{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ERICA B GRIFFIN","gend":1,"add":"1012 BENCH LN","city":"HALIFAX","state":"VA","zip":"24558-9998","dob":"1998-12-31","age":"","mstatus":"","insh":"1440332*01","cliId":"","pno":7579145647,"cno":7579145647,"email":"","ename":"","eno":"","pphy":"BASSIL, HABIB F MD","ppno":4345728977,"pcpadd":"2232 WILBORN AVENUE","pcpcity":"SOUTH BOSTON","pcpstate":"VA","pcpzip":"24592-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4345722510,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["T83.32XA","Z11.3","O23.591","O99.891","O21.9","Z3A.12","O98.512","U07.1","R00.0","Z3A.19","O99.342","F31.9","O99.282","E06.3","Z87.891","Z91.040","R68.83","Z39.1","Z34.82","Z34.83","R00.2","R06.02","R55.","Z34.93","N89.8","Z3A.38","F32.2","F41.1","F90.2","R30.0","N39.0","F22.","N76.0","B96.89","E34.9","E66.9","Z68.38","F17.210","R11.0","R51.9","O23.42","O99.322","F12.90","Z3A.21","Z23.","I08.1","O20.8","R10.9","Z3A.01","Z3A.33","R19.7","O99.02","Z37.0","O99.344","O69.89X0","O76.","Z3A.39","Z20.822","Z79.899","O99.013","R10.2","Z30.430","H10.31","V23.87","O70.0","O66.5","F41.8","Z30.432","R10.31","Z33.1","R11.10","Z86.16","O36.8130","Z3A.28","R32.","Z38.00","P03.3","R11.2","J06.9","Z20.828","R52.","O99.611","K29.00","Z3A.13","M54.89","O26.893","M54.9","Z3A.29","I49.1","I49.3","I44.1"],"date":["2021-04-09","2022-08-19","2021-12-08","2022-06-02","2022-04-30","2021-12-08","2022-02-02","2022-02-02","2022-01-23","2022-01-23","2022-01-23","2022-06-09","2022-01-23","2022-01-23","2022-01-23","2022-01-23","2022-01-23","2022-04-29","2022-04-29","2022-04-29","2022-06-01","2022-05-17","2022-05-24","2022-06-01","2022-06-02","2022-06-02","2022-11-03","2022-11-03","2022-11-03","2022-12-06","2022-12-06","2022-10-19","2021-10-08","2022-12-06","2021-10-07","2021-10-07","2021-10-07","2021-10-07","2021-10-07","2022-01-23","2022-02-02","2022-02-02","2022-02-02","2022-02-02","2022-04-11","2022-05-24","2021-10-27","2022-04-30","2021-10-27","2022-04-30","2022-04-30","2022-06-09","2022-06-11","2022-06-09","2022-06-09","2022-06-09","2022-06-11","2022-06-09","2022-06-09","2022-06-09","2022-06-13","2022-08-02","2022-08-31","2021-10-22","2022-06-11","2022-06-11","2022-06-16","2021-06-23","2021-08-27","2021-12-11","2021-12-11","2022-02-03","2022-03-24","2022-03-24","2022-06-10","2022-06-12","2022-06-12","2022-12-06","2023-01-03","2023-01-03","2021-10-07","2021-12-11","2021-12-11","2021-12-11","2022-02-23","2022-04-04","2022-04-04","2022-04-04","2022-05-19","2022-05-19","2022-05-19"],"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":[["","00378727253","NORETHINDRON","TAB 0.35MG","28","Select","Select",""],["","13668013601","ESCITALOPRAM","TAB 10MG","90","Select","Select",""],["","67877054360","CEFDINIR","CAP 300MG","14","Select","Select",""],["","00536100901","FERROUS SULF","TAB 325MG","30","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","90","Select","Select",""],["","24208083060","NEO\/POLY\/DEX","SUS 0.1% OP","5","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","59779076678","PAIN RELIEF","TAB 325MG","50","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","20","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","14","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":""}]}]}