{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TERESA LAM","gend":1,"add":"PO BOX 355","city":"ELKTON","state":"VA","zip":"22827-9998","dob":"1980-11-27","age":"","mstatus":"","insh":"1908219*01","cliId":"","pno":5408105981,"cno":5408105981,"email":"","ename":"","eno":"","pphy":"STRUNK, ARTHUR F FNP","ppno":5402981200,"pcpadd":"13737 SPOTSWOOD TRL","pcpcity":"ELKTON","pcpstate":"VA","pcpzip":"22827-9998","pcpcounty":"","pcpid":"","pcpname":"SRMHMG - Sentara East Rockingham Health Center","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7575798587,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01.818","E11.65","M06.00","M89.49","M79.7","E55.9","R63.5","Z51.81","R69.","K80.20","E78.2","I10.","E11.9","M06.89","K76.0","Z86.14","Z98.891","Z79.4","R09.02","G45.9","J06.9","R07.9","G44.209","R42.","R09.81","Z88.6","Z88.5","Z88.0","E78.00","E78.5","M06.9","Z86.73","R06.02","R10.11","K21.9","F32.5","M25.521"],"date":["2022-06-07","2022-06-07","2022-03-28","2021-06-02","2021-06-02","2021-06-02","2021-06-02","2021-06-02","2021-09-06","2022-06-07","2022-04-28","2022-04-28","2022-04-28","2022-04-28","2022-04-28","2022-04-28","2022-04-28","2022-04-28","2021-10-18","2021-10-18","2021-09-07","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2022-03-28","2022-03-28","2022-03-28","2022-03-28"],"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":[["","00088221905","LANTUS SOLOS","INJ 100\/ML","30","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","15","Select","Select",""],["","00597015330","JARDIANCE","25 MG","30","Select","Select",""],["","16729044315","BUPROPN HCL","TAB 150MG XL","90","Select","Select",""],["","69097084905","ESCITALOPRAM","TAB 20MG","30","Select","Select",""],["","43547035611","LISINOPRIL","40 MG","90","Select","Select",""],["","00955172805","INSULIN GLARGINE SOLOSTAR","100\/ML (3)","15","Select","Select",""],["","69097084905","ESCITALOPRAM OXALATE","20 MG","90","Select","Select",""],["","00002822259","INSULIN LISPRO KWIKPEN U-","100 100\/ML","15","Select","Select",""],["","68462015713","ONDANSETRON ODT","4 MG","20","Select","Select",""],["","16729044315","BUPROPION XL","150 MG","90","Select","Select",""],["","00169418113","OZEMPIC .","25 OR 0.5","3","Select","Select",""],["","08290320119","ULTRA-FINE MINI PEN NEEDLE","31 GX3\/16\"","500","Select","Select",""],["","00406012305","HYDROCODONE-ACETAMINOPHEN","5 MG-325MG","21","Select","Select",""],["","00378395205","ATORVASTATIN CALCIUM","40 MG","90","Select","Select",""],["","65862056090","PANTOPRAZOLE SODIUM","40 MG","90","Select","Select",""],["","45802006435","TRIAMCINOLONE ACETONIDE","0.1 %","15","Select","Select",""],["","27808023302","DOXYCYCLINE HYCLATE","100 MG","20","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":""}]}]}