","S29.9XXA","J93.9","S76.921A","S61.401A","S51.801A","S60.946A","R10.31","R06.02","R05.9","R11.0","K29.70","K21.9","J45.20","F17.200","V58.89","F43.25","V49.9XXA","S69.81XA","J02.9","R05.","S52.691B","F34.81","R10.13","Z30.09","R10.11","K30.","R19.4","F43.10","J02.0","Z71.89","Z71.3","J01.00","J06.9","N91.1","R07.0","R11.10","R10.10","K59.00","J03.90","R82.90","Z72.51","N89.8","N91.2","M25.512","M25.522","M79.672","Z32.00","Z68.21","M54.2","F12.188","J01.90","J20.9","Z32.02","R10.30","R20.8","G43.109","B37.3","N76.0","Z87.828","U07.1"],"date":["2021-01-16","2021-01-16","2021-01-16","2021-03-18","2021-03-30","2021-03-30","2021-05-17","2021-12-03","2021-12-03","2022-01-13","2021-12-19","2020-12-09","2020-12-09","2021-03-06","2020-12-15","2021-03-16","2021-04-28","2022-02-19","2022-02-19","2021-04-06","2021-04-06","2021-04-06","2021-04-06","2021-03-06","2021-03-10","2021-03-07","2021-03-16","2021-03-18","2021-03-09","2021-03-26","2021-03-26","2021-11-29","2021-11-29","2020-10-09","2020-10-06","2021-01-16","2020-12-15","2020-12-15","2021-03-05","2021-03-05","2021-03-18","2021-03-06","2021-03-06","2021-03-09","2021-03-06","2021-03-11","2021-03-06","2021-03-06","2021-03-06","2021-03-06","2022-08-04","2021-03-06","2021-03-12","2021-12-15","2021-12-15","2021-12-15","2022-03-22","2021-01-16","2021-01-16","2021-01-16","2021-01-16","2021-01-16","2021-01-16","2021-03-05","2021-03-05","2021-03-05","2021-05-26","2021-03-26","2021-03-26","2020-01-19","2020-01-19","2020-01-19","2020-07-02","2020-10-13","2020-10-13","2021-01-15","2021-03-09","2021-03-06","2021-03-16","2021-03-16","2021-03-16","2021-03-22","2021-03-26","2021-03-26","2021-12-02","2021-12-02","2022-08-04","2021-12-02","2021-12-09","2021-12-09","2022-01-13","2021-12-09","2021-12-09","2020-09-16","2021-03-07","2021-03-09","2020-01-22","2020-01-22","2021-03-11","2019-05-21","2019-02-12","2019-12-09","2019-02-08","2019-02-08","2019-02-08","2019-08-16","2019-05-14","2019-05-14","2019-05-14","2019-02-25","2019-09-05","2019-09-05","2019-10-01","2019-10-01","2019-02-13","2019-02-13","2019-12-09","2022-02-11","2022-02-11","2022-01-07","2022-01-27","2022-01-01","2022-03-22","2022-03-22","2022-03-22","2022-03-22","2022-01-02","2022-01-02","2022-08-04","2022-08-04","2022-08-04","2022-02-19","2022-02-19","2022-02-19","2022-02-19","2022-02-19","2022-02-19","2022-01-13"],"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":[["","00378064110","PREDNISONE","TAB 10MG","18","Select","Select",""],["","42806071405","BENZONATATE","CAP 100MG","30","Select","Select",""],["","00054418425","DEXAMETHASON","TAB 4MG","7","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","65862018730","ONDANSETRON","TAB 4MG","30","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","49483061850","NAPROXEN","TAB 500MG","15","Select","Select",""],["","10702000650","CYCLOBENZAPR","TAB 5MG","9","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00363013830","SENNA","TAB 8.6MG","20","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","18","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","12","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","20","Select","Select",""],["","","IBUPROFEN","TAB 800MG","","Select","Select",""],["","","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","","AMOX\/K","TAB 875-125","","Select","Select",""],["","64980051505","OFLOXACIN","DRO 0.3% OP","5","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","","CEFUROXIME","TAB 250MG","","Select","Select",""],["","","DIAZEPAM","TAB 5MG","","Select","Select",""],["","","DICLOFENAC","TAB 75MG DR","","Select","Select",""],["","","ACETAMINOPHN","TAB 500MG","","Select","Select",""],["","","XULANE","DIS 150-35","","Select","Select",""],["","16714061104","SERTRALINE","TAB 25MG","30","Select","Select",""],["","","TRAMADOL","TAB 50MG","","Select","Select",""],["","49884068901","METOCLOPRAM","TAB 10MG","21","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","00093031101","LOPERAMIDE","CAP 2MG","20","Select","Select",""],["","13668042905","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","62332000131","FAMOTIDINE","TAB 20MG","20","Select","Select",""],["","00378729353","NORGEST\/ETHI","TAB ESTRADIO","28","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":""}]}]}