{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DARLINE ESTRADA","gend":1,"add":"1423 COUNTRY CLUB CT","city":"HARRISONBURG","state":"VA","zip":"22802-9998","dob":"1979-09-06","age":"","mstatus":"","insh":"1461832*01","cliId":"","pno":5083738455,"cno":5083738455,"email":"","ename":"","eno":"","pphy":"DARMETKO, HEATHER L NP","ppno":5404331905,"pcpadd":"2034 PRO POINTE LANE","pcpcity":"HARRISONBURG","pcpstate":"VA","pcpzip":"22801-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5404331906,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G89.29","M54.5","M51.36","M17.9","Z13.89","F45.42","M54.16","M19.90","M47.817","M47.9","NO DATA","K59.03","M62.830","I70.299","R53.83","F11.20","G89.4","M72.2","G60.8","M51.26","G90.09","M96.1","N83.209","Z23.","G57.52","M93.872","M62.9","Z01.818","S40.012A","M47.816","M43.16","Z20.822","R51.9","Z47.89","M54.17","M51.37","G58.9","N76.0","B96.89","G43.909","R73.9","Z11.59","Z11.4","H81.10","R31.29","Z87.448","Z87.891","R42.","N28.1","R10.84"],"date":["2023-03-28","2021-03-16","2023-03-28","2023-03-28","2023-03-28","2023-03-01","2023-03-28","2023-02-01","2022-04-27","2021-03-25","2023-03-28","2021-12-08","2023-02-01","2023-03-28","2023-03-28","2023-03-28","2022-11-04","2022-09-07","2023-03-28","2022-04-27","2023-03-28","2023-03-28","2021-12-02","2021-03-22","2022-09-07","2022-04-25","2022-04-25","2022-04-25","2022-09-16","2023-01-11","2023-01-11","2022-02-01","2023-03-04","2022-09-07","2022-01-21","2022-01-21","2022-01-21","2023-03-21","2023-03-21","2023-04-11","2023-04-11","2023-04-11","2023-04-11","2023-03-04","2023-03-04","2023-03-04","2023-03-04","2023-03-04","2023-04-18","2023-04-18"],"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":[["","14539067306","DIFLUNISAL","500 MG","60","Select","Select",""],["","72888008000","TRAMADOL HCL","50 MG","240","Select","Select",""],["","68462030529","NORETHINDRON","TAB 0.35MG","84","Select","Select",""],["","60505384901","CELECOXIB","CAP 200MG","60","Select","Select",""],["","65862052305","GABAPENTIN","TAB 600MG","270","Select","Select",""],["","71930005552","APAP\/CODEINE","TAB 300-30MG","120","Select","Select",""],["","60505025203","TIZANIDINE","TAB 4MG","180","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","50428606624","STOOL SOFTNR","CAP 100MG","56","Select","Select",""],["","00378877035","ESTRADIOL","CRE 0.0001","42","Select","Select",""],["","49281040020","ADACEL","INJ ","0","Select","Select",""],["","49281042250","FLUZONE QUAD","INJ 2022-23","0","Select","Select",""],["","00456120130","LINZESS","CAP 145MCG","30","Select","Select",""],["","80777027398","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","00378728490","LEVONOR\/ETHI","TAB ESTRADIO","91","Select","Select",""],["","00254302902","LUBIPROSTONE","24MCG","60","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","60","Select","Select",""],["","65862019105","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","59267030402","PFIZER BIVAL","INJ BA4\/BA5","0","Select","Select",""],["","00591544310","PREDNISONE","TAB 20MG","5","Select","Select",""],["","16571020210","DICLOFENAC","TAB 50MG DR","60","Select","Select",""],["","00591352530","LIDOCAINE","5 %","30","Select","Select",""],["","60505025203","TIZANIDINE HCL","4 MG","60","Select","Select",""],["","49483060450","IBUPROFEN","800 MG","30","Select","Select",""],["","50111033401","METRONIDAZOLE","500 MG","14","Select","Select",""],["","16571066101","MECLIZINE HCL","25 MG","30","Select","Select",""],["","10702025350","BUTALBITAL-ACETAMINOPHEN-CAFFE","50-325-40","20","Select","Select",""],["","72618300002","NURTEC ODT","75 MG","18","Select","Select",""],["","82607066026","FLOWFLEX COVID-","19 AG HOME TEST","8","Select","Select",""],["","69452034572","SUMATRIPTAN SUCCINATE","50 MG","9","Select","Select",""],["","68382004101","PROMETHAZINE HCL","25 MG","20","Select","Select",""],["","59746000103","METHYLPREDNISOLONE","4 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":""}]}]}