{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARYAM S KHAAFID","gend":1,"add":"537 CUB CREEK ROAD","city":"APPOMATTOX","state":"VA","zip":"24588-9998","dob":"1987-12-23","age":"","mstatus":"","insh":"1824704*01","cliId":"","pno":4343190276,"cno":4343190276,"email":"","ename":"","eno":"","pphy":"BEE, ROBERT DO","ppno":4342003908,"pcpadd":"125 NATIONWIDE DR,","pcpcity":"LYNCHBURG","pcpstate":"VA","pcpzip":"24502-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4342001677,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L28.1","L57.8","Z94.9","D22.61","A41.89","Z94.0","Z48.298","Z79.899","I15.1","E78.5","R80.9","N28.89","Z23.","Z86.16","D84.9","A41.9","N10.","U07.1","Z00.00","L98.9","N12.","N17.9","B96.20","I12.9","NO DATA","D50.9","E87.6","Z28.310","Z82.49","Z88.1","Z88.0","R87.612","R87.810","R07.0","R05.9","R09.81","R51.9","Z01.419","Z97.5","Z87.410","N18.4","D22.9","H66.92","J30.2","R80.1","R11.2","N25.81","N05.9","Z20.2"],"date":["2023-02-16","2023-02-16","2023-02-16","2023-02-16","2022-08-08","2023-01-24","2023-01-24","2023-01-24","2023-01-24","2023-01-24","2023-01-24","2023-01-24","2023-01-24","2021-01-21","2022-01-25","2022-08-11","2022-08-11","2022-08-11","2022-10-05","2022-10-05","2022-08-08","2022-08-08","2022-08-08","2023-05-10","2022-08-08","2022-08-08","2022-08-08","2022-08-08","2022-08-08","2022-08-08","2022-08-08","2023-03-06","2023-03-06","2022-01-17","2022-01-17","2022-01-17","2022-01-17","2022-03-30","2022-03-30","2022-03-30","2023-05-10","2023-02-16","2022-08-04","2022-08-04","2022-01-25","2022-08-07","2023-05-10","2023-05-10","2023-07-20"],"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":[["","64980052810","SODIUM BICAR","TAB 650MG","360","Select","Select",""],["","16729026129","MYCOPHENOLIC","TAB 180MG DR","180","Select","Select",""],["","62332002791","LOSARTAN POT","TAB 25MG","45","Select","Select",""],["","00378204601","TACROLIMUS","1 MG","180","Select","Select",""],["","00378064010","PREDNISONE","5 MG","90","Select","Select",""],["","50742062101","NIFEDIPINE","TAB 60MG ER","180","Select","Select",""],["","00093720198","PRAVASTATIN","TAB 20MG","30","Select","Select",""],["","69452020720","CALCITRIOL","0.25 MCG","30","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","30","Select","Select",""],["","67877054360","CEFDINIR","CAP 300MG","26","Select","Select",""],["","62332002791","LOSARTAN POTASSIUM","25 MG","90","Select","Select",""],["","59651029601","NIFEDIPINE ER","60 MG","180","Select","Select",""],["","16729026129","MYCOPHENOLIC ACID","180 MG","180","Select","Select",""],["","00781717250","AZELAIC ACID","15 %","50","Select","Select",""],["","00093720198","PRAVASTATIN SODIUM","20 MG","90","Select","Select",""],["","33342033354","TRIAMCINOLONE ACETONIDE","0.1 %","454","Select","Select",""],["","16729026129","MYCOPHENOLIC TAB","180MG DR","180","Select","Select",""],["","16729004201","TACROLIMUS CAP","1MG","180","Select","Select",""],["","69452020720","CALCITRIOL CAP","0.25MCG","30","Select","Select",""],["","62332002791","LOSARTAN POT TAB","25MG","15","Select","Select",""],["","00093720198","PRAVASTATIN TAB","20MG","30","Select","Select",""],["","00378064010","PREDNISONE TAB","5MG","90","Select","Select",""],["","59651029601","NIFEDIPINE TAB","60MG ER","180","Select","Select",""],["","63304069301","CLINDAMYCIN CAP","300MG","30","Select","Select",""],["","67877054360","CEFDINIR CAP","300MG","26","Select","Select",""],["","00054327099","FLUTICASONE SPR","50MCG","16","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":""}]}]}