{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LATIERA K BROWN","gend":1,"add":"488 COUNTRY ESTATES ROAD","city":"APPOMATTOX","state":"VA","zip":"24522-9998","dob":"1980-03-05","age":"","mstatus":"","insh":"6612814*01","cliId":"","pno":4349415144,"cno":4349415144,"email":"","ename":"","eno":"","pphy":"ALTIZER, KIMBERLY NP","ppno":4346561717,"pcpadd":"291 MCBRIDE LANE,","pcpcity":"GRETNA","pcpstate":"VA","pcpzip":"24557-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4342007211,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z71.3","E66.01","Z68.41","Z68.43","G47.33","K44.9","K21.9","E78.5","M25.569","S01.81XA","W01.198A","F32.9","K92.1","E55.9","Z78.9","Z68.42","E66.9","Z68.34","Z98.84","M25.50","N25.81","H10.413","K91.2","Z68.37","J06.9","E86.0","L98.7","L30.4","R68.2","R82.998","R68.89","N89.8","R06.02","R53.83","R82.90"],"date":["2022-03-30","2022-10-05","2022-08-26","2022-03-09","2023-03-01","2022-02-28","2023-09-06","2023-09-06","2021-11-24","2021-11-28","2021-11-28","2022-02-03","2022-02-03","2023-08-29","2022-02-03","2022-02-03","2023-09-06","2023-03-01","2023-09-06","2023-03-01","2023-03-01","2021-12-06","2023-09-06","2022-10-05","2022-04-29","2022-03-06","2023-07-12","2023-08-29","2023-08-29","2023-08-29","2023-08-29","2023-08-29","2023-08-29","2023-08-29","2023-08-29"],"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":[["","69097083412","SERTRALINE","TAB 50MG","30","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","12","Select","Select",""],["","59651000305","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","69452015120","VITAMIN D","2 1250 MCG","4","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","45802048678","DOCUSATE SOD","CAP 100MG","60","Select","Select",""],["","70710113908","FLUCONAZOLE","150 MG","2","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","16729008110","NALTREXONE","TAB 50MG","30","Select","Select",""],["","70436001002","BUPROPN HCL","TAB 150MG XL","90","Select","Select",""],["","16729008110","NALTREXONE HCL","50 MG","30","Select","Select",""],["","82607066026","FLOWFLEX COVID-","19 AG HOME TEST","8","Select","Select",""],["","70436001002","BUPROPION XL","150 MG","90","Select","Select",""],["","60008040780","INDICAID COVID-","19 AG HOME TEST","8","Select","Select",""],["","69097083412","SERTRALINE TAB","50MG","30","Select","Select",""],["","65862039010","ONDANSETRON TAB","4MG ODT","20","Select","Select",""],["","45802048678","DOCUSATE SOD CAP","100MG","60","Select","Select",""],["","42858010201","OXYCOD\/APAP TAB","5-325MG","12","Select","Select",""],["","59651000305","OMEPRAZOLE CAP","40MG","30","Select","Select",""],["","69452015120","VITAMIN D CAP","50000UNT","4","Select","Select",""],["","70710113908","FLUCONAZOLE TAB","150MG","2","Select","Select",""],["","50111033401","METRONIDAZOL TAB","500MG","14","Select","Select",""],["","47781030301","NITROFURANTN CAP","100MG","10","Select","Select",""],["","16729008110","NALTREXONE TAB","50MG","30","Select","Select",""],["","70436001002","BUPROPN HCL TAB","150MG XL","90","Select","Select",""],["","00574200815","NYSTOP","100000\/G","60","Select","Select",""],["","50111033401","METRONIDAZOLE","500 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":""}]}]}