{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KERRIE D PERKINS","gend":1,"add":"149 SHORTMANS ROAD","city":"MINERAL","state":"VA","zip":"23117-9998","dob":"1986-06-21","age":"","mstatus":"","insh":"2434138*01","cliId":"","pno":5404291850,"cno":5404291850,"email":"","ename":"","eno":"","pphy":"VONELTEN, CHRISTOPHER B MD","ppno":4344009668,"pcpadd":"631 BERKMAR CIRCLE,","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":"22901-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4343814367,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F12.90","R11.2","R10.13","R10.84","F17.210","Z20.822","B18.2","F10.10","F11.20","F13.10","F15.10","F17.200","F31.9","F33.0","F41.1","F13.20","F43.12","G47.01","L02.91","F11.23","F11.29","F11.93","R40.4","R56.9","R40.20","R09.02","R00.0","R41.82","R06.89","J96.02","N17.9","NO DATA","F41.9","F90.9","F50.2","F41.0","F11.21","F43.10","R07.89","F33.1","O99.322","O98.412","F50.9","G40.909","O99.352","O98.812","L02.01","F14.129","O99.332","O99.342","K02.9","J96.01","E87.2","E86.0","D72.829","Z87.891","R45.1","F33.2","G47.00","Z72.0","R55.","I49.3","G89.29","F31.60","Z3A.25","Z33.1","O99.891","Z3A.00","Z11.59","K08.9","Z20.828","Z79.899","F51.04","B19.20","G25.81","Z86.59","K21.9","F19.90","I48.91","G93.40","F19.921","F14.10","V23.7","Z3A.17","Z3A.16","O09.513","Z3A.28","O98.413","R23.8","K59.00","Z3A.30","K04.7","O99.613","O99.323","O09.523","O99.713","O98.313","B00.9","Z3A.32","O36.5930","Z3A.35","O14.15","A60.00","Z3A.36","Z39.2","O99.343","O98.513","Z36.4","Z34.90","V23.9","O76.","O98.42","O99.324","O99.354","G40.89","Z3A.37","Z37.0","O99.344","O36.5990","O98.419","O99.340","O98.519","Z39.1","Z34.82","Z34.83","O14.14","O98.52","O99.334","F31.31","O28.3"],"date":["2023-02-07","2023-02-07","2023-02-07","2023-02-07","2023-02-07","2023-02-07","2023-08-26","2023-03-02","2023-09-26","2023-03-02","2023-08-17","2023-09-26","2023-09-22","2023-03-02","2023-09-26","2023-03-02","2023-09-26","2023-03-02","2023-07-27","2023-04-08","2023-08-24","2023-04-13","2022-02-12","2023-08-24","2022-02-12","2022-02-12","2022-02-12","2023-04-03","2022-02-15","2022-02-15","2022-02-15","2023-09-26","2023-08-25","2022-02-15","2022-02-15","2022-02-15","2022-02-15","2023-08-26","2022-02-23","2023-09-26","2023-06-06","2023-06-06","2023-08-17","2023-08-25","2023-04-02","2023-04-02","2023-04-03","2023-04-02","2023-04-02","2023-06-06","2023-04-02","2022-02-12","2022-02-12","2022-02-12","2022-02-12","2022-02-12","2023-04-03","2022-02-08","2022-02-08","2023-09-26","2022-02-25","2022-02-25","2023-02-09","2023-06-06","2023-06-06","2023-08-17","2023-08-11","2023-04-02","2023-04-02","2023-07-03","2023-04-17","2023-08-25","2022-02-04","2022-02-04","2022-02-04","2022-02-04","2023-07-13","2022-02-04","2022-02-14","2023-04-03","2023-04-03","2023-04-08","2023-04-08","2023-04-08","2023-04-08","2023-08-11","2023-06-27","2023-08-17","2023-06-30","2023-06-30","2023-07-13","2023-07-13","2023-07-13","2023-08-24","2023-08-24","2023-07-27","2023-08-24","2023-08-25","2023-07-27","2023-08-26","2023-08-17","2023-08-29","2023-08-24","2023-08-24","2023-08-30","2023-08-17","2023-08-17","2023-08-11","2023-08-24","2023-08-24","2023-08-26","2023-08-26","2023-08-26","2023-08-26","2023-08-26","2023-08-26","2023-08-26","2023-08-26","2023-08-24","2023-08-17","2023-08-17","2023-08-17","2023-08-18","2023-08-18","2023-08-18","2023-08-25","2023-08-25","2023-08-25","2023-08-01","2023-08-24"],"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":[["","65862019405","FLUOXETINE CAP","40MG","60","Select","Select",""],["","43547026810","ROPINIROLE TAB","0.25MG","60","Select","Select",""],["","49483060350","IBUPROFEN TAB","600MG","16","Select","Select",""],["","00093310905","AMOXICILLIN CAP","500MG","28","Select","Select",""],["","65862096701","ESZOPICLONE TAB","1MG","14","Select","Select",""],["","55111052130","ATOMOXETINE CAP","40MG","90","Select","Select",""],["","50428067309","CVS D","3 CAP 1000UNIT","30","Select","Select",""],["","31604001870","VITAMIN D TAB","1000UNIT","30","Select","Select",""],["","65862024708","LEVETIRACETA