{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JANICE JAMES","gend":1,"add":"128 N STONEWALL ROAD","city":"NEW CANTON","state":"VA","zip":"23123-9998","dob":"1972-06-08","age":"","mstatus":"","insh":"1684472*01","cliId":"","pno":4348082328,"cno":4348082328,"email":"","ename":"","eno":"","pphy":"JEN, TIFFANY MD","ppno":4346544680,"pcpadd":"13 REBECCA DRIVE,","pcpcity":"PALMYRA","pcpstate":"VA","pcpzip":"22963-9998","pcpcounty":"","pcpid":"","pcpname":"SMJMG - Sentara Palmyra Medical Associates","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8443072857,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R00.2","K21.9","R14.0","R13.10","G47.33","M79.7","R20.8","F41.9","M25.512","V58.89","M62.838","E11.69","G62.9","I47.1","F33.41","E66.01","M25.441","L03.011","E78.5","Z68.42","F45.8","E11.3293","H11.153","H25.011","M24.812","M25.511","S46.011A","R50.9","R51.9","NO DATA","F33.1","R94.31","J02.8","R50.81","F41.8","M76.52","N76.0","R30.0","E11.9","R10.11","G90.521","M25.571","G89.29","S13.9XXA","F07.81","I10.","Z68.43","Z91.041","M54.2","G44.319","Z46.89","R06.00","J01.10","M99.08","Z01.818","B34.9","Z20.822","K30.","R06.83","K25.9","Z86.16","M47.816","M51.36","K29.50","E11.65","R10.9","E11.43","Z12.31","Z12.4","N91.2","K31.84","G89.4","Z91.19","J01.90","B96.89","M25.552","H66.002","R14.2","R41.3","Z12.11","K62.1","D12.3","H52.4","K92.9","K59.00","K76.0","Z86.010","E11.59","I15.2","R48.8","R41.841","T78.1XXA","R60.0","Z11.3","M19.041","K64.9","E55.9","R53.83","Z23."],"date":["2023-08-17","2023-06-16","2022-04-05","2022-04-05","2023-07-14","2023-03-14","2023-03-14","2022-07-05","2022-12-27","2022-12-27","2022-12-27","2023-07-27","2023-09-07","2023-09-25","2023-08-25","2023-07-20","2023-07-27","2023-01-13","2023-08-17","2023-07-20","2023-03-06","2022-09-19","2022-02-17","2022-02-17","2022-10-12","2022-09-28","2022-12-06","2022-04-15","2022-04-15","2023-07-27","2022-09-15","2023-08-17","2021-03-02","2021-03-02","2021-06-25","2021-04-08","2021-06-25","2021-06-25","2023-07-27","2022-04-05","2021-09-22","2021-09-29","2023-07-27","2022-08-31","2023-06-01","2023-08-17","2022-08-31","2022-08-31","2022-08-31","2022-11-09","2023-02-19","2021-03-22","2021-09-13","2022-03-16","2022-04-01","2022-04-06","2022-04-06","2022-11-17","2021-06-25","2021-06-25","2021-06-25","2021-07-30","2021-07-30","2022-04-05","2023-07-20","2021-05-06","2021-05-06","2021-05-06","2021-05-06","2021-05-06","2023-03-13","2023-07-27","2022-03-04","2023-02-09","2023-02-09","2023-03-14","2021-12-30","2023-03-13","2023-06-01","2023-03-06","2023-03-06","2023-03-06","2023-06-14","2023-06-16","2023-07-14","2023-07-27","2023-06-16","2023-07-20","2023-07-20","2023-06-01","2023-06-01","2023-07-14","2023-07-14","2023-09-07","2023-08-01","2023-08-25","2023-07-27","2023-07-27","2023-07-27"],"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":[["","68001033508","LISINOPRIL","20 MG","90","Select","Select",""],["","69315011710","FUROSEMIDE","40 MG","90","Select","Select",""],["","00597015330","JARDIANCE","TAB 25MG","30","Select","Select",""],["","75834050005","METFORMIN","TAB 500MG ER","30","Select","Select",""],["","65862017099","ATENOLOL","100 MG","90","Select","Select",""],["","00310653004","BYDUREON PEN","INJ 2MG","4","Select","Select",""],["","27241009810","DULOXETINE","CAP 30MG","60","Select","Select",""],["","16729017217","AMITRIPTYLIN","TAB 25MG","30","Select","Select",""],["","68462039710","OMEPRAZOLE","40 MG","90","Select","Select",""],["","69097067805","PREGABALIN","50 MG","60","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","28","Select","Select",""],["","29300016910","TIZANIDINE","TAB 4MG","20","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","00093220401","METOCLOPRAM","TAB 5MG","90","Select","Select",""],["","59762040105","SUCRALFATE","TAB 1GM","40","Select","Select",""],["","60505257908","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","00378910293","NITROGLYCER","DIS 0.1MG\/HR","30","Select","Select",""],["","00054029399","AZELASTINE","SPR 0.001","30","Select","Select",""],["","68001025320","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","00002318280","TRULICITY","4.5 MG\/0.5","6","Select","Select",""],["","00245086070","VANDAZOLE","GEL 0.0075","70","Select","Select",""],["","00168027740","CLINDAMYCIN","CRE 2% VAG","40","Select","Select",""],["","00169406013","VICTOZA","INJ 