{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JENNIFER SEKELY","gend":1,"add":"739 LAKEVIEW PKWY","city":"LOCUST GROVE","state":"VA","zip":"22508-9998","dob":"1974-01-26","age":"","mstatus":"","insh":"2376194*01","cliId":"","pno":5408425366,"cno":5408425366,"email":"","ename":"","eno":"","pphy":"WAGNER, BRITTNEY NP","ppno":5409727798,"pcpadd":"4376 GERMANNA HWY,","pcpcity":"LOCUST GROVE","pcpstate":"VA","pcpzip":"22508-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5409723536,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z51.11","C41.9","G89.29","J30.2","Z72.0","F41.1","G89.3","F17.210","R31.9","M54.9","R31.29","K59.00","L23.7","K12.1","R91.8","F41.9","Z20.822","Z79.899","Z72.89","Z51.81","J96.01","J18.9","R77.8","E87.6","Z47.89","Z87.891","C40.01","J44.9","Z96.611","Z82.3","Z80.1","Z80.3","R31.21","M25.611","M62.81","R22.31","C40.02","C40.21","C79.89","Z96.619","E87.70","Z87.01","Z87.09","K21.9","M54.16","M54.17","NO DATA","M51.36","M51.37","M47.816","R06.00","R00.0","D64.9","M89.8X2","Z01.818","R22.30","D49.2","N13.5","N90.89","Z45.2","N94.9","F10.10","F14.90","D64.81","T45.1X5A","Z91.89","Z09.","Z01.89","D61.810","R11.2","T83.32XA","Z53.8","S09.90XA","S00.01XA","F10.120","F32.1","Z13.39","Z13.31","Z87.448","K52.1","E04.1","R06.02","R06.2","V58.89","S43.101D","M25.511","R11.0","Z91.09","J12.9","J20.6","B34.1","R79.89","Z01.810","N83.201","S09.8XXA","F10.129","M47.812","M62.830","R44.0","D64.89","R26.89","Z91.81","Z23.","M79.89","M25.421","Z97.5","T83.39XA","E87.3","I24.8","J44.0","J44.1","J21.0","K76.9","E87.8","E86.0","R74.01","E07.9","B00.1","M48.02","F12.90","G62.9","S43.101S","S49.80XA","G89.18","R82.71","D89.9","K09.8","I51.7","N88.2","N90.7","Z71.6","Z30.430"],"date":["2022-04-05","2023-05-18","2022-03-31","2021-07-02","2023-05-31","2023-05-18","2022-02-20","2021-12-01","2023-05-31","2022-02-01","2022-03-31","2021-09-28","2021-07-16","2021-07-16","2021-07-16","2021-07-16","2022-03-31","2022-03-31","2022-03-08","2022-03-31","2022-11-03","2021-12-25","2021-12-20","2021-12-20","2022-09-27","2022-03-31","2022-03-31","2022-11-03","2022-09-27","2022-03-31","2022-03-31","2022-03-31","2023-06-23","2022-11-09","2022-11-09","2021-04-21","2021-08-18","2021-08-18","2021-09-09","2022-01-04","2022-01-04","2022-01-04","2022-02-01","2022-02-01","2023-01-31","2023-01-31","2022-10-12","2023-01-31","2023-01-31","2022-10-12","2022-11-03","2022-11-07","2021-11-14","2021-08-04","2021-08-04","2021-08-04","2021-08-04","2021-10-13","2021-10-13","2022-05-06","2022-08-24","2021-12-25","2021-05-20","2021-12-01","2022-04-05","2021-07-21","2021-11-09","2021-12-01","2021-12-04","2022-04-05","2021-12-06","2021-12-06","2022-08-28","2022-08-28","2022-08-28","2023-05-18","2022-11-07","2022-11-07","2022-02-20","2022-04-05","2023-05-08","2022-11-03","2022-11-03","2023-05-01","2021-03-18","2021-12-07","2022-03-31","2021-11-14","2021-12-16","2021-12-25","2021-12-25","2021-12-25","2022-02-01","2022-08-24","2022-08-28","2022-08-28","2022-08-28","2022-08-28","2022-08-28","2021-07-02","2021-08-20","2021-09-28","2021-09-28","2021-10-02","2021-10-03","2023-04-05","2021-12-06","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2022-03-08","2022-03-08","2022-03-08","2022-03-31","2021-03-18","2021-03-18","2021-08-18","2021-11-11","2021-12-25","2023-04-05","2023-05-18","2023-06-05","2023-06-05","2023-05-31","2023-06-05"],"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":[["","16714079904","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","00023050601","REFRESH","DRO OP","30","Select","Select",""],["","43598044674","NICOTINE TD","DIS 7MG\/24HR","14","Select","Select",""],["","00536340501","NICOTINE POL","GUM 4MG","100","Select","Select",""],["","55513019001","NEULASTA","INJ 6MG\/0.6M","1","Select","Select",""],["","55111015430","ONDANSETRON","TAB 8MG","20","Select","Select",""],["","10006073021","VITAMIN B1","TAB 100MG","36","Select","Select",""],["","45802086801","POLYETH GLYC","POW 3350 NF","238","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","68585000801","ZINC