{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARTHA SHOTWELL","gend":1,"add":"3146 DAN RIVER RD","city":"SOUTH BOSTON","state":"VA","zip":"24592-9998","dob":"1960-08-14","age":"","mstatus":"","insh":"20034924*01","cliId":"","pno":4344043292,"cno":4344043292,"email":"","ename":"","eno":"","pphy":"MILLS, AMY C NP","ppno":4344043970,"pcpadd":"1320 SEYMOUR DR","pcpcity":"SOUTH BOSTON","pcpstate":"VA","pcpzip":"24592-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4344043371,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","F10.20","R13.10","R12.","B18.2","F11.21","F41.1","K21.9","K22.2","K44.9","F17.200","Z86.19","E78.2","E66.9","Z68.34","M17.11","J01.00","I10.","J96.01","J18.9","I48.91","J44.9","F10.21","I50.31","I47.1","Q21.10","D69.6","I11.0","NO DATA","I08.3","D64.9","G47.33","Z20.822","K59.00","F17.210","R06.02","R00.0","E78.5","R53.1","R06.00","Z99.81","I34.0","F11.90","B17.10","M41.56","F31.9","M48.00","R13.19","K29.50","I08.0","F31.32","M47.812","M41.9","J30.2","J30.9","K29.70","M25.552","Z96.1","H40.033","H26.493","H52.4","Z01.812","Z01.810","E55.9","Z01.89","K59.04","I36.1","F43.21","R09.02","R09.89","F19.10","D50.9","Z79.899","Z87.891","Z68.30"],"date":["2023-02-10","2021-11-10","2021-02-12","2021-06-02","2023-02-10","2023-05-22","2023-05-22","2023-05-03","2023-01-24","2023-01-24","2023-01-24","2023-01-24","2022-03-19","2023-05-03","2022-05-05","2022-05-05","2022-12-01","2023-01-25","2023-02-10","2022-12-22","2022-12-21","2023-05-03","2021-07-20","2023-02-10","2023-02-10","2023-02-10","2023-02-10","2023-02-10","2022-12-22","2022-12-14","2023-05-03","2023-02-10","2022-12-14","2022-12-14","2022-12-14","2022-12-17","2022-12-15","2022-12-15","2023-01-06","2023-04-03","2023-05-03","2023-01-25","2022-12-22","2022-12-22","2022-12-22","2022-12-22","2022-12-22","2021-02-12","2021-02-12","2023-02-10","2023-02-10","2023-02-10","2023-02-10","2023-02-20","2023-02-20","2021-02-12","2021-07-02","2022-04-05","2022-04-05","2022-04-05","2022-04-05","2023-04-26","2023-04-26","2021-06-02","2023-01-24","2023-01-24","2023-01-25","2022-02-14","2022-12-13","2022-12-13","2022-12-13","2023-05-03","2023-05-03","2023-05-03","2023-05-03"],"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":[["","12496120803","SUBOXONE","8 MG-2 MG","60","Select","Select",""],["","68180032002","BUPROPN HCL","TAB 300MG XL","30","Select","Select",""],["","65862001305","SERTRALINE","TAB 100MG","90","Select","Select",""],["","65862056099","PANTOPRAZOLE","TAB 40MG","60","Select","Select",""],["","47781035703","BUPREN\/NALOX","MIS 8-2MG","60","Select","Select",""],["","61442010310","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","57237010099","METOPROL TAR","TAB 25MG","60","Select","Select",""],["","60432026415","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","68462039710","OMEPRAZOLE","40 MG","30","Select","Select",""],["","70000021306","ALLERGY RELF","TAB 10MG","30","Select","Select",""],["","70377004812","PRAVASTATIN","TAB 80MG","30","Select","Select",""],["","62332005491","CLONIDINE","TAB 0.1MG","60","Select","Select",""],["","51224002206","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","45802065087","LORATADINE","10 MG","30","Select","Select",""],["","11534016003","PHENTERMINE","TAB 37.5MG","30","Select","Select",""],["","00591544310","PREDNISONE","TAB 20MG","20","Select","Select",""],["","63304061650","DOXYCYC MONO","CAP 100MG","7","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","60","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","69315011610","FUROSEMIDE","20 MG","30","Select","Select",""],["","00603155416","POT CHLORIDE","POW 20MEQ","30","Select","Select",""],["","60505132501","MIDODRINE","TAB 10MG","90","Select","Select",""],["","00173085910","BREO ELLIPTA","INH 100-25","60","Select","Select",""],["","00536468010","VITAMIN B-1","TAB 100MG","30","Select","Select",""],["","11534016503","FOLIC ACID","TAB 1MG","30","Select","Select",""],["","66993013597","FLUTIC\/VILAN","INH 100-25","60","Select","Select",""],["","10135013201","THIAMINE HCL","TAB 100MG","30","Select","Select",""],["","61442010310","DICLOFENAC SODIUM","75 MG","60","Select","Select",""],["","70377004812","PRAVASTATIN SODIUM","80 MG","18","Select","Select",""],["","57896048930","POLYETHYLENE GLYCOL","3350 17 G\/DOSE","510","Select","Select",""],["","65862001305","SERTRALINE HCL","100 MG","90","Select","Select",""],["","00591044401","GUANFACINE HCL","1 MG","30","Select","Select",""],["","66993007996","FLUTICASONE PROPIONATE HFA","110 MCG","12","Select","Select",""],["","57237010099","METOPROLOL TARTRATE","25 MG","30","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","57237023301","SULFAMETHOXAZOLE-TRIMETHOPRIM","800-160 MG","20","Select","Select",""],["","31722072610","MONTELUKAST SODIUM","10 MG","20","Select","Select",""],["","00713052612","PROMETHEGAN","25 MG","10","Select","Select",""],["","00173071920","FLOVENT HFA","110 MCG","12","Select","Select",""],["","23155050110","HYDROXYZINE HCL","25 MG","10","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":""}]}]}