{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  NAHTANSENOJ E ","gend":0,"add":"PMURC 0667DAOR NWOT","city":"FARMVILLE","state":"VA","zip":"23901-9998","dob":"1969-08-09","age":"","mstatus":"","insh":"30300210*21","cliId":"","pno":"75\/4340034-4","cno":"","email":"","ename":"","eno":"","pphy":"BASHORE, RANDALL T MD","ppno":"434\/581-3271","pcpadd":"RT 15 SOUTH","pcpcity":"NEW CANTON","pcpstate":"VA","pcpzip":23123,"pcpcounty":"","pcpid":"","pcpname":"CENTRAL VIRGINIA HEALTH SERVICES INC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","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":["G47.33","K42.9","Z68.35","J44.9","E11.9","R06.09","J96.11","G47.19","Z72.0","Z11.59","Z20.828","M10.9","E78.5","I10.","Z71.89","Z71.3","M79.672","M79.89","M79.605","R60.0","M25.572","K85.90","E66.9","F17.210","Z87.11","Z83.49","Z83.3","Z82.5","Z82.49","Z82.3","Z68.31","R10.84","R52.","Z88.8","Z79.1","Z79.82","Z79.899","Z88.5","J96.22","J18.9","N17.9","J96.01","E55.9","J96.92","R31.9","I48.91","K86.1","M1A.0790","L24.9","M25.474","A41.9","J96.21","N17.0","R65.21","E11.21","I48.0","Z20.822","J44.0","E66.01","E87.2","R04.0","M1A.9XX0","R31.29","I49.3","I45.19","R94.31","Z12.5","M54.5","I50.9","S46.811A","X58.XXXA","I11.0","I50.33","J90.","R10.9","I34.0","E27.9","K76.0","I48.92","S16.1XXA","S39.012A","V43.52XA","Y92.410","S39.92XA","M54.9","N43.3","N50.819","R10.30","N40.0","R35.1","R06.00","Z92.89","N41.9","Z79.51","R09.02","J18.1","I50.21","F32.9","Z87.39","R06.81","R06.83","J98.4","J45.901","I45.10","R00.0","I51.7","I49.1","I49.9","J96.02","F17.290","K25.9","J20.9","G47.10","Z79.84","R61.","I47.1","I50.22","R94.30","F10.10","Z87.891","Z68.38","Z23.","K29.70","R11.2","K27.9","F10.20","R53.83","I31.9","R06.9","G47.30","J98.11","I45.2","I44.0","J45.909","I42.9","R93.1","J96.90","F17.211","NO DATA","F11.10","X50.0XXA","Z79.01","Z68.33","Z83.438","M25.539","R14.0","B37.0","R07.9","I25.2","M54.2","R51.9","I50.20","R74.8","R06.02"],"date":["2022-06-22","2020-05-28","2021-12-09","2022-10-01","2022-05-18","2020-03-13","2022-06-22","2021-11-09","2021-12-09","2020-11-02","2020-10-19","2022-05-26","2022-02-07","2022-05-18","2022-05-18","2022-05-18","2021-06-12","2021-10-24","2021-06-12","2021-09-16","2021-06-12","2020-05-22","2021-06-12","2022-02-07","2020-05-20","2020-05-20","2022-02-06","2020-05-20","2022-02-06","2020-05-20","2020-05-20","2022-01-10","2022-01-10","2021-07-05","2021-07-05","2021-07-05","2021-07-05","2021-09-16","2021-09-24","2021-10-24","2021-09-24","2022-02-06","2021-09-23","2021-09-18","2021-09-24","2022-02-07","2020-06-12","2020-06-12","2020-06-12","2021-09-16","2021-09-24","2022-02-07","2021-09-26","2021-09-26","2021-09-24","2022-02-07","2022-02-07","2022-02-07","2022-02-07","2021-09-24","2021-09-18","2021-12-09","2021-09-26","2022-01-10","2021-10-24","2021-10-24","2020-04-14","2021-03-20","2022-06-22","2021-10-24","2022-01-10","2022-02-07","2022-02-07","2021-12-09","2022-01-10","2022-02-07","2021-12-09","2021-12-09","2021-12-10","2022-01-10","2020-11-12","2020-11-12","2020-11-12","2020-11-12","2021-03-20","2021-06-08","2021-06-08","2021-06-08","2021-06-14","2021-06-14","2021-12-09","2021-11-09","2021-06-08","2021-06-12","2022-05-18","2019-02-08","2019-02-08","2019-02-08","2019-02-08","2019-12-18","2019-11-09","2019-12-18","2019-10-10","2022-01-10","2019-02-05","2019-09-24","2022-01-10","2019-04-08","2019-09-23","