18MG\/3ML","9","Select","Select",""],["","68001028100","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","11788002705","BENZONATATE","CAP 200MG","45","Select","Select",""],["","00310654004","BYDUREON BC","INJ 2\/0.85ML","10","Select","Select",""],["","08470356001","UNIFINE PNTP","MIS 33GX4MM","100","Select","Select",""],["","16729018317","HYDROCHLOROT","TAB 25MG","90","Select","Select",""],["","62135098505","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","80777027399","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","68001042300","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","00378034501","DIAZEPAM","TAB 5MG","15","Select","Select",""],["","45963043864","ENULOSE","SOL 10GM\/15","45","Select","Select",""],["","00169413212","OZEMPIC","0.25 OR .5","1.5","Select","Select",""],["","57664037718","TRAMADOL HCL","TAB 50MG","8","Select","Select",""],["","70710128501","BACLOFEN","10 MG","90","Select","Select",""],["","68382005001","MELOXICAM","TAB 7.5MG","30","Select","Select",""],["","42858010250","OXYCOD\/APAP","TAB 5-325MG","30","Select","Select",""],["","65649040001","PLENVU","SOL ","3","Select","Select",""],["","33342029809","MEMANTINE","TAB HCL 10MG","180","Select","Select",""],["","27241009810","DULOXETINE HCL","30 MG","30","Select","Select",""],["","45802016000","DICLOFENAC SODIUM","1 %","200","Select","Select",""],["","69452015120","VITAMIN D","2 1250 MCG","8","Select","Select",""],["","16729018317","HYDROCHLOROTHIAZIDE","25 MG","90","Select","Select",""],["","00093314705","CEPHALEXIN","500 MG","21","Select","Select",""],["","33342029809","MEMANTINE HCL","10 MG","60","Select","Select",""],["","55111018015","TIZANIDINE HCL","4 MG","20","Select","Select",""],["","00093220405","METOCLOPRAMIDE HCL","5 MG","90","Select","Select",""],["","60505257908","ATORVASTATIN CALCIUM","20 MG","90","Select","Select",""],["","75834050005","METFORMIN HCL ER","500 MG","360","Select","Select",""],["","42571016101","AMOXICILLIN-CLAVULANATE POTASS","500-125 MG","30","Select","Select",""],["","52536018003","ERYTHROMYCIN","250 MG","42","Select","Select",""],["","00169418113","OZEMPIC .","25 OR 0.5","3","Select","Select",""],["","75834050005","METFORMIN TAB","500MG ER","30","Select","Select",""],["","65862017099","ATENOLOL TAB","100MG","30","Select","Select",""],["","69097052444","DICLOFENAC GEL","1%","200","Select","Select",""],["","69097067805","PREGABALIN CAP","50MG","60","Select","Select",""],["","68001033508","LISINOPRIL TAB","20MG","30","Select","Select",""],["","60505257908","ATORVASTATIN TAB","20MG","30","Select","Select",""],["","68462039710","OMEPRAZOLE CAP","40MG","90","Select","Select",""],["","27241009810","DULOXETINE CAP","30MG","30","Select","Select",""],["","29300016910","TIZANIDINE TAB","4MG","20","Select","Select",""],["","69315011710","FUROSEMIDE TAB","40MG","90","Select","Select",""],["","16729018317","HYDROCHLOROT TAB","25MG","90","Select","Select",""],["","00169406013","VICTOZA INJ","18MG\/3ML","9","Select","Select",""],["","45963043864","ENULOSE SOL","10GM\/15","45","Select","Select",""],["","00378034501","DIAZEPAM TAB","5MG","15","Select","Select",""],["","68001025320","FLUCONAZOLE TAB","150MG","1","Select","Select",""],["","68001042300","NITROFURANTN CAP","100MG","14","Select","Select",""],["","00169413212","OZEMPIC INJ","2\/1.5ML","2","Select","Select",""],["","00002318280","TRULICITY INJ","4.5\/0.5","6","Select","Select",""],["","57664037718","TRAMADOL HCL TAB","50MG","8","Select","Select",""],["","70710128501","BACLOFEN TAB","10MG","90","Select","Select",""],["","42858010250","OXYCOD\/APAP TAB","5-325MG","30","Select","Select",""],["","68382005001","MELOXICAM TAB","7.5MG","30","Select","Select",""],["","33342029809","MEMANTINE TAB HCL","10MG","60","Select","Select",""],["","65649040001","PLENVU SOL","","3","Select","Select",""],["","68001028100","DICLOFENAC TAB","75MG DR","60","Select","Select",""],["","30768060693","B-","12 1000 MCG","30","Select","Select",""],["","08484073200","PRODIGY NO CODING","","100","Select","Select",""],["","42571010301","GLIMEPIRIDE","4 MG","90","Select","Select",""],["","68001036500","METRONIDAZOLE","500 MG","14","Select","Select",""],["","62559043130","HYDROCORTISONE","2.5 %","30","Select","Select",""],["","58160082311","SHINGRIX","50 MCG\/0.5","1","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":""}]}]}