{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CRYSTAL L AGEE","gend":1,"add":"APT 103 PO BOX 165","city":"STUARTS DRAFT","state":"VA","zip":"24477-9998","dob":"1979-02-24","age":"","mstatus":"","insh":"1449934*01","cliId":"","pno":5404877844,"cno":5404877844,"email":"","ename":"","eno":"","pphy":"ALMARODE, CYNTHIA NP","ppno":5408872627,"pcpadd":"40 CHERRY GROVE ROAD,","pcpcity":"MIDDLEBROOK","pcpstate":"VA","pcpzip":"24459-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5408862726,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R05.","Z20.822","H92.02","R42.","K08.89","R68.84","D50.9","M17.0","M23.211","J01.90","M19.90","D72.829","M54.32","M75.51","M75.41","K21.9","R07.89","F45.8","M75.111","S43.431A","M19.011","M75.21","J30.9","M75.42","F90.9","R05.9","B34.9","R11.10","E66.01","F41.1","Z79.899","R11.0","K59.00","S46.012A","M17.11","R51.9","R11.2","M17.12","H69.92","I10.","J00.","K04.7","R13.10","M75.52","S46.011A","K76.0","F41.9","R03.0","Z87.11","K05.6","K29.70","R71.8","R89.1","R06.2","L03.012","M25.512","E55.9","F41.0","NO DATA","M53.3","Z68.41","Z00.00","R00.0","M17.9","M75.101","K05.30","N92.6","E66.9","Z68.38","J30.2","R73.9","H69.93","M25.562","R53.83","Z68.34"],"date":["2021-04-02","2022-09-09","2022-05-08","2022-05-08","2022-05-08","2022-10-10","2023-08-17","2023-06-16","2022-11-29","2023-02-02","2023-02-02","2023-04-28","2023-06-06","2023-07-24","2023-07-24","2023-06-06","2021-01-12","2021-01-12","2021-03-08","2021-02-01","2021-02-01","2021-02-01","2021-03-29","2022-08-19","2023-04-06","2023-08-28","2023-08-28","2023-08-28","2023-06-06","2021-03-12","2021-03-12","2021-06-14","2022-03-23","2021-08-10","2022-08-18","2022-09-09","2022-09-09","2022-10-19","2023-01-20","2023-01-20","2023-02-10","2023-08-02","2021-12-21","2022-03-24","2022-03-24","2022-07-11","2022-07-11","2022-06-28","2022-06-28","2022-09-15","2023-06-06","2022-09-15","2022-09-15","2023-02-10","2023-07-14","2021-06-15","2021-12-21","2021-12-21","2022-03-23","2022-03-23","2023-06-06","2022-07-11","2022-07-11","2022-07-11","2022-09-15","2022-09-15","2022-09-15","2023-08-17","2023-08-17","2023-06-06","2023-06-06","2022-06-06","2022-06-06","2022-08-01","2022-08-01"],"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":[["","00228202996","ALPRAZOLAM","0.5 MG","60","Select","Select",""],["","70461042110","FLUCLVX QUAD","INJ 2021-22","0","Select","Select",""],["","68462039710","OMEPRAZOLE","40 MG","30","Select","Select",""],["","00555097402","AMPHET\/DEXTR","TAB 30MG","60","Select","Select",""],["","62332014271","CELECOXIB","CAP 200MG","30","Select","Select",""],["","68001016100","PROMETHAZINE","TAB 12.5MG","10","Select","Select",""],["","59746017310","PREDNISONE","10 MG","12","Select","Select",""],["","00378632177","VALSART\/HCTZ","TAB 80-12.5","30","Select","Select",""],["","00781261305","AMOXICILLIN","500 MG","30","Select","Select",""],["","57237004105","PENICILLN VK","TAB 500MG","20","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00116200116","CHLORHEX GLU","SOL 0.0012","473","Select","Select",""],["","68001024617","ONDANSETRON","TAB 4MG ODT","6","Select","Select",""],["","68462018022","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","60","Select","Select",""],["","67877032105","IBUPROFEN","800 MG","90","Select","Select",""],["","68001039800","FAMOTIDINE","40 MG","30","Select","Select",""],["","00093314705","CEPHALEXIN","500 MG","21","Select","Select",""],["","70710128500","BACLOFEN","TAB 10MG","60","Select","Select",""],["","42571016201","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","00169452514","WEGOVY","0.25MG\/0.5","2","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","00713052612","PROMETHEGAN","25 MG","12","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","69097067905","PREGABALIN","75 MG","60","Select","Select",""],["","52817033200","CYCLOBENZAPRINE HCL","10 MG","60","Select","Select",""],["","00904759080","FEROSUL","325(65) MG","30","Select","Select",""],["","68001016208","PROMETHAZINE HCL","25 MG","20","Select","Select",""],["","00116200116","CHLORHEXIDINE GLUCONATE","0.12 %","473","Select","Select",""],["","00555097302","DEXTROAMPHETAMINE-AMPHETAMINE","20 MG","90","Select","Select",""],["","57237004199","PENICILLIN V POTASSIUM","500 MG","40","Select","Select",""],["","42571025201","CLINDAMYCIN HCL","300 MG","21","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":""}]}]}