{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KIMBERLY COBBS","gend":1,"add":"10 KIOWA LN","city":"PALMYRA","state":"VA","zip":"22963-9998","dob":"1981-07-15","age":"","mstatus":"","insh":"1771377*01","cliId":"","pno":4349609502,"cno":4349609502,"email":"","ename":"","eno":"","pphy":"VONELTEN, CHRISTOPHER B MD","ppno":4344009668,"pcpadd":"631 BERKMAR CIRCLE","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":"22901-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4343814367,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","F41.1","F33.1","F10.10","Z86.19","F43.12","G89.29","G47.01","F17.200","Z72.0","J01.41","H10.32","T84.59XA","T84.098A","M79.671","L08.9","M20.11","Z20.828","E83.110","D69.6","E53.8","NO DATA","F12.10","J06.9","S91.341A","L02.611","F12.90","Z98.890","F33.0"],"date":["2023-05-08","2023-05-08","2023-05-08","2021-09-14","2022-08-09","2023-05-08","2023-05-08","2023-04-24","2023-05-08","2022-11-04","2022-03-10","2022-03-10","2022-12-01","2022-12-01","2022-12-01","2022-09-27","2022-08-16","2021-01-27","2022-05-02","2022-05-02","2022-05-02","2022-11-04","2022-11-04","2021-01-06","2022-05-26","2022-05-26","2023-03-13","2022-08-02","2022-11-14"],"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":[["","12496120803","SUBOXONE","8 MG-2 MG","28","Select","Select",""],["","43598058230","BUPREN\/NALOX","MIS 8-2MG","28","Select","Select",""],["","00527328943","LEVOTHYROXIN","TAB 175MCG","90","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","68001039900","FLUOXETINE","CAP 10MG","30","Select","Select",""],["","42571025201","CLINDAMYCIN","CAP 300MG","30","Select","Select",""],["","29300024501","BUSPIRONE","TAB 10MG","90","Select","Select",""],["","13107003105","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","68001036103","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","65862064163","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","59746017310","PREDNISONE","TAB 10MG","21","Select","Select",""],["","65862016899","ATENOLOL","TAB 25MG","7","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","28","Select","Select",""],["","43598000614","AUGMENTIN","TAB 500MG","14","Select","Select",""],["","61314062810","POLYMYXIN B\/","SOL TRIMETHP","10","Select","Select",""],["","35046000393","MELATONIN","TAB 5MG","30","Select","Select",""],["","10006073043","VITAMIN B-12","TAB 1000MCG","30","Select","Select",""],["","49884094499","VARENICLINE","PAK 0.5X1MG","53","Select","Select",""],["","65862007705","CIPROFLOXACN","TAB 500MG","20","Select","Select",""],["","43598044874","NICOTINE TD","DIS 21MG\/24H","14","Select","Select",""],["","68001023703","CLONIDINE","TAB 0.1MG","30","Select","Select",""],["","68001051903","BUPROPION XL","150 MG","30","Select","Select",""],["","43598058230","BUPRENORPHINE-NALOXONE","8 MG-2 MG","28","Select","Select",""],["","10006073043","VITAMIN B-","12 1000 MCG","30","Select","Select",""],["","55111052130","ATOMOXETINE HCL","40 MG","30","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":""}]}]}