{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"XAVIER WOOLDRIDGE","gend":0,"add":"110 N MASON ST","city":"HARRISONBURG","state":"VA","zip":"22802-9998","dob":"1997-09-03","age":"","mstatus":"","insh":"20079327*01","cliId":"","pno":5405804282,"cno":5405804282,"email":"","ename":"","eno":"","pphy":"VASS, CALEB A DO","ppno":5406744560,"pcpadd":"4550 LEE HIGHWAY SUITE B,","pcpcity":"DUBLIN","pcpstate":"VA","pcpzip":"24084-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5406744713,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B35.4","F11.23","K04.7","K02.9","G47.00","F17.200","R22.0","K76.89","D18.00","R10.13","Z20.822","R11.2","F11.20","R41.82","F15.229","F19.94","F19.959","F19.980","F16.10","F15.10","F10.10","F15.20","F12.20","F31.9","Z11.1","Z11.3","Z91.14","F11.21","R11.10","U07.1","M00.211","B95.1","R78.81","B95.61","R10.9","R19.7","D72.829","F19.10","F41.9","Z91.51","F11.93","F15.220","F15.980","Z86.59","F11.94","F23.","F11.10","Z01.89","J18.1","R09.02","F11.99","F10.99","Z72.0","F41.1","F90.9","M00.011","M00.811","R10.11","J69.0","V62.84","F10.20","J13.","F43.10","F17.210","Z62.810","Z20.5","Z59.00","J18.9","R53.1","F98.8","F29.","F20.89","M25.511","F11.90","Z79.899","Z76.0","F19.988","Z63.8","L98.499","T50.904A","Z20.828","F39.","NO DATA","F12.90","B19.20","E87.6","F19.939","R11.0","R61."],"date":["2021-12-03","2022-12-15","2022-04-11","2022-04-11","2022-04-11","2023-06-23","2022-04-11","2022-06-15","2022-06-15","2022-07-08","2022-12-05","2022-07-08","2023-02-21","2022-10-08","2022-10-13","2022-12-15","2022-10-13","2022-10-13","2022-10-14","2023-06-23","2022-12-15","2023-02-21","2023-02-21","2023-02-21","2023-02-21","2023-02-21","2023-02-21","2023-03-02","2022-06-13","2022-10-01","2021-11-09","2021-11-15","2021-11-09","2021-11-09","2022-07-08","2021-11-07","2022-11-25","2023-06-19","2021-11-02","2022-11-20","2022-10-08","2022-10-10","2022-10-08","2022-10-08","2022-10-14","2022-11-13","2022-11-13","2022-11-15","2022-11-25","2022-11-25","2022-11-25","2022-11-25","2022-12-06","2021-11-07","2021-11-26","2021-11-08","2021-11-15","2022-07-08","2022-11-20","2022-12-05","2022-11-26","2022-11-20","2022-11-20","2022-11-26","2022-11-20","2022-11-20","2022-11-20","2022-11-20","2022-10-01","2021-11-02","2021-11-26","2022-11-12","2021-11-03","2021-11-17","2021-11-17","2021-12-03","2022-10-10","2022-01-11","2022-10-08","2022-12-05","2022-12-23","2023-06-23","2023-08-12","2023-06-23","2022-12-06","2023-08-12","2023-08-12","2023-08-12","2023-08-12"],"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":[["","00228315303","BUPRENORPHIN","SUB 8MG","3","Select","Select",""],["","50111045001","TRAZODONE","TAB 150MG","30","Select","Select",""],["","00832105410","BACLOFEN","TAB 10MG","30","Select","Select",""],["","59779008001","ATHLETE FOOT","CRE 0.01","15","Select","Select",""],["","00093226301","AMOXICILLIN","TAB 500MG","20","Select","Select",""],["","16571020210","DICLOFENAC","TAB 50MG DR","20","Select","Select",""],["","00591530710","PROMETHAZINE","TAB 25MG","12","Select","Select",""],["","65862018730","ONDANSETRON","TAB 4MG","14","Select","Select",""],["","57237004105","PENICILLN VK","TAB 500MG","40","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","65862056099","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","41167005723","ASPERCREME","CRE 0.1","85","Select","Select",""],["","00378354501","MIRTAZAPINE","45 MG","30","Select","Select",""],["","00115180301","HYDROXYZ PAM","CAP 25MG","30","Select","Select",""],["","59779044574","CVS NICOTINE","DIS 14MG\/24H","7","Select","Select",""],["","59762040105","SUCRALFATE","TAB 