{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DANIELLE   F BIRCKHEAD","gend":1,"add":"1554 MUTTON HOLLOW ROAD","city":"STANARDSVILLE","state":"VA","zip":"22973-9998","dob":"1984-10-15","age":"","mstatus":"","insh":"8759529*01","cliId":"","pno":"540\/748-5929","cno":"","email":"","ename":"","eno":"","pphy":"SECREST, SHERRY J PA","ppno":"434\/243-9466","pcpadd":"1015 SPRING CREEK PKWY","pcpcity":"ZION CROSSROADS","pcpstate":"VA","pcpzip":22942,"pcpcounty":"","pcpid":"","pcpname":"UNIVERSITY OF VIRGINIA PHYSICIANS GROUP","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/243-9499","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R49.0","M25.561","M22.41","M76.31","R26.2","J38.7","R10.84","R14.0","F41.8","F51.04","I10.","K21.9","J30.2","E78.00","K70.31","K74.60","K76.6","K31.89","R30.0","M62.838","J38.1","M54.2","Z01.818","R09.89","R07.0","G89.29","D36.10","R79.89","M54.5","R13.14","F17.200","S46.912A","M79.604","R11.2","K70.30","F17.210","H53.453","Z13.31","G47.09","R52.","R11.11","R07.9","M79.642","M79.645","S69.92XA","NO DATA","Z12.4","R07.89","J01.01","Z01.810","Z71.89","Z78.9","D72.829","Z82.49","Z72.0","R56.9","N92.1","N93.9","I85.10","N92.0","Z98.890","Z09.","Z90.710","R94.5","D50.8","E87.6","R79.0","K21.0","K70.11","F10.20","E87.1","K75.89","F10.239","K70.10","N39.0","J06.9","J45.41","D53.9","D50.0","K76.9","D64.9","F10.99","Z48.89","J98.01","Z23.","R68.89","R51.","F10.10","R61.","E87.2","F12.90","R10.9","E87.3","J90.","J45.909","R79.1","K72.90","K29.90","R00.0","R25.2","Z87.898","M54.9","R40.2411","G43.909","R16.0","N80.0","Z00.00","Z12.31","N64.9","R05.9","J45.21","S89.91XA","S63.501A","Z87.891","Z88.6","S59.911A"],"date":["2021-01-19","2021-07-15","2021-03-08","2021-03-08","2020-10-07","2021-05-12","2021-01-19","2021-01-19","2022-10-18","2022-10-18","2022-04-18","2022-10-18","2022-10-18","2022-04-18","2022-10-18","2020-07-23","2020-07-23","2020-07-23","2020-08-05","2020-08-05","2021-05-12","2020-12-01","2021-01-08","2021-05-12","2021-05-12","2022-10-18","2021-03-08","2022-04-18","2021-07-15","2021-05-12","2021-05-12","2021-08-03","2020-09-03","2020-02-20","2022-04-18","2021-01-08","2021-04-01","2020-01-03","2020-01-03","2020-02-19","2020-02-19","2021-05-26","2020-06-22","2020-06-22","2020-06-22","2022-10-18","2020-10-21","2021-03-14","2021-06-09","2020-12-31","2020-12-31","2020-12-31","2020-12-31","2022-10-18","2021-05-26","2019-01-20","2019-02-13","2019-06-11","2019-04-16","2019-08-28","2019-07-29","2019-08-28","2019-08-28","2019-04-05","2019-04-05","2019-04-24","2019-04-05","2019-09-16","2019-04-24","2019-04-05","2019-04-06","2019-04-09","2019-03-15","2019-01-20","2019-01-20","2019-12-03","2019-09-16","2022-04-18","2019-03-05","2019-04-09","2019-05-14","2019-06-11","2019-08-28","2019-12-03","2022-10-18","2019-01-20","2019-01-19","2019-11-20","2019-09-16","2019-03-15","2019-01-19","2019-04-06","2019-04-06","2019-04-06","2019-07-16","2019-04-06","2019-04-09","2019-03-15","2019-03-15","2019-04-24","2019-04-24","2019-04-24","2019-01-19","2019-01-20","2019-04-08","2019-07-16","2022-04-18","2022-04-28","2022-04-28","2022-01-06","2022-10-18","2022-06-24","2022-11-08","2022-11-08","2022-11-08","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":[["","60505265401","TRAZODONE","TAB 100MG","45","Select","Select",""],["","29300022019","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","68645052354","SERTRALINE","TAB 100MG","180","Select","Select",""],["","31722088490","ROSUVASTATIN","TAB 20MG","90","Select","Select",""],["","16729022501","SPIRONOLACT","TAB 25MG","270","Select","Select",""],["","45802065078","LORATADINE","TAB 10MG","30","Select","Select",""],["","33342030111","ESZOPICLONE","TAB 3MG","30","Select","Select",""],["","62175011843","OMEPRAZOLE","CAP 20MG","180","Select","Select",""],["","00121077516","GG\/CODEINE","SOL 100-10\/5","118","Select","Select",""],["","69315012710","FOLIC","TAB 1000MCG","30","Select","Select",""],["","70010077001","METHOCARBAM","TAB 750MG","30","Select","Select",""],["","49035061246","ALLERGY","TAB 10MG","30","Select","Select",""],["","00781569031","EZETIMIBE","TAB 10MG","90","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","42858000101","OXYCODONE","TAB 5MG","12","Select","Select",""],["","43547040211","FUROSEMIDE","TAB 40MG","45","Select","Select",""],["","57664047758","METOPROL","TAB 50MG","180","Select","Select",""],["","00363087306","NICOTINE","LOZ 4MG MINT","96","Select","Select",""],["","42806071501","BENZONATATE","CAP 200MG","20","Select","Select",""],["","60432026415","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","3","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","90","Select","Select",""],["","57237000630","FLUCONAZOLE","TAB 200MG","2","Select","Select",""],["","00781185220","AMOX\/K","TAB 875-125","14","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","49035019502","EQ","DIS 14MG\/24H","28","Select","Select",""],["","70677008901","SM","LOZ 2MG CHRY","72","Select","Select",""],["","49281042150","FLUZONE","INJ 2021-22","0","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","15","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","60505083001","MOMETASONE","SPR 50MCG","17","Select","Select",""],["","00245531711","KLOR-CON","TAB 10MEQ ER","60","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","20","Select","Select",""],["","63481068447","VOLTAREN","GEL 0.01","100","Select","Select",""],["","00832532411","POT  CL MICRO","TAB 10MEQ ER","60","Select","Select",""],["","63304007601","POT  CHLORIDE","TAB 10MEQ ER","60","Select","Select",""],["","00591544305","PREDNISONE","TAB 20MG","9","Select","Select",""],["","13811071910","NITROFURANTN","CAP 100MG","10","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":""}]}]}