{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JAMESA   E ANDERSON","gend":1,"add":"2255 COMMONWEALTH DR APT C","city":"CHARLOTTESVILLE","state":"VA","zip":"22901-9998","dob":"1983-01-24","age":"","mstatus":"","insh":"9507280*01","cliId":"","pno":"434\/409-8591","cno":"","email":"","ename":"","eno":"","pphy":"OVERSTREET, DANA NP","ppno":"434\/227-5624","pcpadd":"901 PRESTON AVENUE SUITE 301","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22903,"pcpcounty":"","pcpid":"","pcpname":"CENTRAL VIRGINIA HEALTH SERVICES INC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/970-7700","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G47.33","F41.9","Z01.419","N39.0","Z20.2","F41.1","R07.9","R06.02","R22.1","D50.9","R00.0","I51.7","R20.2","I10.","E66.01","Z71.89","Z71.3","Z23.","R53.83","R30.0","Z86.19","Z11.1","R10.31","Z11.4","H10.32","Z30.9","U07.1","J20.9","D50.0","R06.2","R10.32","M79.89","M94.0","R09.89","Z32.01","R00.2","R39.89","R05.","R42.","N30.01","Z11.59","F41.0","Z30.09","Z30.013","Z30.42","G47.30","R10.2","N84.0","N93.9","Z30.011","Z13.220","K44.9","K21.9","Z68.43","Z09.","R07.81","R20.9","G44.82","H57.02","R60.0","E78.5","E87.6","Z53.21","Z88.0","R07.89","I47.9","R55.","G44.209","R25.1","F32.9","G62.9","R43.0","R79.1","R20.0","R73.9","R68.89","M54.5","F41.8","N30.00","A64.","T14.8XXA","G44.89","R10.9","Z87.440","J45.909","Z87.891","H61.23","H81.399","R73.03","G43.809","I20.0","K08.89","S02.5XXA","K08.9","S02.5XXB","G89.29","I49.9"],"date":["2022-08-11","2021-08-28","2021-05-14","2021-05-14","2021-05-14","2021-06-18","2022-10-25","2022-07-18","2020-08-01","2021-04-08","2021-12-31","2020-08-01","2021-02-11","2022-10-25","2022-04-12","2022-04-12","2022-04-12","2021-11-24","2022-08-04","2022-04-05","2021-06-15","2021-07-06","2021-07-06","2021-07-06","2021-07-30","2021-09-02","2021-11-24","2019-02-14","2020-08-03","2019-02-14","2020-01-15","2020-05-07","2020-05-15","2021-01-29","2021-02-22","2022-08-04","2022-07-01","2019-11-21","2022-08-04","2020-09-14","2020-09-14","2022-07-18","2021-03-01","2022-06-03","2022-10-27","2019-10-04","2020-02-28","2020-12-15","2020-02-28","2020-02-28","2020-08-03","2021-02-22","2022-08-04","2021-02-22","2021-03-08","2021-12-31","2020-09-14","2020-09-15","2020-09-15","2021-02-19","2021-02-19","2021-02-19","2022-06-22","2021-12-31","2022-10-25","2020-09-14","2020-09-14","2020-09-14","2020-09-14","2020-11-04","2020-12-15","2021-11-22","2020-05-08","2020-02-06","2020-02-06","2021-01-04","2021-05-04","2021-05-04","2022-07-01","2021-05-17","2021-07-22","2022-02-27","2022-05-03","2022-05-03","2022-08-04","2022-11-05","2022-02-27","2022-02-27","2022-04-12","2022-05-25","2022-10-25","2022-11-05","2022-11-05","2022-11-05","2022-10-07","2022-11-05","2022-11-15"],"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":[["","69097094312","GABAPENTIN","CAP 300MG","30","Select","Select",""],["","13668013601","ESCITALOPRAM","TAB 10MG","90","Select","Select",""],["","42806016005","HYDROXYZ","TAB 25MG","30","Select","Select",""],["","31722070190","LOSARTAN","TAB 50MG","90","Select","Select",""],["","00904672852","SUDOGEST","TAB 60MG","30","Select","Select",""],["","50228014610","HYDROCHLOROT","CAP 12.5MG","90","Select","Select",""],["","65862019405","FLUOXETINE","CAP 40MG","30","Select","Select",""],["","59651000305","OMEPRAZOLE","CAP 40MG","90","Select","Select",""],["","16571066101","MECLIZINE","TAB 25MG","30","Select","Select",""],["","24208039830","IPRATROPIUM","SPR 0.0003","30","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","67877056110","METFORMIN","TAB 500MG","60","Select","Select",""],["","75826011510","PHENAZOPYRID","TAB 200MG","6","Select","Select",""],["","00574050811","FERROUS","TAB 324MG","60","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","21","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","8","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","69238126601","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","00093216568","NALOXONE","SPR 4MG","2","Select","Select",""],["","49483060350","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","50428038612","ACETAMINOPHN","TAB 500MG","30","Select","Select",""],["","00245531911","KLOR-CON","TAB 20MEQ ER","14","Select","Select",""],["","13107008405","LORAZEPAM","TAB 1MG","30","Select","Select",""],["","42806008301","BUSPIRONE","TAB 7.5MG","120","Select","Select",""],["","68180085211","MY","TAB 1.5MG","1","Select","Select",""],["","69097083412","SERTRALINE","TAB 50MG","30","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","59762500801","MISOPROSTOL","TAB 200MCG","4","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","15","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","10","Select","Select",""],["","00591565810","CYCLOBENZAPR","TAB 10MG","21","Select","Select",""],["","68180016106","AZITHROMYCIN","TAB 500MG","6","Select","Select",""],["","53489011905","DOXYCYCL","CAP 100MG","14","Select","Select",""],["","00378064110","PREDNISONE","TAB 10MG","10","Select","Select",""],["","24208031510","POLYMYXIN","SOL TRIMETHP","10","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","5","Select","Select",""],["","45802057178","FEXOFENADINE","TAB 180MG","30","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","00067815203","VOLTAREN","GEL 0.01","100","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","10","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","70461031803","FLUCLVX","INJ 2018-19","0","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","20","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","47781030801","NITROFUR","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":""}]}]}