1GM","60","Select","Select",""],["","13668021805","ARIPIPRAZOLE","10 MG","30","Select","Select",""],["","12496120801","SUBOXONE","8 MG-2 MG","14","Select","Select",""],["","43547028010","ESCITALOPRAM","TAB 5MG","7","Select","Select",""],["","53489011905","DOXYCYCL HYC","CAP 100MG","8","Select","Select",""],["","61269010534","BACITR ZINC","OIN 500UNIT","14","Select","Select",""],["","00093216568","NALOXONE HCL","4 MG","2","Select","Select",""],["","00378555001","ROPINIROLE","TAB 0.5MG","15","Select","Select",""],["","68001023703","CLONIDINE","TAB 0.1MG","30","Select","Select",""],["","60432046400","LIDOCAINE","SOL 2% VISC","100","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","68462019005","NAPROXEN","500 MG","60","Select","Select",""],["","70000005501","CHEST CONGESTION RELIEF","400 MG","60","Select","Select",""],["","65162075750","DIVALPROEX SODIUM ER","500 MG","30","Select","Select",""],["","70436001002","BUPROPION XL","150 MG","30","Select","Select",""],["","70000021306","ALLERGY RELIEF","10 MG","30","Select","Select",""],["","57896010410","ACETAMINOPHEN","325 MG","120","Select","Select",""],["","11822054311","MELATONIN","10 MG","30","Select","Select",""],["","42806054701","VITAMIN D","2 1250 MCG","4","Select","Select",""],["","65862056099","PANTOPRAZOLE SODIUM","40 MG","30","Select","Select",""],["","00378876793","BUPRENORPHINE-NALOXONE","8 MG-2 MG","14","Select","Select",""],["","00228212810","CLONIDINE HCL","0.2 MG","90","Select","Select",""],["","00378555001","ROPINIROLE HCL","0.5 MG","15","Select","Select",""],["","46122057578","SENNA LAX","8.6 MG","30","Select","Select",""],["","00143314250","DOXYCYCLINE HYCLATE","100 MG","20","Select","Select",""],["","00093310905","AMOXICILLIN CAP","500MG","30","Select","Select",""],["","16571020210","DICLOFENAC TAB","50MG DR","20","Select","Select",""],["","57237004105","PENICILLN VK TAB","500MG","40","Select","Select",""],["","65862018730","ONDANSETRON TAB","4MG","14","Select","Select",""],["","00591530710","PROMETHAZINE TAB","25MG","12","Select","Select",""],["","00172572860","FAMOTIDINE TAB","20MG","30","Select","Select",""],["","65862056099","PANTOPRAZOLE TAB","40MG","30","Select","Select",""],["","59762040105","SUCRALFATE TAB","1GM","60","Select","Select",""],["","13668021730","ARIPIPRAZOLE TAB","5MG","7","Select","Select",""],["","43547028010","ESCITALOPRAM TAB","5MG","7","Select","Select",""],["","57664049983","MIRTAZAPINE TAB","15MG","30","Select","Select",""],["","60432046400","LIDOCAINE SOL","2% VISC","100","Select","Select",""],["","61269010534","BACITR ZINC OIN","500UNIT","14","Select","Select",""],["","53489011905","DOXYCYCL HYC CAP","100MG","8","Select","Select",""],["","59779044574","CVS NICOTINE DIS","14MG\/24H","7","Select","Select",""],["","41167005723","ASPERCREME CRE","10%","85","Select","Select",""],["","00591080001","HYDROXYZ PAM CAP","25MG","60","Select","Select",""],["","00378555001","ROPINIROLE TAB","0.5MG","15","Select","Select",""],["","12496120803","SUBOXONE MIS","8-2MG","40","Select","Select",""],["","00093216568","NALOXONE HCL SPR","4MG","2","Select","Select",""],["","68001023703","CLONIDINE TAB","0.1MG","30","Select","Select",""],["","00093226301","AMOXICILLIN TAB","500MG","20","Select","Select",""],["","29300014801","QUETIAPINE FUMARATE","50 MG","14","Select","Select",""],["","16714066202","GABAPENTIN","300 MG","28","Select","Select",""],["","50228017505","BUPROPION HCL SR","150 MG","14","Select","Select",""],["","68462014301","CLINDAMYCIN HCL","150 MG","63","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":""}]}]}