{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DAWN L COOPER","gend":1,"add":"1044 JAMES D HAGOOD HWY","city":"SOUTH BOSTON","state":"VA","zip":"24592-9998","dob":"1991-06-01","age":"","mstatus":"","insh":"7622457*01","cliId":"","pno":4342286560,"cno":4342286560,"email":"","ename":"","eno":"","pphy":"LE, UYEN MD","ppno":4345728921,"pcpadd":"1020 BILL TUCK HWY STE 900,","pcpcity":"SOUTH BOSTON","pcpstate":"VA","pcpzip":"24592-9998","pcpcounty":"","pcpid":"","pcpname":"Fuller-Roberts OB\/GYN & Primary Care","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4345751290,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R51.9","Z83.3","Z80.42","R20.2","Z30.09","Z32.02","Z30.431","NO DATA","C50.912","Z17.0","M25.551","M54.9","Z79.811","Z13.828","I08.8","R06.02","C50.112","R11.0","R07.9","C50.812","C50.312","R07.89","Z30.42","K21.9","R07.2","Z51.0","M54.6","C50.919","R06.09","R00.2","G56.01","G47.09","V58.89","K12.30","M85.80","Z97.5","Z30.432","Z85.3","Z30.430","R53.83","N64.4","Z20.822","D05.12","G47.00","F33.1","C77.3","K92.81","Z31.41","M25.559","M79.659","M25.579","Z90.12","Z51.11","Z79.899","M79.641","M79.642","R07.82"],"date":["2021-01-24","2022-05-16","2022-05-16","2021-01-24","2021-07-16","2021-08-05","2021-09-02","2021-09-21","2023-09-20","2023-09-20","2022-02-14","2022-05-27","2022-07-11","2022-07-11","2022-07-19","2022-07-19","2023-07-27","2023-02-01","2021-09-07","2022-02-03","2021-12-10","2023-09-14","2021-06-18","2022-05-16","2022-05-16","2022-07-01","2023-06-04","2023-05-02","2023-03-14","2023-03-14","2021-01-24","2022-02-28","2022-02-28","2022-02-28","2022-04-11","2022-02-28","2022-04-12","2023-09-14","2021-08-05","2022-07-01","2021-09-13","2022-02-22","2021-09-23","2022-04-11","2021-07-08","2022-02-03","2022-03-21","2022-03-21","2023-05-02","2023-05-02","2023-05-02","2023-05-02","2022-04-11","2022-04-11","2023-06-04","2023-06-04","2023-08-30"],"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":[["","00054418425","DEXAMETHASON","TAB 4MG","24","Select","Select",""],["","59746011506","PROCHLORPER","TAB 10MG","30","Select","Select",""],["","68462010630","ONDANSETRON","TAB 8MG","30","Select","Select",""],["","80777027310","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","69584061250","METHOCARBAM","TAB 750MG","15","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","15","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","00093005805","TRAMADOL HCL","TAB 50MG","15","Select","Select",""],["","68382020906","ANASTROZOLE","TAB 1MG","30","Select","Select",""],["","65162006205","SUCRALFATE","SUS 1GM\/10ML","1200","Select","Select",""],["","16729003415","LETROZOLE","2.5 MG","30","Select","Select",""],["","68462015713","ONDANSETRON ODT","4 MG","30","Select","Select",""],["","68462010630","ONDANSETRON TAB","8MG","30","Select","Select",""],["","00054418425","DEXAMETHASON TAB","4MG","24","Select","Select",""],["","59746011506","PROCHLORPER TAB","10MG","30","Select","Select",""],["","80777027310","MODERNA VAC INJ COVID-","19","0","Select","Select",""],["","69584061250","METHOCARBAM TAB","750MG","15","Select","Select",""],["","00093031401","KETOROLAC TAB","10MG","15","Select","Select",""],["","65862085901","FAMOTIDINE TAB","20MG","30","Select","Select",""],["","65162006205","SUCRALFATE SUS","1GM\/10ML","1200","Select","Select",""],["","00093005805","TRAMADOL HCL TAB","50MG","15","Select","Select",""],["","68382020906","ANASTROZOLE TAB","1MG","30","Select","Select",""],["","16729003415","LETROZOLE TAB","2.5MG","30","Select","Select",""],["","68382005105","MELOXICAM","15 MG","30","Select","Select",""],["","29300041519","CYCLOBENZAPRINE 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":""}]}]}