{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHRISTOPHER TUCKER","gend":0,"add":"202 CORNWALLIS DR APT A","city":"LYNCHBURG","state":"VA","zip":"24502-9998","dob":"1974-04-12","age":"","mstatus":"","insh":"20036432*01","cliId":"","pno":4349279820,"cno":4349279820,"email":"","ename":"","eno":"","pphy":"REDIESKE, CRYSTON MICHELLE NP","ppno":5409672011,"pcpadd":"575 INDUSTRIAL DR","pcpcity":"LOUISA","pcpstate":"VA","pcpzip":"23093-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5409672982,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R33.9","G82.50","R32.","R39.81","R15.9","L22.","N39.0","N31.9","G82.20","G82.53","G89.0","K59.2","M21.941","M21.942","R53.1","S14.155S","S51.002A","R19.7","R10.9","R39.9","G90.4","Z91.81","R82.90","S14.109A","G95.9","M62.81","M50.00","S14.109S","L89.95"],"date":["2023-03-28","2023-03-29","2022-11-28","2023-03-29","2023-03-29","2023-03-29","2021-11-18","2022-11-29","2022-09-27","2023-01-10","2023-01-04","2023-03-29","2023-01-10","2023-01-10","2023-01-10","2023-01-10","2021-03-19","2022-01-27","2022-01-27","2021-02-17","2022-12-19","2021-05-11","2021-08-24","2023-02-17","2023-02-17","2023-02-17","2023-02-17","2023-02-17","2022-12-19"],"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":[["","65862041901","SMZ-TMP","TAB 400-80MG","90","Select","Select",""],["","27241019230","TOLTERODINE","CAP 4MG ER","90","Select","Select",""],["","45963055650","GABAPENTIN","300 MG","18","Select","Select",""],["","50111056103","TRAZODONE","TAB 100MG","90","Select","Select",""],["","00093031101","LOPERAMIDE","CAP 2MG","24","Select","Select",""],["","68180042308","CEFIXIME","CAP 400MG","14","Select","Select",""],["","80681016900","VITAMIN D3","TAB 25MCG","30","Select","Select",""],["","59746038506","TERAZOSIN","CAP 5MG","90","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","28","Select","Select",""],["","67877054360","CEFDINIR","CAP 300MG","28","Select","Select",""],["","51862048601","TRIMETHOPRIM","TAB 100MG","30","Select","Select",""],["","01490003978","PEPTO-BISMOL","262 MG","21","Select","Select",""],["","00904131546","BISMATROL","262 MG","21","Select","Select",""],["","27241019230","TOLTERODINE TARTRATE ER","4 MG","30","Select","Select",""],["","80681016900","VITAMIN D","3 25 MCG","90","Select","Select",""],["","17433987603","ENEMEEZ","283 MG\/5ML","225","Select","Select",""],["","59746038506","TERAZOSIN HCL","5 MG","90","Select","Select",""],["","65862041901","SULFAMETHOXAZOLE-TRIMETHOPRIM","400MG-80MG","30","Select","Select",""],["","60505265401","TRAZODONE HCL","100 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":""}]}]}