{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  SAMOHTHTIMS J ","gend":0,"add":"A NOTLYH 71A400 TPA EV","city":"DANVILLE","state":"VA","zip":"24541-9998","dob":"1958-02-22","age":"","mstatus":"","insh":"25300210*49","cliId":"","pno":"52\/4340768-0","cno":"","email":"","ename":"","eno":"","pphy":"GRABOWSKI, KRISTEN NP","ppno":"434\/835-0105","pcpadd":"2767 FRANKLIN TURNPIKE","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24540,"pcpcounty":"","pcpid":"","pcpname":"DANVILLE PHYSICIAN PRACTICES LLC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I47.1","I10.","E78.2","I73.9","J18.9","N17.9","Z20.828","E78.5","E03.9","K21.9","R73.03","Z12.5","G47.00","G81.94","I63.9","R06.02","E86.0","J44.9","R93.89","J41.1","Z87.01","R13.19","J96.11","Z11.59","J44.1","E83.51","D72.829","Z72.0","Z20.822","A41.9","J18.0","E87.6","D64.9","R51.","G91.9","R90.82","I65.23","J45.40","G45.9","I67.9","I69.354","Z23.","R73.01","G93.41","E43.","J96.91","E87.1","NO DATA","R65.20","B96.1","E78.00","E88.09","R09.02","R00.0","I95.9","R53.1","R78.81","R11.2","T17.920A","T18.128A","F17.210","R07.89","T18.108A","J44.0","J20.9","A09.","R10.84","J06.9","R52.","Z16.30","R19.7","Z71.6","F17.200","N18.3","F10.10","R07.1","K22.2","K22.10","R42.","R10.30","M79.602","Z53.20","J86.9","H61.23","J96.21","F10.20","Z13.1","J84.9","J98.11","Z00.00","M19.90","Z09.","Z76.89","E83.42","R06.9","J80.","E87.2","J98.4"],"date":["2021-08-26","2022-10-19","2021-08-26","2022-10-19","2022-02-19","2022-02-14","2021-09-29","2022-10-19","2022-10-19","2022-10-19","2022-10-19","2022-10-19","2022-10-19","2020-06-12","2020-06-13","2022-02-17","2021-08-26","2022-03-02","2022-03-08","2022-10-19","2021-10-07","2021-10-07","2022-03-08","2022-04-21","2022-03-03","2022-02-14","2021-05-07","2022-03-08","2022-02-14","2022-02-14","2021-08-23","2022-02-14","2022-03-03","2020-06-12","2020-06-12","2020-06-12","2020-06-12","2021-05-18","2020-06-12","2020-06-12","2020-06-12","2022-04-21","2021-04-16","2021-08-23","2021-08-23","2022-07-29","2021-08-23","2022-02-17","2022-02-14","2021-08-23","2021-08-23","2021-08-23","2021-08-23","2021-08-23","2021-08-23","2021-08-23","2021-08-26","2019-05-13","2019-05-13","2019-05-13","2019-05-13","2019-03-09","2019-05-13","2019-03-09","2019-03-09","2019-08-19","2019-08-19","2019-03-06","2019-08-19","2019-03-06","2019-08-19","2019-03-06","2022-03-08","2019-10-01","2022-03-02","2019-03-09","2019-05-13","2019-05-13","2019-11-25","2019-11-25","2019-11-25","2019-11-25","2022-03-08","2022-09-21","2022-03-03","2022-10-19","2022-04-21","2022-02-17","2022-02-17","2022-10-19","2022-10-19","2022-03-02","2022-03-02","2022-03-02","2022-02-13","2022-02-13","2022-02-14","2022-02-14"],"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":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","00054001729","PREDNISONE","TAB 10MG","20","Select","Select",""],["","65162036111","FOLIC","TAB 1MG","30","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","90","Select","Select",""],["","00603020922","MAG","TAB 400MG","60","Select","Select",""],["","00555003302","CHLORDIAZEP","CAP 10MG","4","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","16","Select","Select",""],["","66758019001","KLOR-CON","TAB 20MEQ ER","60","Select","Select",""],["","00115168974","BUDESONIDE","SUS 0.5MG\/2","120","Select","Select",""],["","00378827052","ALBUTEROL","NEB 0.00083","1125","Select","Select",""],["","59651000305","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","57664049983","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","28","Select","Select",""],["","80681000900","VITAMIN","CAP 50MCG","30","Select","Select",""],["","65862053820","LEVOFLOXACIN","TAB 750MG","4","Select","Select",""],["","00173086910","ANORO","AER 62.5-25","60","Select","Select",""],["","00378180510","LEVOTHYROXIN","TAB 75MCG","30","Select","Select",""],["","68180021509","LOSARTAN\/HCT","TAB 50-12.5","30","Select","Select",""],["","67877054360","CEFDINIR","CAP 300MG","10","Select","Select",""],["","29300022705","METRONIDAZOL","TAB 500MG","21","Select","Select",""],["","00121087316","LACTULOSE","SOL 10GM\/15","473","Select","Select",""],["","00378967130","IPRATROPIUM\/","SOL ALBUTER","90","Select","Select",""],["","","FLUZONE","INJ 2020-21","","Select","Select",""],["","00597015561","STIOLTO","AER 2.5-2.5","4","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","57664050658","METOPROL","TAB 25MG","30","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","60","Select","Select",""],["","00228202750","ALPRAZOLAM","TAB 0.25MG","30","Select","Select",""],["","60432053760","NYSTATIN","SUS 100000","473","Select","Select",""],["","00093720298","PRAVASTATIN","TAB 40MG","30","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","50111043301","TRAZODONE","TAB 50MG","30","Select","Select",""],["","00093031101","LOPERAMIDE","CAP 2MG","30","Select","Select",""],["","65162006205","SUCRALFATE","SUS 1GM\/10ML","420","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","68180030360","CEFUROXIME","TAB 500MG","20","Select","Select",""],["","47335066981","DILTIAZEM","CAP 120MG\/24","30","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","10","Select","Select",""],["","68382074516","TIADYLT","CAP 120MG\/24","30","Select","Select",""],["","68382039801","POT  CHLORIDE","TAB 20MEQ ER","60","Select","Select",""],["","65862020290","LOSARTAN","TAB 50MG","30","Select","Select",""],["","58160082311","SHINGRIX","INJ 50MCG","1","Select","Select",""],["","","BOOSTRIX","INJ ","","Select","Select",""],["","13925011890","SE-TAN","CAP ","20","Select","Select",""],["","00093206406","CILOSTAZOL","TAB 100MG","60","Select","Select",""],["","50428887841","CVS","TAB 600MG","20","Select","Select",""],["","63824000832","MUCINEX","TAB 600MG ER","20","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","70461031903","FLUCLVX","INJ 2019-20","0","Select","Select",""],["","69543013611","TRAMADOL","TAB 50MG","8","Select","Select",""],["","55111012701","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","10","Select","Select",""],["","53489011905","DOXYCYCL","CAP 100MG","14","Select","Select",""],["","68180016006","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","50383080416","PROMETH\/COD","SYP 6.25-10","120","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":""}]}]}