{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LEROY WASHINGTON","gend":0,"add":"829 MALLSIDE FOREST CT APT 228","city":"CHARLOTTESVILLE","state":"VA","zip":"22901-9998","dob":"1960-12-18","age":"","mstatus":"","insh":"20036980*01","cliId":"","pno":5403956114,"cno":5403956114,"email":"","ename":"","eno":"","pphy":"MEMARI, MILAD MD","ppno":4349241931,"pcpadd":"1222 JEFFERSON PARK AVE,","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":"22903-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4342444451,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I50.22","I10.","Z86.79","F14.11","F32.9","F19.11","Z86.59","K21.9","B18.2","Z87.898","R53.82","I49.3","F33.9","F19.94","F10.21","N52.9","F15.24","F12.21","NO DATA","F14.20","F10.10","F12.20","F43.23","F43.21","Z63.4","F15.20","R05.9","R56.9","F10.20","G40.009","M25.512","I50.20","G40.019","F32.89","F14.10","G40.909","J30.9","Z12.11","Z23.","R05.","I34.0","I47.1","I34.1","Z98.890","I77.810","Z86.19","I51.9","I42.8","R00.2","F20.9","R07.89","I49.1","D22.9","F33.2","I48.0","F15.21","Z91.199","Z87.74","I42.9","M79.605","M79.604","M79.606","F41.9","F11.21","G40.109"],"date":["2021-07-09","2023-05-23","2023-05-23","2021-07-09","2021-07-09","2021-07-09","2021-07-09","2022-04-29","2021-07-09","2023-05-23","2021-07-09","2021-07-09","2022-11-15","2023-08-14","2023-09-01","2022-11-15","2022-11-15","2022-11-15","2023-05-30","2022-11-15","2022-11-15","2023-05-30","2022-11-15","2023-09-01","2022-11-15","2022-11-15","2022-11-15","2022-12-16","2023-05-30","2022-06-03","2022-10-28","2022-10-28","2022-12-16","2022-12-16","2021-10-26","2021-10-26","2021-03-17","2022-04-11","2022-10-28","2021-08-20","2022-04-29","2023-05-23","2022-04-29","2023-05-23","2022-04-29","2022-04-29","2023-05-23","2022-04-29","2022-04-29","2021-01-08","2023-05-23","2021-01-08","2021-09-09","2021-10-26","2022-04-11","2023-05-30","2023-05-23","2023-05-23","2023-05-23","2023-06-13","2023-06-13","2023-06-13","2023-06-13","2023-05-30","2023-07-31"],"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":[["","00131247835","VIMPAT","100 MG","60","Select","Select",""],["","68382013905","TOPIRAMATE","TAB 50MG","540","Select","Select",""],["","70000017803","ASPIRIN","TAB 81MG EC","90","Select","Select",""],["","47335032688","NALTREXONE","TAB 50MG","60","Select","Select",""],["","80681014800","MELATONIN","TAB 3MG","60","Select","Select",""],["","65862052890","VENLAFAXINE","CAP 75MG ER","60","Select","Select",""],["","70000011001","ALLERGY RELF","SPR 50MCG","16","Select","Select",""],["","55111015810","OMEPRAZOLE","20 MG","30","Select","Select",""],["","59762003501","SILDENAFIL","TAB 50MG","20","Select","Select",""],["","16571040110","CETIRIZINE","TAB 5MG","90","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","68382009205","CARVEDILOL","3.125 MG","60","Select","Select",""],["","00904675180","ASPIRIN LOW","TAB 81MG EC","30","Select","Select",""],["","67877073560","LACOSAMIDE","150 MG","30","Select","Select",""],["","10572010001","PEG-3350","SOL ELECTROL","4000","Select","Select",""],["","65862020299","LOSARTAN POT","TAB 50MG","30","Select","Select",""],["","69097086107","ZONISAMIDE","CAP 100MG","60","Select","Select",""],["","42037010427","ECOTRIN LOW","TAB 81MG EC","30","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","47335032688","NALTREXONE HCL","50 MG","30","Select","Select",""],["","65862052899","VENLAFAXINE HCL ER","75 MG","90","Select","Select",""],["","68382009205","CARVEDILOL TAB","3.125MG","60","Select","Select",""],["","69618006610","ASPIRIN LOW TAB","81MG EC","30","Select","Select",""],["","55111015810","OMEPRAZOLE CAP","20MG","30","Select","Select",""],["","00131247835","VIMPAT TAB","100MG","60","Select","Select",""],["","68382013905","TOPIRAMATE TAB","50MG","180","Select","Select",""],["","65862052890","VENLAFAXINE CAP","75MG ER","90","Select","Select",""],["","47335032688","NALTREXONE TAB","50MG","30","Select","Select",""],["","68462067860","LACOSAMIDE TAB","50MG","28","Select","Select",""],["","10572010001","PEG-","3350 SOL ELECTROL","4000","Select","Select",""],["","42037010427","ECOTRIN LOW TAB","81MG EC","30","Select","Select",""],["","65862020299","LOSARTAN POT TAB","50MG","30","Select","Select",""],["","65162083366","DICLOFENAC GEL","1%","100","Select","Select",""],["","69097086107","ZONISAMIDE CAP","100MG","60","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":""}]}]}