{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JESLYN J JACKSON","gend":1,"add":"340 WAYNERIDGE ROAD","city":"WAYNESBORO","state":"VA","zip":"22980-9998","dob":"1968-05-20","age":"","mstatus":"","insh":"20049077*01","cliId":"","pno":4344009593,"cno":4344009593,"email":"","ename":"","eno":"","pphy":"SEATON, SCOTT M MD","ppno":5409421200,"pcpadd":"1850 ROSSER AVE,","pcpcity":"WAYNESBORO","pcpstate":"VA","pcpzip":"22980-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5409420151,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z09.","Z86.010","K63.5","Z12.11","K64.1","F29.","Z79.899","F31.81","F90.0","E66.01","J30.2","Z20.822","R42.","F25.9","J45.909","M06.9","M79.672","Z11.59","F90.2","M35.1","F31.9","R41.82","V54.16","J45.41","E78.00","M35.9","B35.4","R49.0","J45.40","Z01.811","Z03.818","T43.595A","R53.81","E66.1","Z68.41","E04.9","E56.9","M84.40XA","J10.1","Z79.51","Z88.8","R51.9","J06.9","J45.901","F20.9","T50.905A","R52.","J02.9","J01.90","B00.1","K12.0","F31.60","F15.20","L85.3","L08.9","L29.8","Q80.9","K13.0","Z01.89","M25.511","M25.512","G89.29","S99.921A","W22.03XA","S22.31XA","R07.89"],"date":["2021-04-15","2021-04-15","2021-04-15","2021-04-15","2021-04-15","2021-06-25","2023-01-25","2023-09-12","2023-05-03","2023-09-12","2021-12-22","2022-11-07","2022-01-09","2022-01-09","2022-11-07","2022-01-09","2022-03-22","2021-06-18","2023-09-12","2021-06-15","2022-11-07","2022-01-08","2022-03-22","2022-03-28","2022-06-21","2023-04-25","2021-06-15","2022-10-19","2021-02-11","2021-02-11","2022-01-08","2022-01-08","2022-01-08","2023-01-25","2023-01-25","2021-07-05","2021-07-05","2022-04-19","2022-11-07","2022-11-07","2022-11-07","2023-04-24","2022-11-07","2022-11-07","2021-06-18","2022-01-09","2021-01-29","2021-05-14","2021-05-17","2021-05-17","2021-05-17","2021-06-21","2021-06-21","2021-08-03","2021-08-03","2021-08-03","2021-12-27","2022-06-21","2023-04-25","2023-04-25","2023-04-25","2023-04-24","2023-06-14","2023-06-14","2023-07-19","2023-07-19"],"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":[["","00527150537","AMPHET\/DEXTR","TAB 20MG","90","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","14539067501","HYDROXYZ PAM","CAP 50MG","60","Select","Select",""],["","00186037020","SYMBICORT","160-4.5MCG","10.2","Select","Select",""],["","13668004801","LAMOTRIGINE","150 MG","60","Select","Select",""],["","13107008501","LORAZEPAM","TAB 2MG","60","Select","Select",""],["","61874014530","VRAYLAR","CAP 4.5MG","10","Select","Select",""],["","59779061239","ALLERGY RELF","TAB 10MG","90","Select","Select",""],["","00173068220","VENTOLIN HFA","90 MCG","18","Select","Select",""],["","00228207610","TEMAZEPAM","CAP 15MG","60","Select","Select",""],["","43598072101","HYDROXYCHLOR","TAB 200MG","30","Select","Select",""],["","68462018135","CLOTRIMAZOLE","CRE 0.01","30","Select","Select",""],["","70436001102","BUPROPN HCL","TAB 300MG XL","30","Select","Select",""],["","00766080155","ABREVA","CRE 0.1","2","Select","Select",""],["","43547030403","ARIPIPRAZOLE","10 MG","30","Select","Select",""],["","45802046564","KETOCONAZOLE","SHA 0.02","120","Select","Select",""],["","50383077504","LIDOCAINE","SOL 2% VISC","200","Select","Select",""],["","59267100002","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","59148001871","ABILIFY MAIN","INJ 300MG","1","Select","Select",""],["","16571040250","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","50428036851","EARWAX REMOV","DRO SYSTEM","15","Select","Select",""],["","64980030550","DENTA 5000","CRE PLUS","51","Select","Select",""],["","00591037201","LOXAPINE","CAP 50MG","30","Select","Select",""],["","16571066101","MECLIZINE","TAB 25MG","21","Select","Select",""],["","49483060450","IBUPROFEN","800 