{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HEATHER SULLIVAN","gend":1,"add":"64 SUNSET DR","city":"STUARTS DRAFT","state":"VA","zip":"24477-9998","dob":"1973-01-05","age":"","mstatus":"","insh":"1166007*01","cliId":"","pno":5402554627,"cno":5402554627,"email":"","ename":"","eno":"","pphy":"CHEEK, KIMBERLY M MD","ppno":5402457950,"pcpadd":"201 LEW DEWITT BLVD","pcpcity":"WAYNESBORO","pcpstate":"VA","pcpzip":"22980-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5402457951,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D75.89","F17.210","F10.10","M79.671","W19.XXXA","R60.9","F32.9","F41.9","Z23.","V54.16","L65.9","L29.9","L65.8","L29.8","R19.4","K92.1","Z80.0","R11.0","J20.9","M72.2","I10.","E78.5","R07.9","Z00.00","E02.","E53.8","K76.0","K58.9","G43.909","R05.","R05.3","N95.9","E66.3","F17.290","K70.30","R00.2","R11.2","R06.00","R07.89","Z72.0","Z79.899","Z88.2","Z88.8","Z91.040","R06.09","M47.817","NO DATA","I16.0","Z01.419","R11.10","J01.00","K08.89","F11.10","F10.20","G24.01","N95.0","Z79.890","S92.345A","S92.335A","R23.9","R10.13","F33.0","F41.1","M54.2","G62.89","F11.20","K70.9","K58.0","Z12.31","R25.1","L57.8","L82.0","Z85.828","T07.XXXA","L21.0","L82.1","D12.4","D12.5","K57.30","K64.0","K59.00","R19.7","R10.9","R14.0","F17.200","R06.02","C44.319","C44.01","S92.341D","L21.9","G47.00","R53.1","R42.","J30.89","J34.2","R10.84","Z98.51","Z12.2","L64.9","D22.5","D22.61","D22.62","D22.71","D22.72","F33.2","D22.9"],"date":["2023-03-06","2023-01-09","2023-02-15","2021-10-18","2021-06-18","2021-10-18","2023-01-09","2023-03-06","2022-12-09","2021-10-18","2022-04-19","2023-04-19","2022-04-19","2022-04-12","2022-07-18","2022-08-05","2022-08-05","2023-03-06","2022-11-23","2023-02-07","2023-03-06","2023-01-09","2021-06-14","2022-06-15","2022-06-15","2022-06-15","2023-03-06","2023-03-06","2022-06-15","2021-06-14","2022-06-15","2022-06-15","2022-12-14","2022-08-09","2022-08-09","2023-01-09","2022-10-14","2022-10-14","2022-10-14","2023-03-06","2023-04-06","2023-03-06","2023-03-06","2023-03-06","2022-10-14","2023-03-09","2023-03-09","2021-01-22","2023-04-25","2021-05-20","2023-03-11","2022-08-17","2023-04-21","2023-04-21","2023-03-11","2022-05-12","2023-03-06","2021-06-24","2021-06-24","2022-04-19","2022-08-05","2023-03-16","2023-04-06","2023-02-28","2023-02-28","2023-04-06","2022-12-14","2021-04-19","2021-12-14","2023-03-11","2023-04-19","2022-01-11","2023-04-19","2022-01-11","2022-01-11","2023-04-19","2022-08-05","2022-08-05","2022-08-05","2022-08-05","2022-08-05","2022-08-05","2023-03-06","2022-08-05","2022-08-05","2021-01-22","2021-05-05","2021-06-15","2021-06-21","2022-01-11","2022-07-19","2022-10-14","2022-10-14","2023-01-17","2023-01-17","2023-03-06","2023-03-06","2023-01-09","2023-04-19","2023-04-19","2023-04-19","2023-04-19","2023-04-19","2023-04-19","2023-04-06","2023-04-19"],"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":[["","69097084905","ESCITALOPRAM","TAB 20MG","90","Select","Select",""],["","29300039810","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","65862044990","VALACYCLOVIR","TAB 1GM","30","Select","Select",""],["","68462015305","TOPIRAMATE","TAB 50MG","90","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","30","Select","Select",""],["","42806041501","BUPROPION","TAB 150MG