{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SAMANTHA CARTER","gend":1,"add":"920 POLK ST APT 51","city":"LYNCHBURG","state":"VA","zip":"24504-9998","dob":"1982-06-30","age":"","mstatus":"","insh":"1194719*01","cliId":"","pno":4342586680,"cno":4342586680,"email":"","ename":"","eno":"","pphy":"CLAPP, SUSAN NP","ppno":4342003366,"pcpadd":"800 5TH STREET,","pcpcity":"LYNCHBURG","pcpstate":"VA","pcpzip":"24504-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4345289101,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","V89.2XXA","M62.838","K21.9","U07.1","R09.02","R00.0","J45.909","J96.01","G89.4","E66.01","G43.909","G44.89","R11.0","R10.84","R19.7","M54.5","NO DATA","Z74.3","R06.02","R06.9","F41.9","K52.9","R11.2","A41.9","K51.00","Z20.822","M54.10","A41.89","C18.9","Z68.41","D62.","E83.42","E87.6","G43.709","G47.33","M54.6","Z80.1","Z82.49","Z88.8","R11.11","C53.9","R56.9","K76.0","D64.9","D51.9","K44.9","R51.9","R10.9","R07.0","M19.90","R53.1","Z51.81","M47.816","Z79.899","K62.5","Z88.5","Z68.43","Z79.51","R06.89","Z12.39","Z12.11","J30.89","A60.9","K62.89","C18.6","R10.30","R05.9","K08.89","Z23.","R94.31","Z68.42","Z85.41","S39.012A","M54.30","G89.29","X50.0XXA","M54.40","M79.7","R93.3","K92.1","R11.10","J06.9","D12.4","K57.30","K64.0","K31.84","R68.89","J02.9","B34.9","K63.5","Z83.79","K31.89","R09.81","M25.511","V49.40XA","M54.17"],"date":["2023-01-26","2021-06-18","2021-10-29","2022-02-11","2023-01-26","2022-12-18","2023-01-18","2023-01-18","2021-12-12","2022-12-18","2022-12-22","2023-01-18","2023-01-18","2023-01-29","2023-01-29","2023-02-07","2021-01-26","2023-09-05","2021-12-09","2021-12-11","2021-12-09","2022-02-11","2022-11-17","2023-01-11","2022-12-22","2022-12-22","2022-12-18","2023-03-07","2022-11-16","2022-11-16","2022-12-18","2022-11-19","2022-11-17","2022-12-22","2022-11-16","2022-12-18","2022-11-16","2022-11-16","2022-11-16","2022-11-16","2022-11-16","2022-12-22","2022-12-22","2022-12-22","2022-12-22","2022-12-22","2022-12-22","2023-01-18","2023-01-26","2023-01-18","2023-01-18","2023-01-26","2023-09-05","2023-09-05","2022-10-18","2021-05-29","2022-10-18","2022-10-18","2022-10-18","2021-12-11","2022-02-11","2022-02-11","2022-02-11","2022-02-11","2022-11-28","2022-11-28","2022-11-28","2023-01-23","2023-01-29","2023-03-23","2021-12-09","2021-12-11","2022-12-18","2022-05-12","2022-05-12","2022-05-12","2022-05-12","2022-06-02","2022-07-20","2022-10-19","2022-11-16","2022-11-17","2021-12-31","2022-10-21","2022-10-21","2022-12-21","2022-12-18","2021-12-06","2022-07-13","2022-07-13","2022-10-18","2022-10-19","2022-12-22","2021-10-29","2021-11-15","2021-11-15","2022-08-09"],"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":[["","00093506205","HYDROXYZ HCL","TAB 50MG","60","Select","Select",""],["","00378668910","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","68180071909","AMLODIPINE","TAB 2.5MG","30","Select","Select",""],["","70010016234","LORATADINE","10 MG","30","Select","Select",""],["","29300041510","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","69230031703","ALLERGY RELF","TAB 10MG","30","Select","Select",""],["","31722072610","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","43547028111","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","29300012810","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","60505530701","ACYCLOVIR","800 MG","20","Select","Select",""],["","00054001925","PREDNISONE","TAB 50MG","5","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","40","Select","Select",""],["","42858020350","HYDROCO\/APAP","TAB 10-325MG","28","Select","Select",""],["","11877001140","BINAXNOW COV","KIT HOME TES","4","Select","Select",""],["","00172392670","DIAZEPAM","TAB 5MG","10","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","16571041250","CIPROFLOXACN","TAB 500MG","20","Select","Select",""],["","65862050220","AMOX\/K CLAV","TAB 500-125","15","Select","Select",""],["","47781001101","HYOSCYAMINE","SUB 0.125MG","21","Select","Select",""],["","68382004101","PROMETHAZINE","TAB 25MG","30","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","69452015120","VITAMIN D","CAP 50000UNT","4","Select","Select",""],["","66689000816","NYSTATIN","SUS 100000","100","Select","Select",""],["","59779070053","ANTI-DIARRHE","TAB 2MG","24","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","30","Select","Select",""],["","43598029390","PREGABALIN","CAP 75MG","60","Select","Select",""],["","65162006205","SUCRALFATE","SUS 1GM\/10ML","560","Select","Select",""],["","00143312601","DICYCLOMINE","CAP 10MG","28","Select","Select",""],["","62559043130","HYDROCORTISO","CRE 0.025","30","Select","Select",""],["","31604002731","B-12","TAB 1000 CR","30","Select","Select",""],["","50428027646","CVS VIT B12","TAB 1000 TR","30","Select","Select",""],["","75834014130","LIDOCAINE","CRE 0.05","30","Select","Select",""],["","50383066730","LIDO\/PRILOCN","CRE 2.5-2.5%","30","Select","Select",""],["","11877001140","BINAXNOW COVID-","19 AG SELF TEST","2","Select","Select",""],["","00406012401","HYDROCODONE-ACETAMINOPHEN","7.5-325 MG","90","Select","Select",""],["","57237007630","ONDANSETRON HCL","8 MG","60","Select","Select",""],["","11534018701","BUTALBITAL-ACETAMINOPHEN-CAFFE","50-300-40","42","Select","Select",""],["","00527058601","DICYCLOMINE HCL","10 MG","90","Select","Select",""],["","64980032005","TRIAMCINOLONE ACETONIDE","0.1 %","15","Select","Select",""],["","16571078350","CYCLOBENZAPRINE HCL","10 MG","30","Select","Select",""],["","00378668910","PANTOPRAZOLE SODIUM","40 MG","30","Select","Select",""],["","68462015713","ONDANSETRON ODT","4 MG","30","Select","Select",""],["","00406800503","BUPRENORPHINE-NALOXONE","2 MG-0.5MG","28","Select","Select",""],["","27808005701","PROMETHAZINE-DM","6.25-15\/5","140","Select","Select",""],["","08539900400","LANCING DEVICE","","1","Select","Select",""],["","42192034001","HYOSCYAMINE SULFATE","0.125 MG","120","Select","Select",""],["","69547035302","NARCAN","4 MG","2","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","90 MCG","18","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":""}]}]}