{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"VIVIANA FERNANDEZ","gend":1,"add":"255 VINE ST APT 103","city":"HARRISONBURG","state":"VA","zip":"22802-9998","dob":"1959-12-02","age":"","mstatus":"","insh":"20027234*01","cliId":"","pno":5408366148,"cno":5408366148,"email":"","ename":"","eno":"","pphy":"KOLLMAN, MELISSA K PA","ppno":5405645666,"pcpadd":"1790 E MARKET ST STE 64B,","pcpcity":"HARRISONBURG","pcpstate":"VA","pcpzip":"22801-9998","pcpcounty":"","pcpid":"","pcpname":"SRMHMG - Sentara East Market Street Health Center","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7575798594,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","Z79.4","Z96.1","Z98.41","I73.9","I25.10","E11.42","Z79.899","M79.671","B35.1","G57.61","Q66.71","Q66.72","Z08.","Z85.3","Z92.3","NO DATA","F41.8","D35.02","E04.1","N64.4","Z12.31","K21.9","F41.1","J43.9","I10.","I25.118","R26.2","Z78.9","R09.89","Z11.4","Z11.59","Z23.","H60.391","Z86.73","E78.5","J45.998","I25.2","Z95.5","M25.571","F32.9","E11.65","E78.2","H60.21","Z80.0","R91.1"],"date":["2023-08-24","2023-08-24","2023-08-24","2023-08-24","2023-07-14","2023-07-14","2023-06-20","2021-07-13","2021-09-13","2021-09-13","2021-09-13","2021-09-13","2021-09-13","2021-09-21","2023-06-20","2021-09-21","2022-06-06","2022-07-14","2022-08-29","2022-08-29","2023-06-20","2023-02-13","2023-02-13","2023-02-13","2023-02-13","2023-02-13","2023-02-13","2023-02-13","2023-02-13","2021-08-12","2023-06-20","2023-06-20","2021-10-20","2021-04-19","2021-10-20","2021-10-20","2021-10-20","2021-10-20","2021-04-19","2021-06-01","2021-10-20","2022-04-25","2022-04-25","2021-03-03","2021-09-21","2022-06-06"],"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":[["","53885000810","ONETOUCH DEL","MIS PLUS 33G","100","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00173069700","ADVAIR DISKU","AER 500\/50","60","Select","Select",""],["","59762330403","NITROGLYCERN","SUB 0.4MG","100","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","6","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","3","Select","Select",""],["","00781540292","ROSUVASTATIN","TAB 20MG","30","Select","Select",""],["","00006027731","JANUVIA","TAB 100MG","30","Select","Select",""],["","53885027150","ONETOUCH","TES VERIO","150","Select","Select",""],["","45963067711","METOPROL SUC","TAB 100MG ER","30","Select","Select",""],["","67877022301","GABAPENTIN","300 MG","180","Select","Select",""],["","68462039710","OMEPRAZOLE","40 MG","30","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","51660052653","ALLERGY RELF","TAB 10MG","30","Select","Select",""],["","08290320122","BD PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","43547028110","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","00002879959","HUMALOG KWIK","INJ 100\/ML","3","Select","Select",""],["","00002771559","BASAGLAR","INJ 100UNIT","3","Select","Select",""],["","66993058697","FLUTIC\/SALME","AER 500\/50","60","Select","Select",""],["","00904685260","LORATADINE","10 MG","30","Select","Select",""],["","96295013572","MELATONIN","5 MG","60","Select","Select",""],["","00002143380","TRULICITY","0.75MG\/0.5","2","Select","Select",""],["","08627007801","DEXCOM G","7 RECEIVER","1","Select","Select",""],["","53885027150","ONETOUCH VERIO TEST STRIP","","150","Select","Select",""],["","68180096301","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","08290320122","ULTRA-FINE NANO PEN NEEDLE","32GX 5\/32\"","100","Select","Select",""],["","00173069700","ADVAIR DISKUS","500-50 MCG","60","Select","Select",""],["","53885000810","ONETOUCH DELICA PLUS LANCET","33 GAUGE","100","Select","Select",""],["","27808015701","ROSUVASTATIN CALCIUM","20 MG","30","Select","Select",""],["","43547028110","ESCITALOPRAM OXALATE","10 MG","30","Select","Select",""],["","55111046801","METOPROLOL SUCCINATE","100 MG","30","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","100\/ML (3)","3","Select","Select",""],["","00169633910","NOVOLOG FLEXPEN","100\/ML (3)","6","Select","Select",""],["","57237004330","VALACYCLOVIR","1000 MG","21","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":""}]}]}