{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BLAKE CREWS","gend":0,"add":"2133 DUDLEY ROAD","city":"HALIFAX","state":"VA","zip":"24558-9998","dob":"1990-03-14","age":"","mstatus":"","insh":"2263618*01","cliId":"","pno":4344467350,"cno":4344467350,"email":"","ename":"","eno":"","pphy":"LE, UYEN MD","ppno":4345728921,"pcpadd":"1020 BILL TUCK HWY STE 900","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":4345751290,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F60.3","Z51.81","F14.21","F19.10","F41.1","T50.901A","J69.0","A41.9","T43.592A","J14.","J15.212","F25.9","NO DATA","E83.42","F60.2","T42.1X2A","R33.9","F17.210","T42.4X2A","S09.90XA","M54.2","F60.0","J06.9","R05.9","Z20.828","L50.0","L50.9","F33.2","F15.20","J02.9","Z76.5","R68.84","J30.9","V62.84","F10.10","F15.10","F12.10","Z20.822","F32.0","R00.0","X78.9XXA","F31.60","F11.20","F14.20","F10.20","F12.20","R03.0","V62.85","E78.5","F17.200","Z11.52","F41.8","T78.40XA","R23.2","Z03.818","R40.0","J60.","J18.9","T78.2XXA","R06.89","L29.9","Z91.010","Z91.018","Z81.1","Z91.51","Z00.00","A09.","R06.00","Z20.2","I10.","F32.3","M25.521"],"date":["2023-03-03","2023-03-03","2021-05-06","2023-03-03","2022-07-05","2022-06-28","2022-06-23","2022-06-28","2022-06-30","2022-06-30","2022-06-30","2022-06-30","2022-06-30","2022-06-30","2023-03-03","2022-06-30","2022-06-30","2022-06-30","2022-06-30","2022-07-19","2022-07-20","2022-10-21","2022-12-15","2022-03-02","2022-03-02","2022-02-12","2022-02-12","2023-03-02","2023-03-02","2023-03-13","2022-01-20","2022-03-24","2022-03-24","2023-02-27","2023-02-23","2023-02-27","2023-02-23","2023-02-23","2022-07-05","2022-06-16","2022-06-16","2023-02-27","2023-02-27","2023-02-27","2023-02-27","2023-02-27","2023-02-27","2023-02-27","2023-02-27","2023-02-27","2022-09-06","2021-04-30","2022-02-12","2021-08-15","2022-05-31","2022-06-16","2022-06-16","2022-07-07","2022-02-12","2022-02-12","2022-02-12","2022-06-16","2022-06-16","2022-06-16","2022-06-16","2022-07-19","2023-01-17","2022-02-12","2023-02-23","2023-02-25","2023-02-25","2023-05-22"],"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":[["","00781107710","ALPRAZOLAM","TAB 0.5MG","8","Select","Select",""],["","00185041501","BUPROPION","TAB 150MG SR","180","Select","Select",""],["","64764073030","TRINTELLIX","10 MG","15","Select","Select",""],["","00591544310","PREDNISONE","20 MG","10","Select","Select",""],["","67877025001","QUETIAPINE","TAB 100MG","30","Select","Select",""],["","00456224030","FETZIMA","CAP 40MG","30","Select","Select",""],["","69238207801","PROPRANOLOL","TAB 20MG","180","Select","Select",""],["","70436015542","PROMETHAZINE","SOL DM","240","Select","Select",""],["","00904530660","BANOPHEN","CAP 25MG","30","Select","Select",""],["","49502010202","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","10","Select","Select",""],["","60432060616","PROMETH\/COD","SOL 6.25-10","240","Select","Select",""],["","00143993905","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","65162062711","TRAMADOL HCL","TAB 50MG","12","Select","Select",""],["","00378113401","KETOROLAC","TAB 10MG","15","Select","Select",""],["","00045029721","TYLENOL 8 HR","TAB 650MG","30","Select","Select",""],["","42571016101","AMOX\/K CLAV","TAB 500-125","20","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","51672400501","CARBAMAZEPIN","TAB 200MG","60","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","12","Select","Select",""],["","67877021620","CEFUROXIME","TAB 500MG","6","Select","Select",""],["","00591024110","LORAZEPAM","TAB 1MG","5","Select","Select",""],["","27808023302","DOXYCYCL HYC","CAP 100MG","10","Select","Select",""],["","69584061150","METHOCARBAM","TAB 500MG","20","Select","Select",""],["","00536101001","DIPHENHIST","CAP 25MG","24","Select","Select",""],["","69452027120","LOPERAMIDE","2 MG","15","Select","Select",""],["","68462015740","ONDANSETRON","TAB 4MG ODT","14","Select","Select",""],["","69618002401","DIPHENHYDRAM","CAP 25MG","24","Select","Select",""],["","60505017007","PRAVASTATIN","TAB 40MG","30","Select","Select",""],["","70147031316","CODITUSSIN","LIQ AC","236","Select","Select",""],["","00121077516","GG\/CODEINE","SOL 100-10\/5","236","Select","Select",""],["","42571016201","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","20","Select","Select",""],["","00185067605","HYDROXYZINE PAMOATE","50 MG","60","Select","Select",""],["","78112001106","CHLORASEPTIC SORE THROAT","6 MG-10 MG","18","Select","Select",""],["","68462015713","ONDANSETRON ODT","4 MG","30","Select","Select",""],["","42806001105","SULINDAC","200 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":""}]}]}