MG","90","Select","Select",""],["","60505392801","GUANFACINE","TAB 2MG ER","30","Select","Select",""],["","00169452414","WEGOVY","2.4MG\/0.75","3","Select","Select",""],["","70461032203","FLUCLVX QUAD","INJ 2022-23","0","Select","Select",""],["","59148003913","REXULTI","3 MG","30","Select","Select",""],["","59267030402","PFIZER BIVAL","INJ BA4\/BA5","0","Select","Select",""],["","00169280015","SAXENDA","3 MG\/0.5ML","15","Select","Select",""],["","69238126601","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","59651000305","OMEPRAZOLE","40 MG","30","Select","Select",""],["","00378064010","PREDNISONE","5 MG","49","Select","Select",""],["","68180016011","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","08290320749","BD PEN NEEDL","MIS 32GX6MM","300","Select","Select",""],["","00169185189","NOVOFINE","MIS 32GX6MM","100","Select","Select",""],["","08521550632","FIFTY50 PEN","MIS 32GX6MM","100","Select","Select",""],["","00555097402","DEXTROAMPHETAMINE-AMPHETAMINE","30 MG","90","Select","Select",""],["","59417010410","VYVANSE","40 MG","30","Select","Select",""],["","70436001102","BUPROPION XL","300 MG","30","Select","Select",""],["","43598072101","HYDROXYCHLOROQUINE SULFATE","200 MG","30","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","90 MCG","18","Select","Select",""],["","00310737020","BUDESONIDE-FORMOTEROL FUMARATE","160-4.5MCG","10.2","Select","Select",""],["","67877054360","CEFDINIR","300 MG","20","Select","Select",""],["","16571040250","CETIRIZINE HCL","10 MG","30","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","64980030550","DENTA","5000 PLUS 1.1 %","51","Select","Select",""],["","13668004960","LAMOTRIGINE TAB","200MG","30","Select","Select",""],["","00173068220","VENTOLIN HFA AER","","18","Select","Select",""],["","00591037201","LOXAPINE CAP","50MG","30","Select","Select",""],["","16571066101","MECLIZINE TAB","25MG","21","Select","Select",""],["","70436001102","BUPROPN HCL TAB","300MG XL","30","Select","Select",""],["","43598072101","HYDROXYCHLOR TAB","200MG","30","Select","Select",""],["","00186037020","SYMBICORT AER","160-4.5","10","Select","Select",""],["","00527150537","AMPHET\/DEXTR TAB","20MG","90","Select","Select",""],["","43547030403","ARIPIPRAZOLE TAB","10MG","30","Select","Select",""],["","49483060450","IBUPROFEN TAB","800MG","90","Select","Select",""],["","65862057490","MONTELUKAST TAB","10MG","30","Select","Select",""],["","60505392801","GUANFACINE TAB","2MG ER","30","Select","Select",""],["","00169450514","WEGOVY INJ","0.5MG","2","Select","Select",""],["","59148003613","REXULTI TAB","0.5MG","30","Select","Select",""],["","70461032203","FLUCLVX QUAD INJ","2022-23","0","Select","Select",""],["","00054327099","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","68180016011","AZITHROMYCIN TAB","250MG","6","Select","Select",""],["","59267030402","PFIZER BIVAL INJ BA","4\/BA5","0","Select","Select",""],["","59651000305","OMEPRAZOLE CAP","40MG","30","Select","Select",""],["","08521550632","FIFTY","50 PEN MIS 32GX6MM","100","Select","Select",""],["","00169280015","SAXENDA INJ","18MG\/3ML","15","Select","Select",""],["","69238126601","OSELTAMIVIR CAP","75MG","10","Select","Select",""],["","08290320749","BD PEN NEEDL MIS","32GX6MM","300","Select","Select",""],["","00169185189","NOVOFINE MIS","32GX6MM","100","Select","Select",""],["","00378064205","PREDNISONE TAB","20MG","10","Select","Select",""],["","00228306011","DEXTROAMPHETAMINE-AMPHET ER","20 MG","90","Select","Select",""],["","54092038701","ADDERALL XR","20 MG","90","Select","Select",""],["","55111052830","ATOMOXETINE HCL","25 MG","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":""}]}]}