{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SARAH VERNON","gend":1,"add":"3660 UNION CHURCH ROAD","city":"GLADSTONE","state":"VA","zip":"24553-9998","dob":"1995-04-23","age":"","mstatus":"","insh":"7449569*01","cliId":"","pno":4348291024,"cno":4348291024,"email":"","ename":"","eno":"","pphy":"ARNOLD, ADAM J NP","ppno":4345813271,"pcpadd":"25892 N JAMES MADISON HIGHWAY,","pcpcity":"NEW CANTON","pcpstate":"VA","pcpzip":"23123-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4345811105,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","F11.99","F41.9","G47.00","F11.90","F43.22","G47.9","F17.200","F15.90","F41.1","F12.90","F41.0","F43.10","F13.90","K08.89","Z11.59","M25.572","H00.019","H52.03","H52.222","R06.02","B34.9","R51.9","R09.81","Z20.822","F10.20","Z20.828","U07.1","R05.9","K12.1","J02.9","J32.9","U09.9","R07.9","K59.00","J20.9","F11.93"],"date":["2022-11-21","2022-11-07","2022-11-07","2022-11-07","2022-11-07","2022-11-07","2022-11-07","2022-11-07","2022-11-07","2022-11-21","2022-11-07","2022-11-07","2022-11-21","2022-11-07","2022-11-07","2023-09-06","2021-07-19","2021-08-19","2021-08-19","2021-08-19","2022-09-02","2022-06-24","2022-09-02","2022-09-23","2022-06-24","2022-10-20","2022-03-11","2022-08-30","2022-09-23","2022-09-29","2022-09-28","2022-09-23","2022-09-23","2022-09-02","2023-04-19","2022-03-11","2022-10-10"],"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":[["","67877024201","QUETIAPINE","TAB 25MG","60","Select","Select",""],["","12496120803","SUBOXONE","MIS 8-2MG","21","Select","Select",""],["","13107000334","MIRTAZAPINE","TAB 30MG","60","Select","Select",""],["","00228212850","CLONIDINE","TAB 0.2MG","30","Select","Select",""],["","65862052305","GABAPENTIN","600 MG","120","Select","Select",""],["","47781035703","BUPREN\/NALOX","MIS 8-2MG","21","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","5","Select","Select",""],["","49884094499","VARENICLINE","TAB 0.5& 1MG","56","Select","Select",""],["","12496010001","SUBLOCADE","100 MG\/0.5","0.5","Select","Select",""],["","51224002218","AZITHROMYCIN","250 MG","6","Select","Select",""],["","65162071310","GUANFACINE","TAB 2MG","30","Select","Select",""],["","68382013814","TOPIRAMATE","TAB 25MG","60","Select","Select",""],["","00121086816","NYSTATIN","SUS 100000","160","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","70000047301","ALLERGY RELF","SOL 5MG\/5ML","120","Select","Select",""],["","00904671772","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","57237003101","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","70000044703","SENNA","TAB 8.6MG","60","Select","Select",""],["","67877032101","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","69097084615","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","70000018003","8 HOUR PAIN","TAB 650MG","20","Select","Select",""],["","23155065201","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","00093227534","AMOX\/K CLAV","TAB 875-125","10","Select","Select",""],["","00093083205","CLONAZEPAM","0.5 MG","7","Select","Select",""],["","23155050101","HYDROXYZ HCL","TAB 25MG","30","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","6","Select","Select",""],["","43547028111","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","60505015701","BUPROPION","TAB 100MG","60","Select","Select",""],["","63304069201","CLINDAMYCIN","CAP 150MG","42","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","21","Select","Select",""],["","00116200116","CHLORHEX GLU","SOL 0.0012","473","Select","Select",""],["","00527600274","LIDOCAINE","SOL 2% VISC","100","Select","Select",""],["","50111056101","TRAZODONE","TAB 100MG","30","Select","Select",""],["","45802086803","POLYETH GLYC","POW 3350 NF","510","Select","Select",""],["","37205061273","CLEARLAX","POW ","510","Select","Select",""],["","69367030951","SODIUM FLUOR","CRE 5000 PLS","51","Select","Select",""],["","67877025001","QUETIAPINE FUMARATE","100 MG","30","Select","Select",""],["","00228212850","CLONIDINE HCL","0.2 MG","180","Select","Select",""],["","65162027210","SULFAMETHOXAZOLE-TRIMETHOPRIM","800-160 MG","20","Select","Select",""],["","43386006019","GAVILYTE-C","240-22.72G","4000","Select","Select",""],["","00536340501","NICOTINE GUM","4 MG","100","Select","Select",""],["","70000044703","SENNA LAXATIVE","8.6 MG","60","Select","Select",""],["","00904699880","DOCUSATE SODIUM","100 MG","30","Select","Select",""],["","43547028210","ESCITALOPRAM OXALATE","20 MG","60","Select","Select",""],["","57237000511","FLUCONAZOLE","150 MG","1","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":""}]}]}