{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JAMIE STEPPE","gend":1,"add":"1380 HOWARDSVILLE ROAD","city":"BUCKINGHAM","state":"VA","zip":"23921-9998","dob":"1979-01-02","age":"","mstatus":"","insh":"8611475*01","cliId":"","pno":4344142284,"cno":4344142284,"email":"","ename":"","eno":"","pphy":"BASHORE, RANDALL T MD","ppno":4345813271,"pcpadd":"RT 15 SOUTH,","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":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z20.828","R53.83","R10.33","K21.9","R11.0","E78.2","R53.1","R93.0","I10.","E78.5","R56.9","I63.9","M16.0","M25.559","M25.579","G81.91","F09.","J45.909","K59.00","Z86.711","Z82.3","Z79.899","Z79.82","Z79.02","Z82.49","Z11.52","R29.810","R47.81","R07.9","Z99.81","Z23.","F32.9","E55.9","M70.61","F17.290","G43.909","G43.409","Z86.73","S93.402A","F17.210","M54.89","R52.","M54.2","M25.519","M25.539","R51.9","V58.89","G43.809","Z20.822","M25.551","S13.4XXA","V40.5XXA","Y92.410","Y93.89","H53.9","B34.9","J02.9","J01.90","Z13.39","R29.706","Z81.8","Z83.3","Z82.0","R05.1","E16.1","E16.2","R09.02","M62.81","R41.82"],"date":["2022-02-01","2021-12-06","2021-12-06","2022-08-04","2022-05-10","2022-08-04","2022-12-18","2022-05-15","2022-08-04","2022-05-15","2022-05-15","2022-08-04","2022-12-01","2022-08-04","2021-06-09","2022-12-18","2022-05-13","2022-05-13","2022-05-13","2022-05-13","2022-05-13","2022-05-13","2022-05-13","2022-05-13","2022-05-13","2023-02-16","2022-12-18","2022-12-18","2022-12-18","2022-12-18","2022-03-10","2022-08-04","2022-08-04","2022-12-01","2022-05-11","2022-05-11","2022-06-22","2022-12-18","2021-03-18","2021-09-27","2021-09-27","2021-09-27","2021-09-27","2021-09-27","2021-09-27","2022-06-22","2021-10-06","2022-12-18","2022-12-18","2021-03-17","2021-09-27","2021-09-27","2021-09-27","2021-09-27","2022-06-22","2022-12-14","2022-12-14","2022-12-29","2023-04-12","2022-05-11","2022-05-11","2022-05-11","2022-05-11","2022-12-14","2022-12-18","2022-12-18","2022-12-18","2022-12-18","2022-12-18"],"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":[["","00093005105","CARVEDILOL","3.125 MG","60","Select","Select",""],["","57237016290","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","00172572960","FAMOTIDINE","40 MG","30","Select","Select",""],["","68382012205","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","60505025202","TIZANIDINE","TAB 4MG","30","Select","Select",""],["","65862056099","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","55111019630","CLOPIDOGREL","TAB 75MG","21","Select","Select",""],["","00904679480","ASPIRIN LOW","CHW 81MG","30","Select","Select",""],["","00904404073","ASPIRIN","CHW 81MG","30","Select","Select",""],["","50111064803","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","40985027139","VITAMIN D3","TAB 1000UNIT","30","Select","Select",""],["","63304082805","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","64380073706","VITAMIN D","CAP 50000UNT","4","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","65162067684","AZELASTINE","SPR 0.001","30","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","3","Select","Select",""],["","00054004544","IPRATROPIUM","SPR 0.0003","30","Select","Select",""],["","42571016201","AMOX\/K CLAV","TAB 875-125","14","Select","Select",""],["","45802065087","LORATADINE","10 MG","30","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","68001033408","LISINOPRIL","10 MG","30","Select","Select",""],["","68382012205","AMLODIPINE BESYLATE","5 MG","30","Select","Select",""],["","12496120803","SUBOXONE","8 MG-2 MG","21","Select","Select",""],["","65862056099","PANTOPRAZOLE SODIUM","40 MG","30","Select","Select",""],["","68180035302","SERTRALINE HCL","100 MG","60","Select","Select",""],["","50228017505","BUPROPION HCL SR","150 MG","28","Select","Select",""],["","00904759080","FEROSUL","325(65) MG","30","Select","Select",""],["","00173071520","ADVAIR HFA","45-21 MCG","12","Select","Select",""],["","65862057490","MONTELUKAST SODIUM","10 MG","30","Select","Select",""],["","63304082805","ATORVASTATIN CALCIUM","20 MG","30","Select","Select",""],["","57896075604","GUAIASORB DM","100-10MG\/5","236","Select","Select",""],["","50111064803","FLUOXETINE HCL","20 MG","90","Select","Select",""],["","60505025202","TIZANIDINE HCL","4 MG","30","Select","Select",""],["","68180096301","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","00406802003","BUPRENORPHINE-NALOXONE","8 MG-2 MG","84","Select","Select",""],["","62332010030","ARIPIPRAZOLE","15 MG","28","Select","Select",""],["","58657050004","CODEINE-GUAIFENESIN","10-100MG\/5","200","Select","Select",""],["","45802081184","NALOXONE HCL","4 MG","2","Select","Select",""],["","16729044416","BUPROPION XL","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":""}]}]}