{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JENNIFER MAY","gend":1,"add":"3215 MAYFLOWER DR","city":"LYNCHBURG","state":"VA","zip":"24501-9998","dob":"1979-12-26","age":"","mstatus":"","insh":"20026705*01","cliId":"","pno":4349072470,"cno":4349072470,"email":"","ename":"","eno":"","pphy":"UPSHAW, SELESTE NP","ppno":4349475967,"pcpadd":"320 FEDERAL ST,","pcpcity":"LYNCHBURG","pcpstate":"VA","pcpzip":"24504-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4349475971,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F25.0","S93.602A","R07.89","R07.9","F33.0","F41.9","F15.10","K21.9","F17.210","Z88.0","W19.XXXA","R87.615","Z86.19","Z12.4","N91.2","Z11.3","M79.672","R07.2","F31.9","NO DATA","G47.33","K70.30","G62.1","F31.32","Z00.01","G25.81","S92.911A","S01.01XA","W18.30XA"],"date":["2022-07-27","2022-08-06","2021-08-11","2021-08-11","2023-05-10","2021-08-11","2021-08-11","2023-04-23","2023-04-23","2021-08-11","2022-05-31","2022-09-27","2022-09-27","2022-04-11","2022-04-11","2022-04-11","2022-08-06","2023-04-23","2023-05-17","2023-05-17","2023-04-23","2023-04-23","2023-04-23","2023-09-13","2023-05-17","2023-05-17","2023-08-03","2023-08-03","2023-08-03"],"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":[["","69097014260","ALBUTEROL","AER HFA","7","Select","Select",""],["","59651000305","OMEPRAZOLE","40 MG","30","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","4","Select","Select",""],["","00085113204","PROVENTIL","AER HFA","7","Select","Select",""],["","16729008110","NALTREXONE","TAB 50MG","90","Select","Select",""],["","57237000805","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","43547027010","ROPINIROLE","TAB 1MG","30","Select","Select",""],["","57896048930","POLYETH GLYC","POW 3350 NF","1020","Select","Select",""],["","00093005805","TRAMADOL HCL","TAB 50MG","10","Select","Select",""],["","68180061307","QUETIAPINE","TAB 150MG ER","30","Select","Select",""],["","61874013030","VRAYLAR","CAP 3MG","30","Select","Select",""],["","50111056002","TRAZODONE","TAB 50MG","30","Select","Select",""],["","00115180301","HYDROXYZ PAM","CAP 25MG","60","Select","Select",""],["","43386031214","GAVILAX","POW ","1020","Select","Select",""],["","72060014240","CAPLYTA","42 MG","7","Select","Select",""],["","43547027010","ROPINIROLE HCL","1 MG","90","Select","Select",""],["","50111056001","TRAZODONE HCL","50 MG","30","Select","Select",""],["","69097014260","ALBUTEROL AER HFA","","7","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","00085113204","PROVENTIL AER HFA","","7","Select","Select",""],["","00093005805","TRAMADOL HCL TAB","50MG","10","Select","Select",""],["","43547027010","ROPINIROLE TAB","1MG","30","Select","Select",""],["","50111033401","METRONIDAZOL TAB","500MG","4","Select","Select",""],["","68382050010","OMEPRAZOLE CAP","40MG","30","Select","Select",""],["","16729008110","NALTREXONE TAB","50MG","90","Select","Select",""],["","57237000805","MIRTAZAPINE TAB","15MG","30","Select","Select",""],["","57896048930","POLYETH GLYC POW","3350 NF","1020","Select","Select",""],["","00115180301","HYDROXYZ PAM CAP","25MG","60","Select","Select",""],["","61874011530","VRAYLAR CAP","1.5MG","7","Select","Select",""],["","50111056002","TRAZODONE TAB","50MG","30","Select","Select",""],["","68180061307","QUETIAPINE TAB","150MG ER","30","Select","Select",""],["","43386031214","GAVILAX POW","","1020","Select","Select",""],["","75834002012","VITAMIN D","3 1250 MCG","4","Select","Select",""],["","68180067006","LURASIDONE HCL","20 MG","30","Select","Select",""],["","68180012202","CEPHALEXIN","500 MG","28","Select","Select",""],["","10702001801","OXYCODONE HCL","5 MG","7","Select","Select",""],["","51991029201","OXCARBAZEPINE","150 MG","60","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":""}]}]}