{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRUCE WALTERS","gend":0,"add":"233 VIRGINIA AVE","city":"TIMBERVILLE","state":"VA","zip":"22853-9998","dob":"1959-07-16","age":"","mstatus":"","insh":"20036878*01","cliId":"","pno":5402177636,"cno":5402177636,"email":"","ename":"","eno":"","pphy":"EHTESHAM, SHAHAB M MD","ppno":5405645666,"pcpadd":"1790 64B EAST MARKET ST,","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":8445017984,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G72.81","J44.9","G93.40","I51.7","I48.91","I50.9","G25.81","I50.33","I96.","F41.8","U07.1","R06.02","N30.00","R42.","Z11.59","Z20.822","R11.11","R53.1","K40.90","Z86.73","Z88.0","Z88.6","Z88.1","Z88.8","Z91.041","Z79.899","F17.210","R11.2","I11.0","F41.9","K21.9","Z87.891","R07.89","I69.398","R10.31","I49.9","R52.","R06.9","Z86.79","E78.2","I10.","F33.1","Z72.0","R74.8","H91.93","R11.0","F33.9","R73.9","Z12.11","Z12.5"],"date":["2021-01-07","2023-01-31","2021-01-07","2021-02-13","2023-08-30","2022-04-20","2023-08-30","2021-06-12","2021-01-11","2021-01-11","2021-02-27","2021-06-11","2022-04-20","2022-12-05","2021-01-08","2021-01-08","2022-04-20","2022-04-20","2023-01-31","2023-08-30","2023-01-31","2023-01-31","2023-01-31","2023-01-31","2023-01-31","2023-01-31","2023-01-31","2023-01-31","2022-04-20","2022-04-20","2022-04-20","2022-04-20","2021-04-08","2022-12-05","2023-01-31","2021-06-11","2021-06-11","2021-06-11","2023-02-21","2023-08-30","2023-02-21","2023-02-21","2023-02-21","2023-02-21","2023-02-21","2023-01-31","2023-08-30","2023-08-30","2023-08-30","2023-08-30"],"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":[["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","57896010210","ACETAMINOPHE","TAB 325MG","60","Select","Select",""],["","55111046701","METOPROL SUC","TAB 50MG ER","90","Select","Select",""],["","00536333401","VITAMIN D","TAB 1000UNIT","18","Select","Select",""],["","87701040749","GNP VIT D","TAB 1000UNIT","28","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","68382009705","PAROXETINE","TAB 10MG","90","Select","Select",""],["","00536124801","STIMULANT","TAB 8.6-50MG","30","Select","Select",""],["","24385047847","ANTACID","CHW 500MG","27","Select","Select",""],["","00904641292","CALC ANTACID","CHW 500MG","150","Select","Select",""],["","65862055990","PANTOPRAZOLE","TAB 20MG","30","Select","Select",""],["","80681016900","VITAMIN D3","TAB 25MCG","28","Select","Select",""],["","68462025301","ROPINIROLE","TAB 0.25MG","30","Select","Select",""],["","45963067611","METOPROLOL","TAB 50MG ER","30","Select","Select",""],["","65862053750","LEVOFLOXACIN","TAB 500MG","5","Select","Select",""],["","55111046701","METOPROLOL SUCCINATE","50 MG","90","Select","Select",""],["","68382009705","PAROXETINE HCL","10 MG","30","Select","Select",""],["","00378668877","PANTOPRAZOLE SODIUM","20 MG","90","Select","Select",""],["","43598044674","NICOTINE PATCH","7MG\/24HR","28","Select","Select",""],["","00378395305","ATORVASTATIN CALCIUM","80 MG","90","Select","Select",""],["","68462015713","ONDANSETRON ODT","4 MG","9","Select","Select",""],["","00406012305","HYDROCODONE-ACETAMINOPHEN","5 MG-325MG","12","Select","Select",""],["","68462025401","ROPINIROLE HCL","0.5 MG","30","Select","Select",""],["","68382009705","PAROXETINE TAB","10MG","90","Select","Select",""],["","55111046701","METOPROL SUC TAB","50MG ER","90","Select","Select",""],["","68462025301","ROPINIROLE TAB","0.25MG","90","Select","Select",""],["","65862055990","PANTOPRAZOLE TAB","20MG","90","Select","Select",""],["","65862053750","LEVOFLOXACIN TAB","500MG","5","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":""}]}]}