{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LESLIE HAMILTON","gend":1,"add":"2071 N WHISPERING SPRINGS RD APT 417","city":"HARRISONBURG","state":"VA","zip":"22801-9998","dob":"1986-05-03","age":"","mstatus":"","insh":"20031593*01","cliId":"","pno":5402829199,"cno":5402829199,"email":"","ename":"","eno":"","pphy":"QUINN, STACY W DO","ppno":5405647300,"pcpadd":"1661 SOUTH MAIN STREET","pcpcity":"HARRISONBURG","pcpstate":"VA","pcpzip":"22801-9998","pcpcounty":"","pcpid":"","pcpname":"SRMHMG - Sentara South Main Health Center","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7574317100,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.2","N93.8","N80.9","E22.2","D25.9","G89.18","R10.30","E28.2","E03.9","N30.00","R13.10","K31.84","K59.00","R06.02","Z86.39","R10.13","R11.2","J45.909","E11.9","E78.5","K21.9","G43.909","Z88.0","Z88.5","Z88.8","Z88.2","Z79.890","Z79.51","Z79.899","Z79.84","L30.9","F41.9","M25.511","R10.9","Z87.42","Z20.822","N93.9","N39.0","E11.43","F31.9","K58.9","Z90.49","Z87.891","Z79.1","G89.29","G47.33","R10.33","D50.9","E66.01","Z68.41","J01.90","G43.109","G40.802","E55.9","R10.84","J45.20","E11.69","D64.9","NO DATA","Z28.21","E66.9","R10.31","J45.30","R53.82","R40.0","G47.00","R06.89","R51.9","Z01.818","R06.83","K43.2","Z01.812","K42.9","R10.32","R30.0","E11.42","J45.40","R22.41","E61.1","J31.0","M25.512","N92.1","N76.0","B96.89","F31.32","M47.816","M75.41","M75.21","Z09.","F31.76","I10.","J30.1","R31.9","H66.92","H10.33","J03.90","S93.402A","J02.9","K14.8","F31.70","Z01.419"],"date":["2022-03-24","2021-03-24","2021-03-24","2021-03-24","2021-03-24","2021-04-02","2021-11-18","2022-12-27","2022-12-27","2021-04-13","2021-06-17","2022-12-27","2021-12-10","2021-04-22","2021-11-09","2021-11-18","2021-11-18","2022-12-27","2021-11-18","2022-12-27","2022-12-27","2022-12-27","2022-03-23","2022-03-23","2022-03-23","2022-03-23","2022-12-27","2021-11-18","2022-12-27","2021-11-18","2022-01-27","2022-03-23","2022-05-12","2022-03-24","2022-03-24","2022-12-03","2022-12-27","2022-12-27","2022-12-27","2022-12-27","2022-12-27","2022-12-27","2022-12-27","2022-12-27","2022-08-29","2023-03-27","2021-11-11","2022-05-12","2022-05-12","2021-12-17","2023-01-27","2022-10-24","2022-10-24","2022-10-24","2021-07-07","2021-10-11","2022-05-12","2021-10-11","2021-10-11","2021-10-11","2021-11-09","2022-03-23","2021-01-27","2021-02-03","2021-02-03","2021-02-03","2021-02-03","2021-02-03","2021-03-19","2021-02-03","2021-06-08","2021-06-08","2021-07-02","2021-10-13","2021-10-13","2022-08-29","2022-08-29","2022-08-29","2022-08-29","2022-08-29","2022-08-29","2021-02-05","2021-04-02","2021-04-02","2021-07-28","2021-07-28","2022-05-18","2022-05-18","2021-05-05","2022-05-12","2022-05-12","2022-05-12","2022-12-27","2023-01-19","2023-01-19","2021-09-13","2021-09-13","2021-09-15","2021-09-15","2021-09-15","2023-05-04"],"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":[["","00378180310","LEVOTHYROXIN","TAB 50MCG","90","Select","Select",""],["","50742026001","NIFEDIPINE","TAB 30MG ER","90","Select","Select",""],["","67877056110","METFORMIN","TAB 500MG","60","Select","Select",""],["","10702025350","BUT\/APAP\/CAF","TAB ","10","Select","Select",""],["","70377002911","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","60","Select","Select",""],["","42571038519","TRIAMCINOLON","LOT 0.001","60","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","10","Select","Select",""],["","00093342210","CYCLOBENZAPR","TAB 10MG","60","Select","Select",""],["","65862060012","RIZATRIPTAN","TAB 10MG","12","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","72618300002","NURTEC","TAB 75MG ODT","8","Select","Select",""],["","53746051101","SPIRONOLACT","TAB 25MG","90","Select","Select",""],["","69584009350","BUSPIRONE","TAB 15MG","90","Select","Select",""],["","00378668910","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","00023649810","UBRELVY","TAB 50MG","10","Select","Select",""],["","51759020410","AJOVY","INJ 225\/1.5","2","Select","Select",""],["","69452015120","VITAMIN D","2 1250 MCG","4","Select","Select",""],["","00173071920","FLOVENT HFA","AER 110MCG","12","Select","Select",""],["","69097012403","TOPIRAMATE","100 MG","270","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","00603188016","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","67877054360","CEFDINIR","300 MG","20","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","200","Select","Select",""],["","00472173803","MICONAZOLE 3","SUP 200MG","6","Select","Select",""],["","65162052110","PROMETHAZINE","TAB 25MG","30","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","69097015907","MELOXICAM","TAB 15MG","30","Select","Select",""],["","66993007996","FLUTICAS HFA","AER 110MCG","12","Select","Select",""],["","59651021430","AZELASTINE","SPR 0.001","30","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","20","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","00472173803","MICONAZOLE","3 200 MG","6","Select","Select",""],["","70377002911","ATORVASTATIN CALCIUM","40 MG","90","Select","Select",""],["","53746052101","PROMETHAZINE HCL","25 MG","30","Select","Select",""],["","53746051101","SPIRONOLACTONE","25 MG","90","Select","Select",""],["","00378180310","LEVOTHYROXINE SODIUM","50 MCG","90","Select","Select",""],["","82607066026","FLOWFLEX COVID-","19 AG HOME TEST","8","Select","Select",""],["","68462010530","ONDANSETRON HCL","4 MG","60","Select","Select",""],["","50742026001","NIFEDIPINE ER","30 MG","60","Select","Select",""],["","53489011905","DOXYCYCLINE HYCLATE","100 MG","20","Select","Select",""],["","69315030805","CIPROFLOXACIN HCL","0.3 %","5","Select","Select",""],["","56362000589","IHEALTH COVID-","19 AG HOME TEST","8","Select","Select",""],["","65862057490","MONTELUKAST SODIUM","10 MG","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":""}]}]}