{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KIMBERLEE CHISM","gend":1,"add":"130 POPLAR CREEK ST APT 115","city":"SOUTH BOSTON","state":"VA","zip":"24592-9998","dob":"1976-12-21","age":"","mstatus":"","insh":"2093810*01","cliId":"","pno":4342224401,"cno":4342224401,"email":"","ename":"","eno":"","pphy":"HARRELL, WHITNEY NP","ppno":4345751336,"pcpadd":"1627 SEYMOUR DRIVE SUITE B","pcpcity":"SOUTH BOSTON","pcpstate":"VA","pcpzip":"24592-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4345751349,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.9","F33.2","J20.9","Z20.828","M50.021","I67.9","M54.12","F41.1","B20.","F33.9","Z23.","Z21.","M54.2","Z12.11","Z11.59","Z01.89","N91.1","U07.1","I51.7","B34.2","B34.9","R11.2","Z87.891","Z88.5","Z88.0","R05.9","M62.838","M54.9","Z13.9","M75.52","M79.602","G56.03","J10.1","R05.1","Z01.810","Z01.812","K63.5","D12.3","K75.9","NO DATA","Z80.41"],"date":["2023-04-13","2023-03-23","2022-01-12","2022-12-08","2022-03-22","2022-03-22","2022-03-22","2023-04-21","2023-04-13","2022-09-13","2022-09-13","2022-09-13","2022-12-13","2023-04-13","2023-04-07","2022-10-25","2022-03-03","2022-07-07","2022-07-04","2022-07-04","2022-07-04","2022-07-05","2023-04-13","2022-07-05","2022-07-05","2022-07-05","2022-02-16","2022-02-16","2021-02-11","2021-02-11","2021-02-11","2021-02-11","2022-12-08","2022-12-08","2023-04-07","2023-04-07","2023-04-13","2023-04-13","2023-04-13","2023-04-13","2023-04-13"],"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":[["","49702023113","TRIUMEQ","600-50-300","30","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","67877043403","ARIPIPRAZOLE","20 MG","30","Select","Select",""],["","43547028210","ESCITALOPRAM","TAB 20MG","30","Select","Select",""],["","00093005401","BUSPIRONE","TAB 10MG","180","Select","Select",""],["","00115180401","HYDROXYZ PAM","CAP 50MG","90","Select","Select",""],["","60505257908","ATORVASTATIN","TAB 20MG","90","Select","Select",""],["","69097015807","MELOXICAM","TAB 7.5MG","60","Select","Select",""],["","40985027416","D3 SUPER STR","CAP 2000UNIT","30","Select","Select",""],["","00832167011","FLUVOXAMINE","TAB 25MG","30","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00054418425","DEXAMETHASON","TAB 4MG","14","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","45802095301","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","00832105515","BACLOFEN","TAB 20MG","20","Select","Select",""],["","00555077902","MEDROXYPR AC","TAB 10MG","7","Select","Select",""],["","23155019101","BUPROPION","TAB 75MG","30","Select","Select",""],["","80777027310","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","68462025501","ROPINIROLE","TAB 1MG","30","Select","Select",""],["","60505036302","OFLOXACIN","DRO 0.3%OTIC","10","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","20","Select","Select",""],["","64380079901","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","70954006020","PREDNISONE","TAB 20MG","7","Select","Select",""],["","64380076921","PEG-3350\/KCL","SOL \/SODIUM","4000","Select","Select",""],["","11917017094","VITAMIN D3","CAP 2000UNIT","90","Select","Select",""],["","65862018501","CLINDAMYCIN HCL","150 MG","28","Select","Select",""],["","60505015801","BUPROPION HCL","75 MG","30","Select","Select",""],["","00115180401","HYDROXYZINE PAMOATE","50 MG","90","Select","Select",""],["","00832167011","FLUVOXAMINE MALEATE","25 MG","30","Select","Select",""],["","68462025501","ROPINIROLE HCL","1 MG","30","Select","Select",""],["","00116200116","CHLORHEXIDINE GLUCONATE","0.12 %","473","Select","Select",""],["","00093005401","BUSPIRONE HCL","10 MG","180","Select","Select",""],["","64380080707","IBUPROFEN","800 MG","28","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":""}]}]}