{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CRYSTAL SMITH","gend":1,"add":"4900 WHITMELL SCHOOL RD LOT 14","city":"DRY FORK","state":"VA","zip":"24549-9998","dob":"1986-02-21","age":"","mstatus":"","insh":"7349629*01","cliId":"","pno":4342036806,"cno":4342036806,"email":"","ename":"","eno":"","pphy":"SPICER, ELIZABETH G NP","ppno":4348573600,"pcpadd":"414 PARK AVE,","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":"24541-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4348573601,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["NO DATA","F41.0","F41.9","R10.30","Z32.02","R05.9","R06.2","J40.","M54.16","I10.","Z88.1","J01.90","K04.7","J32.9","R51.9","R10.31","N20.2","R10.2","N92.1","R19.00","N39.0","R39.15","B37.9","R30.0","Q50.4","E11.9","N87.9","G89.18","J02.0","L40.9","E78.5","M19.90","Z79.4","Z87.891","L40.50","M54.2","R53.83","R79.89","R70.0","R79.82","Z28.89","Z79.899","K50.90","I49.9","Z71.3","Z71.82","E66.01","N83.201","R87.613","A60.00","K50.00","N20.0","L40.0","K76.0","R10.32","Z53.20","G47.00","N89.8","E10.9","H53.143"],"date":["2023-05-26","2022-03-29","2022-03-29","2022-01-20","2022-01-20","2023-07-20","2022-04-11","2022-04-11","2023-05-26","2023-07-20","2023-05-02","2023-07-20","2022-08-23","2023-08-25","2023-08-25","2022-06-11","2022-06-11","2023-06-15","2023-06-15","2023-04-26","2022-08-10","2022-08-10","2022-08-10","2022-08-10","2023-06-15","2023-07-20","2023-06-15","2021-04-10","2022-05-30","2023-07-20","2023-07-20","2023-07-20","2023-07-20","2023-07-20","2022-03-29","2021-01-04","2021-01-04","2021-01-04","2021-01-04","2021-01-04","2021-01-04","2021-01-04","2022-03-29","2022-03-29","2022-03-29","2022-03-29","2022-03-29","2022-11-29","2022-11-29","2022-11-29","2022-11-29","2022-06-12","2023-01-05","2021-07-01","2021-08-27","2021-08-27","2021-12-22","2021-12-22","2022-03-01","2022-03-01"],"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":[["","00597015390","JARDIANCE","TAB 25MG","30","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","300","Select","Select",""],["","68645052354","SERTRALINE","TAB 100MG","30","Select","Select",""],["","00093005405","BUSPIRONE","TAB 10MG","60","Select","Select",""],["","53885004401","ONE TOUCH","KIT VERIO FL","1","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","100","Select","Select",""],["","68382080601","TRAZODONE","TAB 100MG","30","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","63304061650","DOXYCYC MONO","CAP 100MG","20","Select","Select",""],["","21922002411","TRIAMCINOLON","OIN 0.0005","430","Select","Select",""],["","00406048410","APAP\/CODEINE","TAB 300-30MG","30","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","15","Select","Select",""],["","00169413212","OZEMPIC","INJ 2\/1.5ML","2","Select","Select",""],["","68645058459","METFORMIN","TAB 1000MG","60","Select","Select",""],["","59572063106","OTEZLA","TAB 30MG","180","Select","Select",""],["","72205000390","ROSUVASTATIN","TAB 10MG","90","Select","Select",""],["","68645055654","LISINOP\/HCTZ","TAB 10-12.5","90","Select","Select",""],["","59746017509","PREDNISONE","20 MG","18","Select","Select",""],["","60432060416","PROMETHAZINE","SYP DM","120","Select","Select",""],["","00143928501","AMOXICILLIN","875 MG","20","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","20","Select","Select",""],["","00143924920","AMOX\/K CLAV","TAB 875-125","14","Select","Select",""],["","65162068110","PHENAZOPYRID","TAB 100MG","10","Select","Select",""],["","55111014512","FLUCONAZOLE","150 MG","2","Select","Select",""],["","65862044930","VALACYCLOVIR","TAB 1GM","20","Select","Select",""],["","49502039475","INSULIN GLAR","INJ 100U\/ML","15","Select","Select",""],["","65162047810","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","00074210001","SKYRIZI PEN","150 MG\/ML","1","Select","Select",""],["","65162019011","NAPROXEN","500 MG","30","Select","Select",""],["","53885027210","ONETOUCH VERIO TEST STRIP","","200","Select","Select",""],["","00406012301","HYDROCODONE-ACETAMINOPHEN","5 MG-325MG","60","Select","Select",""],["","49035013606","LIDOCAINE PAIN RELIEF","4 %","30","Select","Select",""],["","55111028130","LEVOFLOXACIN","750 MG","7","Select","Select",""],["","21922001707","CLOBETASOL PROPIONATE","0.05 %","60","Select","Select",""],["","29300041519","CYCLOBENZAPRINE HCL","10 MG","12","Select","Select",""],["","68180065208","DOXYCYCLINE MONOHYDRATE","100 MG","20","Select","Select",""],["","52817032000","BACLOFEN","10 MG","90","Select","Select",""],["","50228018010","GABAPENTIN","300 MG","81","Select","Select",""],["","63304069301","CLINDAMYCIN HCL","300 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":""}]}]}