{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JULIE SMITHSON","gend":1,"add":"1402 WAKEFIELD ROAD","city":"LYNCHBURG","state":"VA","zip":"24503-9998","dob":"1964-06-02","age":"","mstatus":"","insh":"20073067*01","cliId":"","pno":4349448009,"cno":4349448009,"email":"","ename":"","eno":"","pphy":"MEADOWS, JAMES MD","ppno":4342003908,"pcpadd":"125 NATIONWIDE DR,","pcpcity":"LYNCHBURG","pcpstate":"VA","pcpzip":"24502-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4342005948,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R21.","L81.0","L40.0","F41.9","K51.90","Z72.0","Z85.3","Z20.828","L28.1","L28.0","L40.8","L40.9","M35.9","NO DATA","L40.50","Z15.89","L73.8","Z20.822"],"date":["2022-10-05","2021-04-29","2021-09-09","2023-03-08","2023-03-08","2023-03-08","2023-03-08","2021-02-28","2022-06-07","2021-11-09","2022-06-07","2022-12-05","2022-12-05","2022-12-05","2023-07-10","2023-07-10","2022-04-26","2021-02-28"],"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":[["","65862090901","CELECOXIB CAP","200MG","30","Select","Select",""],["","68180031909","BUPROPN HCL TAB","150MG XL","90","Select","Select",""],["","65862014836","SUMATRIPTAN TAB","100MG","9","Select","Select",""],["","00078063941","COSENTYX PEN INJ","300DOSE","2","Select","Select",""],["","00781237101","AMPHET\/DEXTR CAP","30MG ER","30","Select","Select",""],["","00781106110","ALPRAZOLAM TAB","0.25MG","25","Select","Select",""],["","11534016503","FOLIC ACID TAB","1MG","30","Select","Select",""],["","51672125903","CLOBETASOL OIN","0.05%","60","Select","Select",""],["","68462053253","CLOBETASOL SOL","0.05%","50","Select","Select",""],["","45802006405","TRIAMCINOLON CRE","0.1%","454","Select","Select",""],["","52817033200","CYCLOBENZAPR TAB","10MG","30","Select","Select",""],["","54092039101","ADDERALL XR CAP","30MG","30","Select","Select",""],["","42806031250","DOXYCYCL HYC TAB","100MG","28","Select","Select",""],["","69238117009","DOXEPIN HCL CAP","25MG","30","Select","Select",""],["","00781237101","DEXTROAMPHETAMINE-AMPHET ER","30 MG","30","Select","Select",""],["","00781106110","ALPRAZOLAM","0.25 MG","25","Select","Select",""],["","54092039101","ADDERALL XR","30 MG","30","Select","Select",""],["","65862014836","SUMATRIPTAN SUCCINATE","100 MG","9","Select","Select",""],["","00555057202","METHOTREXATE","2.5 MG","48","Select","Select",""],["","65862090901","CELECOXIB","200 MG","30","Select","Select",""],["","11534016503","FOLIC ACID","1 MG","30","Select","Select",""],["","29300041510","CYCLOBENZAPRINE HCL","10 MG","30","Select","Select",""],["","65862014836","SUMATRIPTAN","TAB 100MG","9","Select","Select",""],["","68180031909","BUPROPN HCL","TAB 150MG XL","90","Select","Select",""],["","00078063941","COSENTYX PEN","INJ 300DOSE","2","Select","Select",""],["","00781237101","AMPHET\/DEXTR","CAP 30MG ER","30","Select","Select",""],["","68462053253","CLOBETASOL","SOL 0.0005","50","Select","Select",""],["","45802006405","TRIAMCINOLON","CRE 0.001","454","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","42806031250","DOXYCYCL HYC","TAB 100MG","28","Select","Select",""],["","69238117009","DOXEPIN HCL","CAP 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":""}]}]}