{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CORIE WILLNER","gend":0,"add":"2420 S MAIN ST","city":"HARRISONBURG","state":"VA","zip":"22801-9998","dob":"1962-11-30","age":"","mstatus":"","insh":"2345144*01","cliId":"","pno":"","cno":"","email":"","ename":"","eno":"","pphy":"JOHNSTON, PAUL T PA","ppno":"540\/564-7300","pcpadd":"1661 S MAIN STREET","pcpcity":"HARRISONBURG","pcpstate":"VA","pcpzip":22801,"pcpcounty":"","pcpid":"","pcpname":"SRMHMG - Sentara South Main Health Center","plan":"OHP","program":"MEDICAID","lob":"M4","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/431-7100","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z43.3","E11.65","I10.","T83.010A","N30.00","C18.7","N40.0","Z43.2","E11.9","R79.0","R33.9","F41.8","N40.1","N13.8","R31.0","T83.090A","I12.9","N18.9","E11.22","Z87.891","Z88.5","Z88.8","Z93.3","Z90.49","R31.9","N30.01","R06.02","Z85.038","K43.2","K43.5","N31.9","Z93.59","T82.338A","K66.0","T38.0X5A","Z79.4","Z98.890","NO DATA","R10.84","R52.","Z20.828","Z96.0","R79.89","Z72.0","F32.9","R33.8","N32.0","N13.1","T83.028A","V58.89","Z48.3","B96.4","B96.20","H57.02","N39.498","G47.00","D69.6","R39.81","N13.30","Z20.822","Z79.84","Z79.899","Z93.6","C18.9","Z79.82","K80.20","Z71.89","N13.5","Z46.6","K52.9","K91.89","Z93.2","N17.9","H61.23","H81.10","N13.4","R55."],"date":["2021-05-14","2021-09-14","2021-09-14","2021-02-15","2021-08-12","2021-07-28","2021-06-22","2021-07-09","2021-07-09","2021-09-14","2021-09-14","2021-07-28","2021-12-27","2021-12-27","2021-07-26","2021-02-19","2021-06-08","2021-06-26","2021-06-08","2021-07-09","2021-05-14","2021-02-19","2021-05-14","2021-02-19","2021-02-19","2021-07-26","2021-02-17","2021-07-09","2021-03-02","2021-03-02","2021-06-08","2021-06-04","2021-05-14","2021-05-14","2021-05-15","2021-05-18","2021-05-18","2021-06-08","2021-06-26","2021-06-26","2021-07-15","2021-09-03","2021-09-14","2021-09-14","2021-09-14","2021-06-08","2021-05-10","2021-06-30","2021-02-18","2021-02-19","2021-06-08","2021-06-08","2021-06-08","2021-06-08","2021-06-08","2021-06-08","2021-06-08","2021-07-10","2021-07-09","2021-07-09","2021-07-09","2021-07-09","2021-07-09","2021-07-29","2021-02-19","2021-03-22","2021-04-28","2021-07-20","2021-07-20","2021-08-12","2021-05-14","2021-06-10","2021-06-26","2021-11-24","2021-11-24","2021-06-26","2021-07-26"],"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":[["","68645057559","GLIPIZIDE","TAB 10MG","180","Select","Select",""],["","76385013301","NADOLOL","TAB 20MG","90","Select","Select",""],["","70954000510","OXYBUTYNIN","TAB 5MG","90","Select","Select",""],["","00002143480","TRULICITY","INJ 1.5\/0.5","2","Select","Select",""],["","68645051554","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","42806054909","DUTASTERIDE","CAP 0.5MG","30","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","31722070190","LOSARTAN","TAB 50MG","90","Select","Select",""],["","50383056510","NEOMYCIN","TAB 500MG","6","Select","Select",""],["","52536010513","ERYTHROMYCIN","TAB 500MG BS","6","Select","Select",""],["","32909071103","READI-CAT","SUS BERRY","900","Select","Select",""],["","00093220301","METOCLOPRAM","TAB 10MG","3","Select","Select",""],["","10572010001","PEG-3350","SOL ELECTROL","4000","Select","Select",""],["","57896048914","POLYETH","POW 3350 NF","238","Select","Select",""],["","00002773701","INSULIN","INJ 100\/ML","10","Select","Select",""],["","00088222033","LANTUS","INJ 100\/ML","10","Select","Select",""],["","65162068210","PHENAZOPYRID","TAB 200MG","9","Select","Select",""],["","65162027250","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","00406324301","HYDROMORPHON","TAB 2MG","15","Select","Select",""],["","00002751001","HUMALOG","INJ 100\/ML","10","Select","Select",""],["","00536124710","SENEXON-S","TAB 8.6-50MG","30","Select","Select",""],["","65162062710","TRAMADOL","TAB 50MG","10","Select","Select",""],["","55111028130","LEVOFLOXACIN","TAB 750MG","7","Select","Select",""],["","13668000701","ZOLPIDEM","TAB 5MG","14","Select","Select",""],["","65862018730","ONDANSETRON","TAB 4MG","20","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","10","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","15","Select","Select",""],["","00904645780","DOK","CAP 100MG","30","Select","Select",""],["","70000036502","STOOL","CAP 100MG","30","Select","Select",""],["","00003089321","ELIQUIS","TAB 2.5MG","60","Select","Select",""],["","68382013201","TAMSULOSIN","CAP 0.4MG","90","Select","Select",""],["","00093031101","LOPERAMIDE","CAP 2MG","240","Select","Select",""],["","17478071130","LIDOCAINE","GEL 2% JELLY","30","Select","Select",""],["","31722071101","SILDENAFIL","TAB 100MG","6","Select","Select",""],["","16571020210","DICLOFENAC","TAB 50MG DR","30","Select","Select",""],["","43547028111","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","49035019402","EQ","DIS 21MG\/24H","28","Select","Select",""],["","43598044828","NICOTINE","DIS 21MG\/24H","28","Select","Select",""],["","49281072110","FLUBLOK","INJ 2021-22","0","Select","Select",""],["","52268010001","GOLYTELY","SOL ","4000","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":""}]}]}