{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TERESA LAMBERT","gend":1,"add":"801 WESTERN ROAD","city":"WAYNESBORO","state":"VA","zip":"22980-9998","dob":"1959-01-26","age":"","mstatus":"","insh":"20038547*01","cliId":"","pno":5402562973,"cno":5402562973,"email":"","ename":"","eno":"","pphy":"STOVALL, SAMARA R PA","ppno":5402132630,"pcpadd":"22 N MEDICAL PARK DRIVE,","pcpcity":"FISHERSVILLE","pcpstate":"VA","pcpzip":"22939-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5402132631,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["A41.9","J18.9","A48.1","R65.21","J18.1","I95.9","I48.91","I25.10","I42.9","Z00.00","J44.9","F17.290","B19.20","E04.1","Z12.39","A60.9","R05.2","F41.9","Z46.82","R22.43","I10.","J12.89","J96.01","J96.21","J90.","R07.9","R41.82","A41.89","G93.41","R64.","J91.8","D69.59","D70.3","I24.8","E87.1","F14.229","Z68.1","Z78.1","I48.92","Z12.2","F17.210","R91.8","M25.519","K21.9","M75.42","M25.512","S02.5XXA"],"date":["2021-08-26","2021-08-26","2021-09-02","2021-08-26","2021-08-21","2021-08-21","2023-04-07","2023-04-07","2023-04-07","2023-04-07","2023-04-07","2023-04-07","2023-04-07","2023-04-07","2023-04-07","2022-03-09","2022-03-09","2023-04-07","2021-08-18","2021-08-18","2021-08-25","2021-08-22","2021-08-24","2021-08-16","2021-08-18","2021-08-16","2021-08-16","2021-08-16","2021-08-16","2021-08-16","2021-08-16","2021-08-16","2021-08-16","2021-08-16","2021-08-16","2021-08-16","2021-08-16","2021-08-16","2021-08-16","2022-08-24","2022-08-24","2022-08-22","2023-04-07","2023-04-07","2023-05-04","2023-04-13","2023-05-05"],"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 ","26","Select","Select",""],["","70377000812","ROSUVASTATIN","TAB 20MG","90","Select","Select",""],["","31722070530","VALACYCLOVIR","1000 MG","5","Select","Select",""],["","00093083205","CLONAZEPAM","TAB 0.5MG","14","Select","Select",""],["","00003089421","ELIQUIS","TAB 5MG","60","Select","Select",""],["","57664050658","METOPROL TAR","TAB 25MG","30","Select","Select",""],["","33342002332","LEVOFLOXACIN","TAB 750MG","6","Select","Select",""],["","00093117410","PENICILLN VK","TAB 500MG","28","Select","Select",""],["","00173085910","BREO ELLIPTA","INH 100-25","60","Select","Select",""],["","50428029821","CHEST CONGES","TAB 400MG","42","Select","Select",""],["","00378932032","WIXELA INHUB","AER 100\/50","60","Select","Select",""],["","64380071307","BENZONATATE","200 MG","30","Select","Select",""],["","66689000816","NYSTATIN","SUS 100000","480","Select","Select",""],["","00173069500","ADVAIR DISKU","AER 100\/50","60","Select","Select",""],["","68462039030","ESOMEPRAZOLE MAGNESIUM","20 MG","30","Select","Select",""],["","66993013597","FLUTICASONE-VILANTEROL","100-25MCG","60","Select","Select",""],["","00173071520","ADVAIR HFA","45-21 MCG","12","Select","Select",""],["","59779060027","ASPIRIN EC","81 MG","90","Select","Select",""],["","69097014260","ALBUTEROL SULFATE HFA","90 MCG","6.7","Select","Select",""],["","43598043611","NITROGLYCERIN","0.4 MG","25","Select","Select",""],["","66993008696","FLUTICASONE-SALMETEROL HFA","45-21 MCG","12","Select","Select",""],["","65862050320","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","14","Select","Select",""],["","00054350049","LIDOCAINE HCL VISCOUS","2 %","100","Select","Select",""],["","00173085910","BREO ELLIPTA INH","100-25","60","Select","Select",""],["","50428029821","CHEST CONGES TAB","400MG","42","Select","Select",""],["","00093083205","CLONAZEPAM TAB","0.5MG","14","Select","Select",""],["","31722070530","VALACYCLOVIR TAB","1GM","5","Select","Select",""],["","64380071306","BENZONATATE CAP","200MG","30","Select","Select",""],["","00378932032","WIXELA INHUB AER","100\/50","60","Select","Select",""],["","66689000816","NYSTATIN SUS","100000","480","Select","Select",""],["","00173069500","ADVAIR DISKU AER","100\/50","60","Select","Select",""],["","57664050658","METOPROL TAR TAB","25MG","30","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":""}]}]}