{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CYNTHIA  M BREEDEN","gend":1,"add":"149 SPRING CREST LN APT 109","city":"STAUNTON","state":"VA","zip":"24401-9998","dob":"1968-06-16","age":"","mstatus":"","insh":"20024344*01","cliId":"","pno":5402803275,"cno":5402803275,"email":"","ename":"","eno":"","pphy":"KUBLER, AMY E NP-C","ppno":5404148495,"pcpadd":"42 LAMBERT STREET SUITE 121,","pcpcity":"STAUNTON","pcpstate":"VA","pcpzip":"24401-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5403026106,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.10","R11.0","R51.9","R11.2","I10.","R56.9","R10.84","R53.1","R10.31","R10.32","Z51.81","NO DATA","E87.6","R10.9","R19.7","R68.83","F32.9","F41.9","G40.909","Z90.49","Z90.710","Z28.310","Z79.899","Z20.822","Z88.6","Z88.8","Z88.5","Z88.1","E78.5","M54.5","W19.XXXA","F41.1","M25.512","K31.84","M54.2","G89.29","R42.","R26.2","R11.10","R10.11","R69.","R00.0","R10.30","K21.9","G47.00","G40.89","E86.0","R63.4","R63.0","K92.1","K92.0","R07.9","G43.909","Z03.818","K59.00","Z87.442","R10.0","Z13.6","M54.6","N39.0","H53.8","R10.13","Z91.19","R05.9","K58.9","Z87.891","R31.9","R06.02","R25.1","R07.81","M25.572","F32.1","R25.2","N10.","R52.","R50.9","R06.00","R11.15","R55.","R41.0","G62.9","Z13.29","E55.9","K30.","R26.9","R47.81","R07.89","K62.5","I16.0","F17.210","M54.9","S83.91XA","Z79.83","Z83.49","S39.012A","S30.0XXA","S89.91XA","S49.91XA","R73.03","E03.9"],"date":["2021-01-21","2023-03-07","2022-01-21","2023-05-27","2023-05-27","2022-10-01","2022-02-12","2022-12-08","2023-05-27","2022-02-19","2022-07-19","2022-12-08","2022-10-01","2022-10-01","2022-10-01","2022-12-08","2022-12-08","2022-12-08","2022-12-08","2022-12-08","2022-12-08","2022-12-08","2022-12-08","2022-12-08","2022-12-08","2022-12-08","2022-12-08","2022-12-08","2023-02-13","2021-03-02","2021-02-02","2022-03-03","2021-04-10","2021-09-07","2021-04-10","2022-02-19","2021-12-03","2021-12-03","2022-02-14","2021-12-26","2022-11-06","2022-12-08","2022-05-14","2022-07-19","2023-01-05","2022-07-19","2022-11-06","2021-08-03","2021-01-20","2021-01-20","2021-01-20","2022-09-18","2021-11-09","2021-11-29","2022-02-12","2021-12-26","2022-02-19","2022-03-03","2022-09-18","2023-03-07","2021-05-11","2022-09-18","2021-06-29","2022-12-08","2022-01-31","2022-06-07","2022-02-26","2022-09-18","2021-01-05","2021-12-30","2021-06-29","2021-08-03","2021-08-03","2021-12-03","2021-12-07","2022-12-08","2021-12-30","2022-04-22","2022-05-14","2022-05-14","2022-07-19","2023-02-13","2023-02-13","2021-03-30","2022-11-06","2021-05-06","2021-05-31","2021-08-07","2021-06-26","2021-06-26","2021-08-07","2022-02-19","2022-06-07","2022-03-18","2022-06-07","2022-06-07","2022-06-07","2022-06-07","2022-06-07","2022-06-07"],"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":[["","55111018015","TIZANIDINE","TAB 4MG","30","Select","Select",""],["","68382080601","TRAZODONE","TAB 100MG","30","Select","Select",""],["","55111015330","ONDANSETRON","TAB 4MG","60","Select","Select",""],["","68180044901","QUETIAPINE","TAB 300MG","21","Select","Select",""],["","29300013601","CLONIDINE","TAB 0.2MG","90","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","180","Select","Select",""],["","45802075830","PROMETHAZINE","SUP 12.5MG","1","Select","Select",""],["","00527058601","DICYCLOMINE","CAP 10MG","14","Select","Select",""],["","10135068308","POLYETH GLYC","POW 3350 NF","238","Select","Select",""],["","16714066302","GABAPENTIN","400 MG","90","Select","Select",""],["","00093321205","CLONAZEPAM","1 MG","180","Select","Select",""],["","00597007547","SPIRIVA","CAP HANDIHLR","90","Select","Select",""],["","00093598627","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","00093505698","ATORVASTATIN","TAB 10MG","90","Select","Select",""],["","59746011506","PROCHLORPER","TAB 10MG","30","Select","Select",""],["","68382080601","TRAZODONE HCL","100 MG","30","Select","Select",""],["","57237007530","ONDANSETRON HCL","4 MG","60","Select","Select",""],["","68382004101","PROMETHAZINE HCL","25 MG","90","Select","Select",""],["","68180045001","QUETIAPINE FUMARATE","400 MG","90","Select","Select",""],["","55111018015","TIZANIDINE HCL","4 MG","90","Select","Select",""],["","42806054701","VITAMIN D","2 1250 MCG","4","Select","Select",""],["","29300013601","CLONIDINE HCL","0.2 MG","90","Select","Select",""],["","70377002811","ATORVASTATIN CALCIUM","20 MG","90","Select","Select",""],["","31722071390","PANTOPRAZOLE SODIUM","40 MG","180","Select","Select",""],["","65862007701","CIPROFLOXACIN HCL","500 MG","14","Select","Select",""],["","00574722612","COMPRO","25 MG","30","Select","Select",""],["","68462015713","ONDANSETRON ODT","4 MG","15","Select","Select",""],["","29300013601","CLONIDINE TAB","0.2MG","90","Select","Select",""],["","31722071390","PANTOPRAZOLE TAB","40MG","180","Select","Select",""],["","55111018015","TIZANIDINE TAB","4MG","30","Select","Select",""],["","68180044901","QUETIAPINE TAB","300MG","21","Select","Select",""],["","68382080601","TRAZODONE TAB","100MG","30","Select","Select",""],["","55111015330","ONDANSETRON TAB","4MG","60","Select","Select",""],["","45802075830","PROMETHAZINE SUP","12.5MG","5","Select","Select",""],["","00527058601","DICYCLOMINE CAP","10MG","14","Select","Select",""],["","68382004101","PROMETHAZINE TAB","25MG","90","Select","Select",""],["","00591350904","CLONIDINE DIS","0.2\/24HR","4","Select","Select",""],["","10135068308","POLYETH GLYC POW","3350 NF","238","Select","Select",""],["","16729013800","CLONAZEPAM TAB","2MG","90","Select","Select",""],["","50228018105","GABAPENTIN CAP","400MG","30","Select","Select",""],["","00597007541","SPIRIVA CAP HANDIHLR","","30","Select","Select",""],["","00093598627","EPINEPHRINE INJ","0.3MG","2","Select","Select",""],["","59746011506","PROCHLORPER TAB","10MG","30","Select","Select",""],["","00093505698","ATORVASTATIN TAB","10MG","90","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":""}]}]}