{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ELSIE A LEE","gend":1,"add":"PO BOX 46","city":"DRAKES BRANCH","state":"VA","zip":"23937-9998","dob":"1972-09-14","age":"","mstatus":"","insh":"20077333*01","cliId":"","pno":4342088575,"cno":4342088575,"email":"","ename":"","eno":"","pphy":"BHAT, SHRIDHAR MD","ppno":8048194000,"pcpadd":"107 S 5TH STREET,","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":"23219-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8048195221,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F15.20","F31.81","L98.9","E86.0","J44.9","E11.9","Z20.2","Z20.822","Z88.0","Z88.8","D50.0","N92.0","R45.1","R50.9","R10.9","R51.9","F33.9","G25.0","F41.9","F43.0","R39.12","NO DATA","R53.83","R42.","F15.10","R07.9","R11.0","R06.02","K21.9","F32.9","D64.9","F43.10","K13.79","E87.6","E83.42"],"date":["2022-12-01","2022-11-10","2021-08-17","2021-08-17","2023-05-21","2023-05-21","2021-08-17","2022-08-29","2021-08-17","2021-08-17","2021-10-15","2021-10-15","2022-08-29","2022-08-29","2022-08-29","2022-08-29","2022-11-09","2022-11-09","2023-05-21","2023-05-21","2023-05-21","2023-05-21","2023-05-21","2023-05-21","2023-06-20","2022-05-24","2022-05-24","2022-05-24","2022-05-24","2023-05-22","2022-08-29","2022-11-07","2023-06-20","2023-06-20","2023-06-20"],"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":[["","00378668910","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","70954002110","PRAZOSIN HCL","5 MG","30","Select","Select",""],["","50111045001","TRAZODONE","TAB 150MG","30","Select","Select",""],["","00093100305","BUSPIRONE","TAB 15MG","60","Select","Select",""],["","68001045508","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","68382013905","TOPIRAMATE","TAB 50MG","60","Select","Select",""],["","68382004101","PROMETHAZINE","TAB 25MG","15","Select","Select",""],["","23155050105","HYDROXYZ HCL","TAB 25MG","30","Select","Select",""],["","00904641292","CALC ANTACID","CHW 500MG","30","Select","Select",""],["","68382013210","TAMSULOSIN","CAP 0.4MG","60","Select","Select",""],["","00115166101","PROPRANOLOL","TAB 40MG","60","Select","Select",""],["","69315011610","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","00093227534","AMOX\/K CLAV","TAB 875-125","14","Select","Select",""],["","16714069211","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","51293064701","BETHANECHOL","TAB 25MG","15","Select","Select",""],["","59651036105","IBUPROFEN","600 MG","12","Select","Select",""],["","57237002801","AMOXICILLIN","500 MG","21","Select","Select",""],["","00378668910","PANTOPRAZOLE TAB","40MG","30","Select","Select",""],["","68001045508","ESCITALOPRAM TAB","10MG","30","Select","Select",""],["","70954002110","PRAZOSIN HCL CAP","5MG","30","Select","Select",""],["","50111045001","TRAZODONE TAB","150MG","30","Select","Select",""],["","00093100305","BUSPIRONE TAB","15MG","60","Select","Select",""],["","69315011610","FUROSEMIDE TAB","20MG","30","Select","Select",""],["","23155050105","HYDROXYZ HCL TAB","25MG","30","Select","Select",""],["","68382013905","TOPIRAMATE TAB","50MG","7","Select","Select",""],["","00115166101","PROPRANOLOL TAB","40MG","60","Select","Select",""],["","68382013210","TAMSULOSIN CAP","0.4MG","60","Select","Select",""],["","00904641292","CALC ANTACID CHW","500MG","30","Select","Select",""],["","00093317431","ALBUTEROL AER HFA","","8","Select","Select",""],["","51293064701","BETHANECHOL TAB","25MG","15","Select","Select",""],["","00093227534","AMOX\/K CLAV TAB","875-125","14","Select","Select",""],["","16714069211","FLUCONAZOLE TAB","150MG","2","Select","Select",""],["","68382004101","PROMETHAZINE TAB","25MG","15","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":""}]}]}