SULFATE","CAP 220MG","90","Select","Select",""],["","31722077701","ACYCLOVIR","TAB 400MG","180","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","20","Select","Select",""],["","69618001001","ACETAMIN","TAB 325MG","60","Select","Select",""],["","00603188016","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","00054418425","DEXAMETHASON","TAB 4MG","8","Select","Select",""],["","00406324301","HYDROMORPHON","TAB 2MG","84","Select","Select",""],["","50228017705","GABAPENTIN","TAB 600MG","30","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","00904679480","ASPIRIN LOW","CHW 81MG","84","Select","Select",""],["","59746011506","PROCHLORPER","TAB 10MG","30","Select","Select",""],["","00023324015","REFRESH OPTI","DRO 0.5-0.9%","30","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","29300035505","TRAMADOL HCL","50 MG","28","Select","Select",""],["","80777027399","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","17","Select","Select",""],["","0","COMPOUND"," ","150","Select","Select",""],["","50383066730","LIDO\/PRILOCN","CRE 2.5-2.5%","30","Select","Select",""],["","00406051201","OXYCOD\/APAP","TAB 5-325MG","15","Select","Select",""],["","00054001829","PREDNISONE","TAB 20MG","2","Select","Select",""],["","00904676320","ROBAFEN","LIQ 200\/10ML","720","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","20","Select","Select",""],["","49035045875","ALLERGY REL","TAB 10MG","30","Select","Select",""],["","00378967193","IPRATROPIUM\/","SOL ALBUTER","360","Select","Select",""],["","49035053260","EQ NICOTINE","GUM 4MG MINT","20","Select","Select",""],["","00121174410","GUAIFENESIN","SOL 100\/5ML","1180","Select","Select",""],["","00093342501","LORAZEPAM","0.5 MG","20","Select","Select",""],["","60505024701","MIRTAZAPINE","15 MG","90","Select","Select",""],["","80777028299","MODERNA BIVA","INJ BA4\/BA5","0","Select","Select",""],["","00832105415","BACLOFEN","TAB 10MG","60","Select","Select",""],["","49281072210","FLUBLOK QUAD","INJ 2022-23","0","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","00597007541","SPIRIVA HANDIHALER","18 MCG","30","Select","Select",""],["","00536340501","NICOTINE GUM","4 MG","100","Select","Select",""],["","68180096301","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","43598044674","NICOTINE PATCH","7MG\/24HR","14","Select","Select",""],["","43386016106","MISOPROSTOL","200 MCG","3","Select","Select",""],["","70010016305",""," ","30","Select","Select",""],["","49035053260","EQ NICOTINE GUM","4MG MINT","60","Select","Select",""],["","43598044674","NICOTINE TD DIS","7MG\/24HR","14","Select","Select",""],["","00054418425","DEXAMETHASON TAB","4MG","8","Select","Select",""],["","42806071401","BENZONATATE CAP","100MG","20","Select","Select",""],["","00121174410","GUAIFENESIN SOL","100\/5ML","1180","Select","Select",""],["","16714079904","CETIRIZINE TAB","10MG","30","Select","Select",""],["","55111015430","ONDANSETRON TAB","8MG","20","Select","Select",""],["","55513019001","NEULASTA INJ","6MG\/0.6M","1","Select","Select",""],["","57664037708","TRAMADOL HCL TAB","50MG","28","Select","Select",""],["","00536311301","NICOTINE POL GUM","4MG MINT","100","Select","Select",""],["","59746011506","PROCHLORPER TAB","10MG","30","Select","Select",""],["","50228017705","GABAPENTIN TAB","600MG","30","Select","Select",""],["","60505024701","MIRTAZAPINE TAB","15MG","30","Select","Select",""],["","00093342501","LORAZEPAM TAB","0.5MG","20","Select","Select",""],["","80777027399","MODERNA VAC INJ COVID-","19","0","Select","Select",""],["","00832105415","BACLOFEN TAB","10MG","60","Select","Select",""],["","00597007541","SPIRIVA CAP HANDIHLR","","30","Select","Select",""],["","49281072210","FLUBLOK QUAD INJ","2022-23","0","Select","Select",""],["","80777028299","MODERNA BIVA INJ BA","4\/BA5","0","Select","Select",""],["","68180096301","ALBUTEROL AER HFA","","17","Select","Select",""],["","00135047502","NICORETTE","4 MG","100","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":""}]}]}