{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JEANIQUA   L JACKSON","gend":1,"add":"612 DOE ST APT 114","city":"DANVILLE","state":"VA","zip":"24541-9998","dob":"1978-05-13","age":"","mstatus":"","insh":"20071873*01","cliId":"","pno":4347106024,"cno":4347106024,"email":"","ename":"","eno":"","pphy":"HAIRSTON, VANESSA P FNP","ppno":4346857095,"pcpadd":"4520 MEDICAL CENTER ROAD","pcpcity":"AXTON","pcpstate":"VA","pcpzip":"24054-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4346852990,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z00.00","Z00.8","F25.1","F31.81","F32.3","R60.0","D64.9","G89.21","G50.0","M54.9","M79.7","Z91.14","M54.17","G89.4","G47.00","U07.1","S60.511A","Z88.5","Z88.8","S69.91XA","F43.10","F31.9","E55.9","M51.17","S13.4XXA","M51.36","M25.562","R51.9","A41.51","N10.","D50.9","K58.9","D57.3","F41.9","Z20.822","Z90.49","Z98.84","Z98.890","I10.","R40.4","T50.904A","R41.82","T88.7XXA","F69.","A41.9","N12.","R78.81","F11.10","Z71.51","F17.210","F32.9","Z04.6","F33.9","F41.3","NO DATA","J01.90","J30.9","G50.9","K12.2","E53.8","W22.8XXA","R44.2","R41.0","R00.0","M79.2","K91.2","R11.0","U09.9","R10.9","T50.901A","R53.81","F29.","Z79.899"],"date":["2021-03-09","2021-10-07","2021-12-10","2022-03-06","2021-12-05","2021-12-07","2022-06-30","2021-12-05","2021-12-05","2021-12-05","2023-02-21","2021-12-05","2022-05-31","2023-01-19","2023-02-21","2022-08-29","2022-08-26","2023-01-25","2023-01-05","2022-08-26","2023-01-28","2022-11-19","2022-11-22","2023-02-21","2023-01-28","2023-01-05","2023-01-05","2023-01-25","2023-01-28","2023-01-28","2023-01-28","2023-01-28","2023-01-28","2023-01-28","2023-01-28","2023-01-28","2023-01-28","2023-01-28","2023-02-21","2022-06-03","2022-06-03","2022-06-03","2022-06-03","2022-06-03","2023-01-31","2023-01-31","2023-01-31","2021-08-07","2021-08-07","2021-08-07","2021-10-06","2021-08-07","2022-01-30","2022-12-20","2022-09-22","2022-10-24","2022-10-24","2021-07-08","2021-07-08","2021-09-30","2022-08-26","2021-03-09","2021-03-09","2021-03-09","2023-01-19","2021-06-07","2022-08-29","2022-08-29","2023-01-28","2022-06-03","2022-06-03","2021-10-06","2022-06-30"],"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":[["","47781026405","OXYCODONE","TAB 15MG","120","Select","Select",""],["","69499033060","CHLORZOXAZON","TAB 250MG","120","Select","Select",""],["","13668000805","ZOLPIDEM","TAB 10MG","30","Select","Select",""],["","51991070610","ALPRAZOLAM","1 MG","60","Select","Select",""],["","21922000909","DICLOFENAC","GEL 0.01","300","Select","Select",""],["","60432046551","LIDOCAINE","SOL 0.04","300","Select","Select",""],["","50228035390","PREGABALIN","CAP 100MG","60","Select","Select",""],["","30768030417","MULTIVI ADLT","CHW GUMMIES","60","Select","Select",""],["","37205038878","CHILD MULTI","CHW VIAMIN","60","Select","Select",""],["","10877051272","ANIMAL SHAPE","CHW VIT COMP","60","Select","Select",""],["","00304048501","CHEWVITES","CHW ","60","Select","Select",""],["","00005452835","CENTRUM","CHW ","60","Select","Select",""],["","00093117201","PENICILLN VK","TAB 250MG","30","Select","Select",""],["","55289086801","MULTIPLE VIT","CHW \/IRON","60","Select","Select",""],["","00093416173","AMOXICILLIN","SUS 400\/5ML","100","Select","Select",""],["","51991029405","OXCARBAZEPIN","TAB 600MG","60","Select","Select",""],["","63868015710","ALLERGY RELF","TAB 10MG","30","Select","Select",""],["","33342010215","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","69680011210","CYANOCOBALAM","INJ 1000MCG","1","Select","Select",""],["","69315011610","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","08290309574","3ML LL SYRNG","MIS 22GX1.5\"","2","Select","Select",""],["","55111016405","OLANZAPINE","TAB 5MG","30","Select","Select",""],["","75834001060","ERGOCALCIFER","SOL 8000\/ML","60","Select","Select",""],["","27241009706","DULOXETINE","CAP 20MG","60","Select","Select",""],["","50228014601","HYDROCHLOROT","CAP 12.5MG","30","Select","Select",""],["","55111017915","TIZANIDINE","TAB 2MG","60","Select","Select",""],["","68382024705","BENZONATATE","CAP 100MG","15","Select","Select",""],["","00781729685","ALBUTEROL","AER HFA","7","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00054032656","FLUTIC\/SALME","AER 100\/50","60","Select","Select",""],["","65862018730","ONDANSETRON","TAB 4MG","20","Select","Select",""],["","00173069500","ADVAIR DISKU","AER 100\/50","60","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","67877019810","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","42571016242","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","26","Select","Select",""],["","66993058497","FLUTICASONE-SALMETEROL","100-50 MCG","60","Select","Select",""],["","00245010801","FERROUS SULFATE","325(65) MG","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":""}]}]}