{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TONYA SPIVEY-HEFFINGER","gend":1,"add":"428 CASCADE RD LOT 19","city":"CASCADE","state":"VA","zip":"24069-9998","dob":"1972-12-20","age":"","mstatus":"","insh":"2206546*01","cliId":"","pno":"434\/489-1774","cno":"434\/489-1774","email":"","ename":"","eno":"","pphy":"GRABOWSKI, KRISTEN NP","ppno":"434\/835-0105","pcpadd":"2767 FRANKLIN TURNPIKE","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24540,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/835-0295","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I75.023","R06.00","I10.","E78.5","F17.210","M54.2","M47.22","M25.512","F31.9","F41.9","F33.1","F51.01","F10.10","G43.909","Z11.59","K21.9","J30.2","Z68.30","NO DATA","K86.1","G25.81","G47.00","G89.4","Z79.899","M25.511","Z20.828","J06.9","U07.1","J10.1","G89.29"],"date":["2020-04-17","2020-04-17","2022-02-17","2022-02-17","2020-04-06","2021-01-19","2022-06-13","2022-06-13","2022-06-02","2022-06-02","2020-11-09","2020-11-09","2020-11-09","2022-04-20","2022-02-17","2022-02-17","2022-02-17","2022-02-17","2022-04-20","2022-02-17","2022-04-20","2022-04-20","2022-05-12","2022-05-12","2022-05-12","2020-11-30","2022-01-31","2022-01-31","2022-01-31","2022-04-20"],"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":[["","60432060416","PROMETHAZINE","SYP DM","200","Select","Select",""],["","64380074207","BUSPIRONE","TAB 10MG","180","Select","Select",""],["","00378803077","LANSOPRAZOLE","CAP 30MG DR","90","Select","Select",""],["","61442010301","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","72618300002","NURTEC","TAB 75MG ODT","16","Select","Select",""],["","61874013030","VRAYLAR","CAP 3MG","30","Select","Select",""],["","00378668910","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","67877051190","ATORVASTATIN","TAB 10MG","30","Select","Select",""],["","55111029336","SUMATRIPTAN","TAB 100MG","18","Select","Select",""],["","59762444002","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","23155050210","HYDROXYZ","TAB 50MG","60","Select","Select",""],["","68382013510","LOSARTAN","TAB 25MG","90","Select","Select",""],["","57237007530","ONDANSETRON","TAB 4MG","40","Select","Select",""],["","51224002218","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","68180013601","ESCITALOPRAM","TAB 20MG","30","Select","Select",""],["","65862052890","VENLAFAXINE","CAP 75MG ER","30","Select","Select",""],["","00173072020","FLOVENT","AER 220MCG","12","Select","Select",""],["","33342002208","LEVOFLOXACIN","TAB 500MG","7","Select","Select",""],["","16571040250","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","45802008801","ALBUTEROL","AER HFA","8","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","00023650110","UBRELVY","TAB 100MG","16","Select","Select",""],["","16729023301","ROPINIROLE","TAB 0.5MG","30","Select","Select",""],["","67877024901","QUETIAPINE","TAB 50MG","60","Select","Select",""],["","60758011905","PREDNISOLONE","SUS 1% OP","5","Select","Select",""],["","16729000815","PRAVASTATIN","TAB 10MG","30","Select","Select",""],["","49035065071","EQ","TAB 20MG","60","Select","Select",""],["","49035092301","EYE","DRO 0.025%OP","10","Select","Select",""],["","16714066202","GABAPENTIN","CAP 300MG","81","Select","Select",""],["","00832105415","BACLOFEN","TAB 10MG","90","Select","Select",""],["","16729017401","AMITRIPTYLIN","TAB 75MG","30","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","21","Select","Select",""],["","00173088210","BREO","INH 200-25","60","Select","Select",""],["","00904578017","HEARTBURN","TAB 20MG","60","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","21","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":""}]}]}