{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JAMIE WOODS","gend":0,"add":"11 MONTGOMERY AVE","city":"STAUNTON","state":"VA","zip":"24401-9998","dob":"1977-11-25","age":"","mstatus":"","insh":"1674222*01","cliId":"","pno":5404486476,"cno":5404486476,"email":"","ename":"","eno":"","pphy":"FORMATO, ERICA L MD","ppno":5404377920,"pcpadd":"103 COMMUNITY WAY,","pcpcity":"STAUNTON","pcpstate":"VA","pcpzip":"24401-9998","pcpcounty":"","pcpid":"","pcpname":"SRMHMG - Sentara Primary Care and Therapy Center - Staunton","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8334063983,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.9","Z03.818","NO DATA","R11.2","D68.51","Z76.89","M54.32","R20.2","I25.10","Z79.82","Z72.0","Z88.8","M54.42","M54.16","F17.210","M54.9","G89.29","M79.89","R22.42","M79.605","I10.","Z79.899","M51.27","M79.642","I25.2","S40.021A","Z86.73","M54.12","M19.011","M19.90","M62.830","M51.37","Z13.89","F45.42","G62.9","M53.2X6","M54.5","M25.512","R07.9","R10.84","R11.10","R52.","D72.829","G89.11","M54.30","G54.9","S49.92XA","M25.511","R45.4","R45.1","K04.7","S16.1XXA","M79.641","M25.531","M21.831","S63.92XA","L03.90","M54.40","G89.4","E86.0","R19.7","R10.9","Z87.19","Z71.6","R53.1","R11.0","R69.","M48.07","M47.817","M43.17","M43.16","M51.17","M54.17","I69.398","Z53.21","R10.30","N39.0","Z51.81","A08.39","R50.9","A08.4","D68.2","K21.9","K29.70","R10.10","R31.9","R53.83","R93.41","R20.0","R42.","M25.551","S43.431A","S43.432A","M54.41","M19.012","M67.814","M67.813","M51.36","M54.2","Z79.891"],"date":["2023-02-08","2021-11-13","2023-08-01","2022-01-15","2023-02-08","2022-02-02","2022-03-14","2023-02-21","2023-07-22","2023-07-22","2023-07-22","2023-07-22","2023-07-22","2023-07-11","2022-11-12","2023-07-22","2023-07-22","2022-05-03","2022-05-03","2022-07-13","2023-07-22","2023-07-22","2022-06-26","2022-11-12","2023-02-08","2022-11-11","2023-02-08","2023-03-13","2023-05-08","2023-06-22","2023-06-22","2023-07-22","2023-06-22","2023-06-22","2023-06-22","2023-06-22","2021-01-23","2023-02-08","2021-04-11","2021-06-24","2021-06-24","2021-11-13","2021-12-29","2022-08-23","2022-05-17","2022-05-17","2022-08-23","2023-02-08","2022-10-29","2022-10-29","2023-01-05","2023-03-06","2021-01-25","2021-01-25","2021-01-25","2022-11-16","2022-11-16","2023-07-22","2023-02-08","2022-05-21","2022-01-15","2022-01-15","2022-01-15","2022-01-15","2022-05-21","2022-05-21","2022-05-21","2022-07-13","2022-07-13","2022-07-13","2022-07-13","2022-07-13","2023-02-27","2023-02-27","2021-07-21","2021-12-29","2021-12-29","2022-09-26","2022-05-21","2021-11-13","2022-05-21","2022-05-21","2022-05-21","2022-05-21","2022-05-21","2021-12-29","2021-12-29","2021-12-29","2022-03-11","2022-08-23","2022-08-23","2023-03-01","2023-03-01","2023-02-27","2023-03-01","2023-03-01","2023-03-01","2023-07-11","2023-07-11","2023-07-22"],"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":[["","16714020030","ONDANSETRON","TAB 4MG ODT","15","Select","Select",""],["","55111028130","LEVOFLOXACIN","TAB 750MG","7","Select","Select",""],["","00172392560","DIAZEPAM","2 MG","1","Select","Select",""],["","00406051201","OXYCOD\/APAP","TAB 5-325MG","5","Select","Select",""],["","42806040021","METHYLPRED","TAB 4MG","21","Select","Select",""],["","65162010250","GABAPENTIN","300 MG","30","Select","Select",""],["","42858000101","OXYCODONE","TAB 5MG","7","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","28","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","12","Select","Select",""],["","59746017310","PREDNISONE","10 MG","26","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","00591352530","LIDOCAINE","5 %","60","Select","Select",""],["","00904673080","ACETAMIN","TAB 500MG","18","Select","Select",""],["","49035048462","ACETAMINOPHN","TAB 500MG","18","Select","Select",""],["","68645056354","IBUPROFEN","800 MG","90","Select","Select",""],["","57664037708","TRAMADOL HCL","TAB 50MG","28","Select","Select",""],["","53746014601","HYDROCOD\/IBU","TAB 5-200MG","10","Select","Select",""],["","31722053401","METHOCARBAM","TAB 750MG","90","Select","Select",""],["","00093094801","DICLOFEN POT","TAB 50MG","60","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","10","Select","Select",""],["","00406051201","OXYCODONE-ACETAMINOPHEN","5 MG-325MG","9","Select","Select",""],["","29300041519","CYCLOBENZAPRINE HCL","10 MG","90","Select","Select",""],["","69315090405","LORAZEPAM","0.5 MG","1","Select","Select",""],["","43386035610","HYDROCODONE-ACETAMINOPHEN","5 MG-325MG","2","Select","Select",""],["","42806040021","METHYLPREDNISOLONE","4 MG","21","Select","Select",""],["","16571020150","DICLOFENAC SODIUM","75 MG","60","Select","Select",""],["","42858000101","OXYCODONE HCL","5 MG","6","Select","Select",""],["","57237004001","PENICILLIN V POTASSIUM","250 MG","56","Select","Select",""],["","68462015713","ONDANSETRON ODT","4 MG","9","Select","Select",""],["","16714008310","HYDROXYZINE HCL","50 MG","10","Select","Select",""],["","69238120202","BUPRENORPHINE","5 MCG\/HR","4","Select","Select",""],["","55111015330","ONDANSETRON HCL","4 MG","14","Select","Select",""],["","12496120803","SUBOXONE","8 MG-2 MG","6","Select","Select",""],["","47781035703","BUPRENORPHINE-NALOXONE","8 MG-2 MG","6","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":""}]}]}