{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALYSSA COX","gend":1,"add":"1575 RICHMOND BLVD APT C31","city":"DANVILLE","state":"VA","zip":"24540-9998","dob":"2001-11-09","age":"","mstatus":"","insh":"7834489*01","cliId":"","pno":4345489196,"cno":4345489196,"email":"","ename":"","eno":"","pphy":"JALANDHARA, VINITKUMAR R MD","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":["Z20.2","A41.9","J69.0","J96.00","T50.911A","R06.02","R77.8","T40.1X1A","A49.1","G93.41","F05.","G93.49","Z99.11","G93.1","T50.901A","R41.82","F14.10","Z88.8","U07.1","Z20.822","A08.4","S09.90XA","R51.9","H93.13","H90.3","Z93.1","R13.10","R13.12","K31.89","Z93.0","R49.0","R41.841","R26.89","R27.0","M62.81","F43.23","F11.10","G47.00","F41.9","F41.0","F40.10","F32.9","F19.10","V58.89","F11.23","F11.20","J06.9","R05.","Z20.828","R53.81","F41.8","R25.8","R26.2","R41.844","F31.9","F19.19","G47.9","Z43.1","R56.9","R41.3","Z79.01","M25.861","R20.0","F10.20","J02.9","L30.9","I63.9","R20.2","M79.641","R03.0","F11.90","T40.605A","Z01.419","Z71.9","Z28.21","L02.91","J96.01","T42.4X1A","N39.0","F33.1","NO DATA","F19.90","N12.","R35.0","J40.","R40.4","T50.904A","R40.20","R06.89","T88.7XXA","F31.81","J38.6","Q31.0","K21.9","R63.0","S06.301A","R27.9","S09.8XXA","W22.8XXA","F42.8","Z87.891","Z04.6","R09.02","I95.9","V72.85","N90.7","W10.9XXA","Z87.820","N76.0","J18.9","J96.90"],"date":["2022-03-14","2021-10-01","2021-10-01","2021-10-01","2021-10-01","2021-08-29","2021-08-29","2021-09-02","2021-09-01","2021-10-01","2021-10-01","2021-10-01","2021-09-16","2022-01-09","2022-02-15","2022-02-15","2022-02-15","2023-02-06","2022-02-15","2023-02-20","2022-08-25","2023-02-06","2023-02-06","2023-03-09","2023-03-09","2021-09-12","2021-11-10","2021-12-29","2021-09-09","2021-09-30","2021-11-09","2021-11-09","2021-11-09","2021-11-09","2021-12-28","2021-11-09","2021-11-09","2021-11-24","2022-09-27","2021-11-24","2021-11-24","2021-11-24","2021-11-24","2021-11-10","2022-01-25","2022-04-28","2023-01-17","2021-04-06","2021-04-06","2021-10-01","2021-10-01","2021-10-01","2021-10-01","2021-10-01","2021-10-01","2021-10-01","2021-10-01","2021-10-01","2021-10-01","2021-10-01","2021-10-01","2021-10-01","2021-10-01","2022-04-22","2022-06-30","2022-06-30","2022-06-30","2022-06-30","2022-09-27","2022-09-27","2022-01-09","2022-02-15","2022-12-02","2022-12-02","2022-12-02","2022-12-02","2021-09-09","2021-09-03","2021-05-21","2021-12-06","2022-01-09","2022-01-09","2022-05-06","2022-05-06","2023-02-20","2022-02-15","2021-08-27","2022-02-15","2021-08-27","2021-08-27","2021-09-18","2021-11-17","2021-11-17","2021-12-29","2021-11-24","2021-12-27","2021-12-27","2022-02-23","2022-02-23","2021-01-27","2022-01-09","2022-01-09","2022-02-15","2022-02-15","2022-02-23","2022-11-28","2022-12-10","2022-12-10","2022-03-14","2021-08-27","2021-08-27"],"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":[["","27808023302","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","13811071910","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","68180013601","ESCITALOPRAM","TAB 20MG","30","Select","Select",""],["","00603020922","MAG OXIDE","TAB 400MG","30","Select","Select",""],["","45802086866","POLYETH GLYC","POW 3350 NF","60","Select","Select",""],["","12496120803","SUBOXONE","MIS 8-2MG","5","Select","Select",""],["","62175011843","OMEPRAZOLE","CAP 20MG","60","Select","Select",""],["","00131248035","VIMPAT","TAB 200MG","60","Select","Select",""],["","69452015120","VITAMIN D","CAP 50000UNT","4","Select","Select",""],["","51991001406","MELATONIN","TAB 3MG","30","Select","Select",""],["","00093506110","HYDROXYZ HCL","TAB 25MG","120","Select","Select",""],["","00527133001","BACLOFEN","TAB 10MG","90","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","14","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","30","Select","Select",""],["","00378161001","DICYCLOMINE","CAP 10MG","24","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","51224002250","AZITHROMYCIN","250 MG","4","Select","Select",""],["","65862022701","LAMOTRIGINE","TAB 25MG","42","Select","Select",""],["","29300022705","METRONIDAZOL","TAB 500MG","4","Select","Select",""],["","43598058230","BUPREN\/NALOX","MIS 8-2MG","5","Select","Select",""],["","52817018000","CLONIDINE","TAB 0.1MG","60","Select","Select",""],["","70954002010","PRAZOSIN HCL","CAP 2MG","30","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","14","Select","Select",""],["","69097083412","SERTRALINE","TAB 50MG","30","Select","Select",""],["","45802005435","TRIAMCINOLON","OIN 0.00025","60","Select","Select",""],["","00054001925","PREDNISONE","TAB 50MG","6","Select","Select",""],["","65162062711","TRAMADOL HCL","TAB 50MG","15","Select","Select",""],["","00536132706","ACETAMINOPHE","TAB 325MG","50","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":""}]}]}