{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"THURMA L ROMANO","gend":1,"add":"2515 MOOREFIELD ROAD","city":"MINERAL","state":"VA","zip":"23117-9998","dob":"1959-05-26","age":"","mstatus":"","insh":"20064317*01","cliId":"","pno":5408723526,"cno":5408723526,"email":"","ename":"","eno":"","pphy":"RICHMOND, JILL ELIZABETH NP","ppno":5407350560,"pcpadd":"115 JEFFERSON HIGHWAY SUITE 9,","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":5409679405,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M17.12","I10.","J44.9","E78.5","Z47.1","Z96.653","I69.351","I12.9","N18.9","K21.9","M19.90","D63.1","F32.9","R94.5","Z96.652","R92.1","R92.8","J44.1","D62.","R73.9","M25.762","E78.00","Z20.822","F17.210","Z79.02","Z79.899","Z86.73","Z96.651","Z88.5","Z91.041","D64.9","G47.01","Z53.21","G89.18","R26.89","R53.1","N32.81","I69.398","R20.0","Z79.82","Z79.891","E78.2","I63.9","Z23.","I63.10","F10.10","Z99.81","Z79.52","Z11.59","R05.9","M17.0","Z98.890","N60.12","N64.89"],"date":["2021-04-12","2023-03-24","2021-05-04","2021-04-11","2021-05-04","2021-04-11","2021-04-15","2021-04-11","2021-04-11","2021-12-22","2021-04-11","2021-04-11","2021-05-04","2021-04-12","2022-08-03","2021-09-28","2021-09-28","2022-02-01","2021-04-15","2021-04-08","2021-04-08","2021-04-08","2021-04-08","2021-04-08","2021-05-04","2021-05-04","2021-05-04","2022-08-03","2021-04-08","2021-04-08","2021-04-21","2023-03-24","2022-04-29","2021-01-05","2021-05-04","2021-05-04","2021-01-05","2021-01-05","2021-01-05","2021-05-04","2021-05-04","2023-03-24","2021-12-22","2021-12-22","2023-03-24","2021-05-04","2021-05-04","2021-05-04","2022-01-24","2022-01-24","2021-04-15","2021-02-10","2021-09-28","2021-09-28"],"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":[["","68180072003","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","80681008500","MELATONIN","TAB 3MG","30","Select","Select",""],["","60505265301","TRAZODONE","TAB 50MG","30","Select","Select",""],["","00085113204","PROVENTIL","AER HFA","7","Select","Select",""],["","00363049860","MUCUS RELIEF","TAB 600MG ER","28","Select","Select",""],["","42806040021","METHYLPRED","TAB 4MG","21","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00781185220","AMOX\/K CLAV","TAB 875-125","14","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","7","Select","Select",""],["","63824000832","MUCINEX","TAB 600MG ER","28","Select","Select",""],["","55111012105","ATORVASTATIN","TAB 10MG","90","Select","Select",""],["","68180035302","SERTRALINE","TAB 100MG","90","Select","Select",""],["","70710168400","FAMOTIDINE","40 MG","90","Select","Select",""],["","68645059090","CLOPIDOGREL","75 MG","90","Select","Select",""],["","65162068210","PHENAZOPYRID","TAB 200MG","6","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","20","Select","Select",""],["","00378668877","PANTOPRAZOLE","TAB 20MG","90","Select","Select",""],["","70954000520","OXYBUTYNIN","TAB 5MG","180","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","20","Select","Select",""],["","80777027310","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","65162063609","PANTOPRAZOLE SODIUM","20 MG","90","Select","Select",""],["","68645051554","AMLODIPINE BESYLATE","5 MG","30","Select","Select",""],["","70954000510","OXYBUTYNIN CHLORIDE","5 MG","180","Select","Select",""],["","75834025501","ATORVASTATIN CALCIUM","10 MG","90","Select","Select",""],["","68645052354","SERTRALINE HCL","100 MG","90","Select","Select",""],["","50111056001","TRAZODONE HCL","50 MG","90","Select","Select",""],["","00781729685","ALBUTEROL SULFATE HFA","90 MCG","6.7","Select","Select",""],["","80681017400","VITAMIN D","3 1250 MCG","4","Select","Select",""],["","68180072003","AMLODIPINE TAB","5MG","90","Select","Select",""],["","13668033005","TRAZODONE TAB","50MG","30","Select","Select",""],["","80681008500","MELATONIN TAB","3MG","30","Select","Select",""],["","42806040021","METHYLPRED TAB","4MG","21","Select","Select",""],["","00363049860","MUCUS RELIEF TAB","600MG ER","14","Select","Select",""],["","69097014260","ALBUTEROL AER HFA","","7","Select","Select",""],["","00085113204","PROVENTIL AER HFA","","7","Select","Select",""],["","55111012105","ATORVASTATIN TAB","10MG","90","Select","Select",""],["","63824000832","MUCINEX TAB","600MG ER","28","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","00781185220","AMOX\/K CLAV TAB","875-125","14","Select","Select",""],["","68180035302","SERTRALINE TAB","100MG","90","Select","Select",""],["","00172572960","FAMOTIDINE TAB","40MG","90","Select","Select",""],["","00378668877","PANTOPRAZOLE TAB","20MG","90","Select","Select",""],["","65162068210","PHENAZOPYRID TAB","200MG","6","Select","Select",""],["","00143992801","CIPROFLOXACN TAB","500MG","20","Select","Select",""],["","65862035705","CLOPIDOGREL TAB","75MG","90","Select","Select",""],["","80777027310","MODERNA VAC INJ COVID-","19","0","Select","Select",""],["","70954000520","OXYBUTYNIN TAB","5MG","60","Select","Select",""],["","65862042005","SMZ\/TMP DS TAB","800-160","20","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":""}]}]}