{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TIFFANY L NELSON","gend":1,"add":"PO BOX 96","city":"LOUISA","state":"VA","zip":"23093-9998","dob":"1976-06-08","age":"","mstatus":"","insh":"2276104*01","cliId":"","pno":5402236936,"cno":5402236936,"email":"","ename":"","eno":"","pphy":"KRUSCHWITZ, ERIN NP","ppno":5409679401,"pcpadd":"115 JEFFERSON HIGHWAY SUITE 9,","pcpcity":"LOUISA","pcpstate":"VA","pcpzip":"23093-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5409679405,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.9","F11.20","F12.10","Z71.51","F32.9","G50.0","G47.00","D72.829","N30.01","M54.5","R30.0","G89.29","F41.1","F11.21","F13.10","F33.0","F14.10","Z20.822","F10.21","F14.21","F12.21","F31.81","F13.21","NO DATA","K59.00","G25.81","F33.9","N92.0","M25.511","M25.531","Z20.828","Z23.","R07.1","R39.9","Z01.419","Z30.011","F11.23","F19.10","F43.10","R92.8","U07.1","R51.9","J02.9","F13.20","F14.20","S16.1XXA","V89.2XXA","Y92.410","Y93.89","R11.2","S93.402A","Z12.4","N94.6","R10.84","R52.","R06.9","R00.1","R11.0","S99.912A","F39.","F31.9","F40.01","K21.9","N39.0","F17.290","J31.0","R00.0","J30.9","M79.2","J30.2","H10.13","J30.89"],"date":["2021-10-29","2022-12-01","2022-12-01","2021-02-28","2023-09-06","2022-06-08","2021-05-17","2021-05-17","2021-08-31","2021-08-31","2023-06-19","2021-08-31","2022-12-01","2022-02-23","2022-11-30","2021-12-02","2022-12-01","2022-01-19","2022-11-30","2022-02-23","2022-02-23","2022-02-14","2022-02-23","2022-12-01","2022-11-30","2022-11-30","2022-11-30","2023-01-19","2021-10-01","2021-01-14","2021-05-03","2021-05-13","2021-08-12","2021-10-01","2022-11-03","2022-11-03","2021-02-25","2021-06-30","2022-03-15","2021-07-27","2022-01-14","2023-01-19","2022-01-14","2022-03-15","2022-03-15","2021-01-26","2021-01-26","2021-01-26","2021-01-26","2023-06-19","2021-10-05","2022-11-03","2023-01-19","2023-06-19","2021-05-06","2021-05-06","2021-05-06","2021-05-06","2021-10-11","2021-10-29","2021-10-29","2021-10-29","2023-01-19","2023-06-19","2023-06-19","2023-08-03","2023-06-19","2023-09-06","2023-09-06","2023-08-03","2023-08-03","2023-08-03"],"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":[["","16729013616","CLONAZEPAM","TAB 0.5MG","1","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","30","Select","Select",""],["","13668000705","ZOLPIDEM","TAB 5MG","30","Select","Select",""],["","00603188016","LIDOCAINE","5 %","10","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","8","Select","Select",""],["","60505025203","TIZANIDINE","TAB 4MG","40","Select","Select",""],["","42806016005","HYDROXYZ HCL","TAB 25MG","120","Select","Select",""],["","70710122600","AMITRIPTYLIN","TAB 25MG","30","Select","Select",""],["","69097094312","GABAPENTIN","300 MG","30","Select","Select",""],["","13668013601","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","69097084507","CYCLOBENZAPR","TAB 5MG","6","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","60","Select","Select",""],["","00172392770","DIAZEPAM","TAB 10MG","11","Select","Select",""],["","59651039001","BUSPIRONE","TAB 7.5MG","90","Select","Select",""],["","57664051083","MIRTAZAPINE","TAB 7.5MG","28","Select","Select",""],["","59746011306","PROCHLORPER","TAB 5MG","10","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","00093031101","LOPERAMIDE","CAP 2MG","20","Select","Select",""],["","00228212750","CLONIDINE","TAB 0.1MG","14","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","10","Select","Select",""],["","00228202950","ALPRAZOLAM","TAB 0.5MG","15","Select","Select",""],["","70436001002","BUPROPN HCL","TAB 150MG XL","90","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","20","Select","Select",""],["","68382002310","ATENOLOL","TAB 