TAB","750MG","60","Select","Select",""],["","57237016199","OMEPRAZOLE CAP","20MG","60","Select","Select",""],["","57664049983","MIRTAZAPINE TAB","15MG","30","Select","Select",""],["","65162018810","NAPROXEN TAB","250MG","20","Select","Select",""],["","31604001870","VITAMIN D","TAB 1000UNIT","30","Select","Select",""],["","72252050502","VALTOCO SPR","5MG","2","Select","Select",""],["","70710122600","AMITRIPTYLIN TAB","25MG","30","Select","Select",""],["","50428043019","CVS B","6 TAB 100MG","30","Select","Select",""],["","00074262528","MAVYRET TAB","100-40MG","84","Select","Select",""],["","00536137223","NICOTINE GUM","4 MG","200","Select","Select",""],["","12496120803","SUBOXONE","8 MG-2 MG","14","Select","Select",""],["","00054017713","BUPRENORPHINE HCL","8 MG","28","Select","Select",""],["","49483070210","FLUOXETINE HCL","20 MG","30","Select","Select",""],["","23155050105","HYDROXYZINE HCL","25 MG","90","Select","Select",""],["","60505024701","MIRTAZAPINE","15 MG","30","Select","Select",""],["","60687043198","HEALTHYLAX","17 G","36","Select","Select",""],["","16103036311","SENNA","8.6 MG","120","Select","Select",""],["","68001040303","LEVETIRACETAM","500 MG","60","Select","Select",""],["","87701040813","MELATONIN","3 MG","60","Select","Select",""],["","61874013030","VRAYLAR","3 MG","30","Select","Select",""],["","51660052605","ALLERGY RELIEF","10 MG","30","Select","Select",""],["","68462010530","ONDANSETRON HCL","4 MG","20","Select","Select",""],["","46122001452","CLEARLAX","17 G","60","Select","Select",""],["","68645056259","IBUPROFEN","600 MG","30","Select","Select",""],["","00781261305","AMOXICILLIN","500 MG","30","Select","Select",""],["","68001043800","LORATADINE","10 MG","4","Select","Select",""],["","65862018601","CLINDAMYCIN HCL","300 MG","56","Select","Select",""],["","70436005901","BUPROPION HCL SR","150 MG","30","Select","Select",""],["","00536132710","ACETAMINOPHEN","325 MG","30","Select","Select",""],["","72140003868","EUCERIN","","114","Select","Select",""],["","57896085101","VITAMIN B-","1 100 MG","30","Select","Select",""],["","12496131002","SUBUTEX","8 MG","14","Select","Select",""],["","16571074024","NITROFURANTOIN","25 MG\/5 ML","10","Select","Select",""],["","00536589688","NICOTINE PATCH","21 MG\/24HR","28","Select","Select",""],["","50268067701","PRENATAL PLUS VITAMIN-MINERAL","27 MG-1 MG","90","Select","Select",""],["","60258019309","PRENATABS RX","29 MG-1 MG","90","Select","Select",""],["","58657017001","M-NATAL PLUS","27 MG-1 MG","30","Select","Select",""],["","65862044830","VALACYCLOVIR","500 MG","180","Select","Select",""],["","77333071510","PRENATAL","27MG-0.8MG","90","Select","Select",""],["","68645059459","FAMOTIDINE","20 MG","180","Select","Select",""],["","43386031208","GAVILAX","17 G\/DOSE","238","Select","Select",""],["","39328010610","PRENATAL VITAMIN PLUS LOW IRON","27 MG-1 MG","90","Select","Select",""],["","63402030430","LATUDA","40 MG","30","Select","Select",""],["","43547026810","ROPINIROLE","TAB 0.25MG","30","Select","Select",""],["","65862019405","FLUOXETINE","CAP 40MG","180","Select","Select",""],["","65862096701","ESZOPICLONE","TAB 1MG","14","Select","Select",""],["","55111052130","ATOMOXETINE","CAP 40MG","90","Select","Select",""],["","30768019936","VITAMIN D3","CAP 1000UNIT","30","Select","Select",""],["","50428067309","CVS D3","CAP 1000UNIT","30","Select","Select",""],["","72252050502","VALTOCO","SPR 5MG","2","Select","Select",""],["","65862024708","LEVETIRACETA","TAB 750MG","60","Select","Select",""],["","57237016199","OMEPRAZOLE","CAP 20MG","60","Select","Select",""],["","65162018810","NAPROXEN","TAB 250MG","20","Select","Select",""],["","50428043019","CVS B6","TAB 100MG","30","Select","Select",""],["","00074262528","MAVYRET","TAB 100-40MG","84","Select","Select",""],["","70710122600","AMITRIPTYLIN","TAB 25MG","30","Select","Select",""],["","00406055201","OXYCODONE HCL","5 MG","15","Select","Select",""],["","70756061030","OFLOXACIN","0.3 %","10","Select","Select",""],["","00093220301","METOCLOPRAMIDE HCL","10 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":""}]}]}