{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   ALLIUQCASMAILLIW D","gend":1,"add":"EL 206TS SIW","city":"DANVILLE","state":"VA","zip":"24541-9998","dob":"1968-04-09","age":"","mstatus":"","insh":"04500210*24","cliId":"","pno":"97\/4344241-2","cno":"434\/792-1424","email":"","ename":"","eno":"","pphy":"FALGUI, VICENTE MD","ppno":"434\/791-4648","pcpadd":"212 SOUTH MAIN STREET SUITE 3","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I63.9","I10.","I69.354","H66.92","Z00.00","Z23.","Z13.1","Z13.89","Z79.899","R41.3","F33.1","F41.1","G47.00","E89.0","E78.5","Z86.39","R62.7","R63.6","R13.10","R07.0","Z01.419","Z71.9","E66.3","N18.2","E78.2","J01.90","R63.4","R39.81","G47.10","F90.0","G47.33","F31.81","F14.10","G47.9","G47.52","I49.8","Z92.29","N89.8","E03.8","N39.0","H61.22","R06.2","M54.9","E03.9","R26.89","H69.82","H93.8X2","Z13.9","N17.9","Z79.1","Z90.09","D50.9","H66.90","M21.372","H92.02","M26.609","R80.9","J06.9","F41.9","G47.30","F06.0","F14.20","J30.2","M62.81","F39.","H31.092","H52.03","H25.813"],"date":["2022-10-17","2022-10-10","2022-08-25","2020-09-29","2020-12-07","2020-12-07","2020-12-07","2020-12-07","2020-12-07","2022-04-11","2021-06-09","2022-07-19","2021-06-09","2021-06-23","2021-06-23","2021-06-23","2022-08-25","2022-08-25","2022-08-25","2022-08-31","2022-09-15","2022-09-15","2022-09-15","2021-11-02","2020-05-22","2020-04-24","2020-04-24","2021-01-02","2022-05-19","2022-10-17","2022-10-17","2022-07-19","2022-07-19","2020-10-12","2020-10-12","2020-10-12","2021-08-26","2021-08-26","2021-09-22","2021-09-22","2022-05-19","2020-08-19","2020-09-10","2022-09-09","2022-10-17","2020-01-23","2020-01-23","2020-01-29","2020-06-12","2020-11-02","2020-06-12","2021-04-07","2020-01-09","2020-02-24","2020-10-14","2020-10-14","2021-11-02","2020-03-23","2020-05-22","2020-10-12","2021-10-19","2021-10-19","2020-03-23","2020-03-23","2020-03-23","2022-02-17","2022-02-17","2022-02-17"],"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":[["","00536333401","VITAMIN","TAB 1000UNIT","30","Select","Select",""],["","68382080510","TRAZODONE","TAB 50MG","45","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","90","Select","Select",""],["","69238184001","LEVOTHYROXIN","TAB 200MCG","30","Select","Select",""],["","45963067711","METOPROL","TAB 100MG ER","90","Select","Select",""],["","31722070110","LOSARTAN","TAB 50MG","30","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","43598081115","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","60432060416","PROMETHAZINE","SYP DM","120","Select","Select",""],["","00115175701","CYPROHEPTAD","TAB 4MG","90","Select","Select",""],["","65862017760","CEFDINIR","CAP 300MG","14","Select","Select",""],["","50580072697","ZYRTEC","TAB 10MG","30","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","42","Select","Select",""],["","00904678370","ASPIRIN","TAB 81MG EC","90","Select","Select",""],["","65162010150","GABAPENTIN","CAP 100MG","60","Select","Select",""],["","23155050105","HYDROXYZ","TAB 25MG","30","Select","Select",""],["","63402030630","LATUDA","TAB 60MG","30","Select","Select",""],["","00054429731","FUROSEMIDE","TAB 20MG","45","Select","Select",""],["","62037099901","POT  CL MICRO","TAB 20MEQ ER","30","Select","Select",""],["","55111012305","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","65862069790","VENLAFAXINE","CAP 150MG ER","30","Select","Select",""],["","13107000334","MIRTAZAPINE","TAB 30MG","30","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","49884090738","MEGESTROL","SUS 40MG\/ML","600","Select","Select",""],["","00904676320","ROBAFEN","LIQ 200\/10ML","236","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00781707787","METRONIDAZOL","GEL 0.75%VAG","70","Select","Select",""],["","42037010479","DEBROX","SOL 6.5% OT","15","Select","Select",""],["","00185012201","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","00781618667","CIPRO\/DEXA","SUS 0.3-0.1%","8","Select","Select",""],["","00527133001","BACLOFEN","TAB 10MG","45","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","30","Select","Select",""],["","69097084805","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","65862056090","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","00065853302","CIPRODEX","SUS 0.3-0.1%","8","Select","Select",""],["","64380071206","BENZONATATE","CAP 100MG","30","Select","Select",""],["","31604002741","MELATONIN","TAB 3MG","30","Select","Select",""],["","29300012410","MELOXICAM","TAB 7.5MG","60","Select","Select",""],["","60505083305","AZELASTINE","SPR 0.001","30","Select","Select",""],["","57237002801","AMOXICILLIN","TAB 500MG","14","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","00904323252","CALCIUM","TAB 600MG","60","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","7","Select","Select",""],["","51645073108","CALCIUM\/D","TAB 600-200","60","Select","Select",""],["","68682092005","TETRACAINE","SOL 0.5% OP","5","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","2","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":""}]}]}