SR","90","Select","Select",""],["","68462026190","ROSUVASTATIN","TAB 5MG","90","Select","Select",""],["","55111046801","METOPROL SUC","TAB 100MG ER","90","Select","Select",""],["","69315013301","IMIPRAM HCL","TAB 10MG","30","Select","Select",""],["","00378727253","NORETHINDRON","TAB 0.35MG","84","Select","Select",""],["","11534016503","FOLIC ACID","1 MG","30","Select","Select",""],["","50742065728","ESTRA\/NORETH","TAB 1-0.5MG","28","Select","Select",""],["","68462039710","OMEPRAZOLE","40 MG","90","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","14","Select","Select",""],["","64380071306","BENZONATATE","CAP 200MG","21","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00093545542","MIMVEY","TAB 1-0.5MG","30","Select","Select",""],["","68180018001","CEFADROXIL","CAP 500MG","14","Select","Select",""],["","65162062711","TRAMADOL HCL","TAB 50MG","12","Select","Select",""],["","68382003416","VENLAFAXINE","CAP 37.5 ER","14","Select","Select",""],["","68462053228","CLOBETASOL","SOL 0.0005","50","Select","Select",""],["","45802011222","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","45802046564","KETOCONAZOLE","SHA 0.02","120","Select","Select",""],["","49884051072","TESTOSTERONE","GEL 1%(50MG)","150","Select","Select",""],["","60432052804","SELENIUM SUL","LOT 0.025","118","Select","Select",""],["","49022005622","HAIR REGROW","AER 5% WOMEN","60","Select","Select",""],["","00591079501","DICYCLOMINE","TAB 20MG","60","Select","Select",""],["","13668033005","TRAZODONE","TAB 50MG","30","Select","Select",""],["","00406117003","NALTREXONE","TAB 50MG","30","Select","Select",""],["","68382091634","METHYLPRED","TAB 4MG","21","Select","Select",""],["","68001051206","QUETIAPINE FUMARATE ER","150 MG","30","Select","Select",""],["","68001018408","QUETIAPINE FUMARATE","100 MG","30","Select","Select",""],["","00378729553","ESTRADIOL-NORETHINDRONE ACETAT","1 MG-0.5MG","84","Select","Select",""],["","68001045608","ESCITALOPRAM OXALATE","20 MG","30","Select","Select",""],["","43598058230","BUPRENORPHINE-NALOXONE","8 MG-2 MG","2","Select","Select",""],["","68180087673","NORETHINDRONE","0.35 MG","28","Select","Select",""],["","00591079501","DICYCLOMINE HCL","20 MG","60","Select","Select",""],["","12496120803","SUBOXONE","8 MG-2 MG","4","Select","Select",""],["","29300039810","AMLODIPINE BESYLATE","10 MG","90","Select","Select",""],["","50383070016","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","13107003134","MIRTAZAPINE","15 MG","30","Select","Select",""],["","68001043604","CETIRIZINE HCL","10 MG","90","Select","Select",""],["","00093216568","NALOXONE HCL","4 MG","2","Select","Select",""],["","13668033005","TRAZODONE HCL","50 MG","30","Select","Select",""],["","00093342605","LORAZEPAM","1 MG","4","Select","Select",""],["","70436005901","BUPROPION HCL SR","150 MG","90","Select","Select",""],["","68001016208","PROMETHAZINE HCL","25 MG","6","Select","Select",""],["","68462015713","ONDANSETRON ODT","4 MG","30","Select","Select",""],["","68001023703","CLONIDINE HCL","0.1 MG","9","Select","Select",""],["","68462026190","ROSUVASTATIN CALCIUM","5 MG","90","Select","Select",""],["","60687012125","ACAMPROSATE CALCIUM","333 MG","28","Select","Select",""],["","00713067831","NYSTATIN","100000\/G","30","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":""}]}]}