50MG","30","Select","Select",""],["","13668004701","LAMOTRIGINE","100 MG","180","Select","Select",""],["","50111064701","FLUOXETINE","CAP 10MG","5","Select","Select",""],["","00115165903","PROPRANOLOL","TAB 10MG","28","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","16729008110","NALTREXONE","TAB 50MG","30","Select","Select",""],["","69097015807","MELOXICAM","TAB 7.5MG","30","Select","Select",""],["","49884030802","CLONAZEP ODT","TAB 0.5MG","8","Select","Select",""],["","51991074690","DULOXETINE","CAP 20MG","60","Select","Select",""],["","66689000816","NYSTATIN","SUS 100000","100","Select","Select",""],["","00116200116","CHLORHEX GLU","SOL 0.0012","473","Select","Select",""],["","14539067501","HYDROXYZ PAM","CAP 50MG","90","Select","Select",""],["","59676058005","JANSSEN VACC","INJ COVID-19","0","Select","Select",""],["","58160088752","FLUARIX QUAD","INJ 2021-22","0","Select","Select",""],["","63402030430","LATUDA","TAB 40MG","28","Select","Select",""],["","00093226301","AMOXICILLIN","TAB 500MG","30","Select","Select",""],["","00536340501","NICOTINE POL","GUM 4MG","200","Select","Select",""],["","65757030001","VIVITROL","INJ 380MG","1","Select","Select",""],["","00093216568","NALOXONE HCL","SPR ","1","Select","Select",""],["","45802048678","DOCUSATE SOD","CAP 100MG","30","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","30","Select","Select",""],["","64380074605","PRAMIPEXOLE","TAB 0.125MG","30","Select","Select",""],["","80681007100","VITAMIN B-12","TAB 100MCG","30","Select","Select",""],["","59779030603","CVS PURELAX","POW ","510","Select","Select",""],["","71930005552","APAP\/CODEINE","TAB 300-30MG","8","Select","Select",""],["","00832105410","BACLOFEN","TAB 10MG","45","Select","Select",""],["","50268085215","VITAMIN B12","TAB 100MCG","30","Select","Select",""],["","80777028299","MODERNA BIVA","INJ BA4\/BA5","0","Select","Select",""],["","68462030529","NORETHINDRON","TAB 0.35MG","84","Select","Select",""],["","96439001101","RESET","MIS ","1","Select","Select",""],["","70461032203","FLUCLVX QUAD","INJ 2022-23","0","Select","Select",""],["","64380074805","PRAMIPEXOLE DIHYDROCHLORIDE","0.5 MG","30","Select","Select",""],["","00280006502","ASTEPRO ALLERGY","205.5 MCG","23","Select","Select",""],["","68462030529","NORETHINDRONE","0.35 MG","84","Select","Select",""],["","68180086111","AZITHROMYCIN","250 MG","6","Select","Select",""],["","16571040250","CETIRIZINE HCL","10 MG","90","Select","Select",""],["","70436001002","BUPROPION XL","150 MG","30","Select","Select",""],["","70436005901","BUPROPION HCL SR","150 MG","90","Select","Select",""],["","47781030301","NITROFURANTOIN MONO-MACRO","100 MG","14","Select","Select",""],["","64980030550","DENTA","5000 PLUS 1.1 %","51","Select","Select",""],["","42806016005","HYDROXYZINE HCL","25 MG","90","Select","Select",""],["","50111033401","METRONIDAZOLE","500 MG","30","Select","Select",""],["","57237016199","OMEPRAZOLE","20 MG","30","Select","Select",""],["","49483060350","IBUPROFEN","600 MG","60","Select","Select",""],["","65862057490","MONTELUKAST SODIUM","10 MG","30","Select","Select",""],["","69097083305","SERTRALINE HCL","25 MG","45","Select","Select",""],["","69584009150","BUSPIRONE HCL","5 MG","60","Select","Select",""],["","50268085215","VITAMIN B-","12 100 MCG","30","Select","Select",""],["","68462010630","ONDANSETRON HCL","8 MG","30","Select","Select",""],["","16571041250","CIPROFLOXACIN HCL","500 MG","14","Select","Select",""],["","65862039010","ONDANSETRON ODT","4 MG","12","Select","Select",""],["","67877054360","CEFDINIR","300 MG","14","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":""}]}]}