{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SUSAN JEFFERSON","gend":1,"add":"720 SONGBIRD LN","city":"DANVILLE","state":"VA","zip":"24540-9998","dob":"1971-02-08","age":"","mstatus":"","insh":"1538293*01","cliId":"","pno":4347102229,"cno":4347102229,"email":"","ename":"","eno":"","pphy":"SEEPE, CAROLYN S MD","ppno":4347914110,"pcpadd":"173 EXECUTIVE DRIVE","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":"24540-9998","pcpcounty":"","pcpid":"","pcpname":"Sovah Family Medical Residency Clinic","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":4344252503,"add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4347914003,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.9","F41.1","F11.20","M96.1","M54.17","G89.4","Z79.899","N34.0","N36.8","N76.4","F31.4","F33.0","F41.0","F43.11","J44.9","Z87.891","R06.09","Z87.01","R93.89","L60.0","L60.2","M79.674","M79.675","NO DATA","F17.200","F43.10","Z87.828","R30.0","Z32.02","J44.1","Z72.0","Z20.822","F11.21","R06.00","R05.3","J45.40","R91.8","R06.02","F48.2","Z23.","H25.13","J44.0","E66.3","R03.0","R09.81","R05.8","Z68.27","G43.009","Z68.25","F17.210","N90.7","R10.2","Z01.411","Z13.1","E07.9","E75.6","E55.9","R79.9","F32.9","F41.9","Z53.29","K21.9","R91.1","Z91.048","R94.31","J02.9","F31.89","M79.7","F41.8","M53.80","Z68.29","J18.9","Z80.3","Z30.42","E78.5","R63.5","E78.2","Z13.31","Z00.00","Z12.4","Z68.24","Z13.89","Z80.41","N75.0","F43.12","Z86.59"],"date":["2023-04-04","2023-04-12","2023-03-31","2021-12-14","2021-11-16","2021-10-19","2021-10-19","2021-07-28","2021-07-28","2021-07-28","2023-04-12","2021-11-04","2023-04-12","2023-04-12","2022-08-08","2022-08-08","2022-08-08","2022-08-08","2022-08-08","2023-01-11","2023-01-11","2023-01-11","2023-01-11","2023-03-24","2023-03-24","2022-08-31","2021-04-09","2021-05-03","2021-05-03","2022-06-16","2023-04-04","2022-06-18","2021-10-19","2022-02-08","2022-02-08","2021-01-18","2021-01-18","2021-10-04","2023-04-04","2021-12-01","2022-03-08","2022-06-18","2022-06-18","2022-06-18","2022-06-18","2022-06-18","2022-06-18","2022-09-01","2021-07-01","2023-02-08","2021-07-15","2021-07-15","2021-07-20","2021-07-20","2021-07-20","2021-07-20","2021-07-20","2021-07-20","2022-08-31","2022-08-31","2021-10-04","2021-10-04","2021-10-04","2021-10-04","2021-10-04","2022-04-20","2022-04-20","2022-04-20","2022-04-20","2022-04-20","2022-04-20","2021-02-01","2021-10-28","2021-10-28","2023-02-08","2023-02-08","2022-07-13","2022-07-13","2021-02-04","2021-02-04","2021-02-04","2021-02-04","2021-08-11","2021-08-11","2023-04-04","2023-04-04"],"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":[["","00135050802","NICORETTE","LOZ 2MG MINT","72","Select","Select",""],["","16714019501","LAMOTRIGINE","100 MG","60","Select","Select",""],["","00536589588","NICOTINE TD","DIS 14MG\/24H","28","Select","Select",""],["","55513084101","AIMOVIG","INJ 70MG\/ML","1","Select","Select",""],["","76204020025","ALBUTEROL","NEB 0.00083","225","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00173088710","TRELEGY","AER ELLIPTA","60","Select","Select",""],["","51224000160","BENZONATATE","200 MG","30","Select","Select",""],["","61874014530","VRAYLAR","4.5 MG","30","Select","Select",""],["","00093406810","PRAZOSIN HCL","2 MG","60","Select","Select",""],["","16714017202","TIZANIDINE","TAB 4MG","135","Select","Select",""],["","16714008212","HYDROXYZ HCL","TAB 25MG","120","Select","Select",""],["","78206012601","DULERA","200-5 MCG","13","Select","Select",""],["","16714033202","GABAPENTIN","800 MG","120","Select","Select",""],["","12496120803","SUBOXONE","8 MG-2 MG","60","Select","Select",""],["","16729011917","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","66993037179","MEDROXYPR AC","INJ 150MG\/ML","1","Select","Select",""],["","29300013905","DIVALPROEX","TAB 250MG DR","90","Select","Select",""],["","65862056099","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","00173086910","ANORO ELLIPT","AER 62.5-25","60","Select","Select",""],["","16714079904","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","80777027310","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","55111029236","SUMATRIPTAN","TAB 50MG","9","Select","Select",""],["","64597030160","NUEDEXTA","20 MG-10MG","60","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","60432060416","PROMETHAZINE","SYP DM","210","Select","Select",""],["","55111068301","IBU","TAB 600MG","60","Select","Select",""],["","65862001901","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","33342032915","TRIAMCINOLON","CRE 0.001","45","Select","Select",""],["","16714017402","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","59746017310","PREDNISONE","10 MG","48","Select","Select",""],["","59385002360","BELBUCA","MIS 300MCG","60","Select","Select",""],["","63824017163","DELSYM","SUS 30MG\/5ML","120","Select","Select",""],["","00143980350","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","69848000609","ALLERGY","TAB 10MG","30","Select","Select",""],["","16714015901","ONDANSETRON","TAB 4MG","20","Select","Select",""],["","68180016111","AZITHROMYCIN","TAB 500MG","5","Select","Select",""],["","57896063412","MAG OXIDE","TAB 400MG","30","Select","Select",""],["","70710111001","CYPROHEPTAD","TAB 4MG","30","Select","Select",""],["","76204001055","ALBUTEROL SULFATE","0.63MG\/3ML","150","Select","Select",""],["","16714079904","CETIRIZINE HCL","10 MG","30","Select","Select",""],["","55111029236","SUMATRIPTAN SUCCINATE","50 MG","9","Select","Select",""],["","16729011917","MONTELUKAST SODIUM","10 MG","30","Select","Select",""],["","65862056099","PANTOPRAZOLE SODIUM","40 MG","30","Select","Select",""],["","16714008212","HYDROXYZINE HCL","25 MG","120","Select","Select",""],["","16714017202","TIZANIDINE HCL","4 MG","135","Select","Select",""],["","70436015541","PROMETHAZINE-DM","6.25-15\/5","120","Select","Select",""],["","55111028130","LEVOFLOXACIN","750 MG","10","Select","Select",""],["","57896063412","MAGNESIUM OXIDE","400 MG","30","Select","Select",""],["","00548540000","MEDROXYPROGESTERONE ACETATE","150 MG\/ML","1","Select","Select",""],["","62756097083","BUPRENORPHINE-NALOXONE","8 MG-2 MG","56","Select","Select",""],["","16714015901","ONDANSETRON HCL","4 MG","20","Select","Select",""],["","16714017303","ATORVASTATIN CALCIUM","10 MG","30","Select","Select",""],["","70710111001","CYPROHEPTADINE HCL","4 MG","30","Select","Select",""],["","55513084101","AIMOVIG AUTOINJECTOR","70 MG\/ML","1","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA","90 MCG","8.5","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":""}]}]}