{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"THOMAS B GORDON","gend":0,"add":"1074 CELT ROAD","city":"STANARDSVILLE","state":"VA","zip":"22973-9998","dob":"1974-04-02","age":"","mstatus":"","insh":"2404224*01","cliId":"","pno":4349731234,"cno":4349731234,"email":"","ename":"","eno":"","pphy":"YEAMAN, ALLISON MD","ppno":4346544600,"pcpadd":"3263 PROFIT RD STE 101,","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":"22911-9998","pcpcounty":"","pcpid":"","pcpname":"SMJMG - Sentara Forest Lakes Family Medicine","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4349751384,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.2","F22.","F33.9","F41.9","F90.9","F41.1","M79.672","M79.671","R52.","F29.","Z71.6","R07.9","R25.2","S39.012A","Z79.899","M79.662","M79.661","R07.89","R06.02","R11.0","NO DATA","Z88.1","R53.1","F41.0","Z72.0","F25.1","R10.13","I20.0","F17.210","M25.571","R68.83","S90.821A","S90.822A","I10.","Z53.21","H04.123","H53.19","H53.60","R73.9","R09.02","R06.89","R94.31","V62.84","M54.9"],"date":["2023-08-24","2022-08-26","2021-11-03","2022-06-06","2021-11-03","2022-05-30","2022-01-31","2022-01-31","2022-06-23","2022-08-28","2022-08-28","2022-04-01","2021-09-30","2022-06-23","2021-09-15","2021-09-30","2021-09-30","2021-09-30","2021-09-30","2021-09-30","2021-09-30","2022-06-17","2022-05-21","2022-04-01","2022-04-01","2022-08-26","2021-08-18","2022-04-01","2022-06-17","2022-06-17","2022-06-17","2022-06-17","2022-06-17","2022-06-17","2021-08-24","2022-01-05","2022-01-05","2022-01-05","2022-05-21","2022-05-21","2022-05-21","2022-05-21","2022-06-06","2022-06-23"],"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":[["","23155050110","HYDROXYZ HCL","TAB 25MG","30","Select","Select",""],["","16729020101","BUSPIRONE","TAB 7.5MG","60","Select","Select",""],["","52817033050","CYCLOBENZAPR","TAB 5MG","20","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","00536338601","NICOTINE POL","GUM 2MGFRUIT","100","Select","Select",""],["","68462039610","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","64380080807","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","55111016830","OLANZAPINE","20 MG","90","Select","Select",""],["","68462013801","OXCARBAZEPIN","TAB 300MG","90","Select","Select",""],["","68001018000","QUETIAPINE","TAB 50MG","30","Select","Select",""],["","68001018300","QUETIAPINE FUMARATE","300 MG","60","Select","Select",""],["","68462013801","OXCARBAZEPINE","300 MG","30","Select","Select",""],["","27808022301","PALIPERIDONE ER","3 MG","7","Select","Select",""],["","60505327803","OLANZAPINE ODT","20 MG","30","Select","Select",""],["","50111056002","TRAZODONE HCL","50 MG","60","Select","Select",""],["","50458056301","INVEGA SUSTENNA","156 MG\/ML","1","Select","Select",""],["","29300024601","BUSPIRONE HCL","15 MG","60","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":""}]}]}