{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MICHELLE DEPRIEST","gend":1,"add":"1546 FREDERICKSHALL ROAD","city":"BUMPASS","state":"VA","zip":"23024-9998","dob":"1960-10-26","age":"","mstatus":"","insh":"20026457*01","cliId":"","pno":8044896275,"cno":8044896275,"email":"","ename":"","eno":"","pphy":"BREWER, STEVEN PA","ppno":8048830052,"pcpadd":"16618 MOUNTAIN ROAD STE B,","pcpcity":"MONTPELIER","pcpstate":"VA","pcpzip":"23192-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8048830054,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J44.9","R09.02","Z20.822","F41.9","F34.1","G89.4","M79.7","T14.8XXA","J18.0","K59.00","F31.9","G62.9","R06.00","F17.200","I10.","E78.00","K21.9","E87.6","J98.4","F32.9","M47.816","NO DATA","M54.2","Z96.651","J43.9","J96.11","Z23.","R06.2","M54.31","R10.9","B02.23"],"date":["2023-08-24","2023-04-03","2023-03-06","2023-08-21","2021-04-05","2023-07-31","2023-07-31","2021-05-03","2021-09-20","2021-07-17","2023-05-01","2022-11-14","2023-07-26","2022-12-14","2023-08-21","2022-10-10","2022-10-10","2022-10-10","2021-09-29","2023-05-01","2021-11-15","2023-08-21","2022-06-13","2022-06-13","2022-12-14","2022-12-14","2021-10-04","2023-03-06","2023-01-09","2023-04-03","2023-08-21"],"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":[["","69315011610","FUROSEMIDE","TAB 20MG","60","Select","Select",""],["","00228203196","ALPRAZOLAM","1 MG","45","Select","Select",""],["","60505257908","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","43598081115","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","68001015303","CARVEDILOL","3.125 MG","60","Select","Select",""],["","65862056090","PANTOPRAZOLE","TAB 40MG","60","Select","Select",""],["","00173088710","TRELEGY","AER ELLIPTA","60","Select","Select",""],["","69452015120","VITAMIN D","2 1250 MCG","12","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00173086910","ANORO ELLIPT","AER 62.5-25","60","Select","Select",""],["","68462019005","NAPROXEN","500 MG","60","Select","Select",""],["","41167432007","ALLEGRA-D","TAB 24 HOUR","30","Select","Select",""],["","42571016242","AMOX\/K CLAV","TAB 875-125","10","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","00591352530","LIDOCAINE","5 %","30","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","45","Select","Select",""],["","43386031214","GAVILAX","POW ","510","Select","Select",""],["","80777027315","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","64980047201","METAXALONE","TAB 800MG","90","Select","Select",""],["","43598044870","NICOTINE TD","DIS 21MG\/24H","28","Select","Select",""],["","46122056803","GNP NICOTINE","DIS 21MG\/24H","14","Select","Select",""],["","59746017210","PREDNISONE","5 MG","14","Select","Select",""],["","70436005902","BUPROPION","TAB 150MG SR","180","Select","Select",""],["","27808023302","DOXYCYCL HYC","CAP 100MG","7","Select","Select",""],["","68382005105","MELOXICAM","TAB 15MG","30","Select","Select",""],["","33332042210","AFLURIA QUAD","INJ 2022-23","0","Select","Select",""],["","50111056003","TRAZODONE","TAB 50MG","90","Select","Select",""],["","00173086910","ANORO ELLIPTA","62.5-25MCG","60","Select","Select",""],["","43598081115","CETIRIZINE HCL","10 MG","30","Select","Select",""],["","65862050320","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","10","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","00378827091","ALBUTEROL SULFATE","2.5 MG\/3ML","90","Select","Select",""],["","46122056803","GNP NICOTINE DIS","21MG\/24H","14","Select","Select",""],["","00093317431","ALBUTEROL AER HFA","","8","Select","Select",""],["","68462019005","NAPROXEN TAB","500MG","60","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","00173086910","ANORO ELLIPT AER","62.5-25","60","Select","Select",""],["","00228203196","ALPRAZOLAM TAB","1MG","45","Select","Select",""],["","69315011610","FUROSEMIDE TAB","20MG","60","Select","Select",""],["","68001043697","CETIRIZINE TAB","10MG","30","Select","Select",""],["","65862056090","PANTOPRAZOLE TAB","40MG","60","Select","Select",""],["","41167432007","ALLEGRA-D TAB","24 HOUR","30","Select","Select",""],["","00143980305","DOXYCYCL HYC CAP","100MG","7","Select","Select",""],["","76204020025","ALBUTEROL NEB","0.083%","75","Select","Select",""],["","68382005105","MELOXICAM TAB","15MG","30","Select","Select",""],["","69452015120","VITAMIN D CAP","50000UNT","4","Select","Select",""],["","00591352530","LIDOCAINE PAD","5%","30","Select","Select",""],["","50111056003","TRAZODONE TAB","50MG","30","Select","Select",""],["","33332042210","AFLURIA QUAD INJ","2022-23","0","Select","Select",""],["","59746017310","PREDNISONE TAB","10MG","14","Select","Select",""],["","52817033200","CYCLOBENZAPRINE HCL","10 MG","45","Select","Select",""],["","60505257908","ATORVASTATIN CALCIUM","20 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":""}]}]}