2019-09-23","2019-09-27","2019-09-23","2019-11-09","2019-09-23","2019-09-23","2019-02-14","2019-04-08","2019-04-08","2019-04-08","2022-06-22","2019-04-08","2019-12-30","2019-01-30","2019-01-30","2019-02-01","2019-02-01","2019-02-01","2019-01-31","2019-09-23","2019-11-09","2019-09-24","2019-01-31","2019-02-14","2019-01-31","2019-02-14","2019-02-14","2019-02-14","2019-02-14","2019-02-14","2019-02-14","2022-01-10","2022-02-07","2022-02-07","2022-02-06","2022-03-23","2022-01-10","2022-06-22","2022-01-10","2022-01-10","2022-01-14","2022-01-14","2022-03-27","2022-05-18","2022-02-06"],"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":[["","00310620530","FARXIGA","TAB 5MG","30","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","70377002911","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","00591554310","ALLOPURINOL","TAB 100MG","60","Select","Select",""],["","00143301801","COLCHICINE","CAP 0.6MG","30","Select","Select",""],["","60242011810","ASPIRIN","TAB 81MG EC","30","Select","Select",""],["","50742061610","METOPROL","TAB 50MG ER","30","Select","Select",""],["","31722070190","LOSARTAN","TAB 50MG","30","Select","Select",""],["","68382075810","METFORMIN","TAB 500MG","60","Select","Select",""],["","00173088710","TRELEGY","AER ELLIPTA","60","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00603188016","LIDOCAINE","PAD 0.05","10","Select","Select",""],["","43547040211","FUROSEMIDE","TAB 40MG","90","Select","Select",""],["","69097012705","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","00093742698","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","00173086910","ANORO","AER 62.5-25","60","Select","Select",""],["","","GLIPIZIDE","TAB 5MG","","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","","INDOMETHACIN","CAP 50MG","","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","8","Select","Select",""],["","59779044874","CVS","DIS 21MG\/24H","21","Select","Select",""],["","00173071920","FLOVENT","AER 110MCG","12","Select","Select",""],["","00378064110","PREDNISONE","TAB 10MG","18","Select","Select",""],["","66993007996","FLUTICAS","AER 110MCG","12","Select","Select",""],["","66689000816","NYSTATIN","SUS 100000","140","Select","Select",""],["","49884093547","DICLOFENAC","GEL 0.01","500","Select","Select",""],["","","LORATADINE","TAB 10MG","","Select","Select",""],["","62332049341","TIZANIDINE","CAP 6MG","21","Select","Select",""],["","00003089421","ELIQUIS","TAB 5MG","180","Select","Select",""],["","43547022650","METHOCARBAM","TAB 750MG","21","Select","Select",""],["","51660052601","ALLERGY","TAB 10MG","30","Select","Select",""],["","68382065001","ISOSORB","TAB 30MG ER","30","Select","Select",""],["","","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","","ONETOUCH","MIS LANCETS","","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","10","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","20","Select","Select",""],["","00378967130","IPRATROPIUM\/","SOL ALBUTER","180","Select","Select",""],["","59467031830","MITIGARE","CAP 0.6MG","20","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","4","Select","Select",""],["","64764011901","COLCRYS","TAB 0.6MG","20","Select","Select",""],["","65862053820","LEVOFLOXACIN","TAB 750MG","3","Select","Select",""],["","31604001870","VITAMIN","TAB 1000UNIT","60","Select","Select",""],["","","TRIAMCINOLON","CRE 0.001","","Select","Select",""],["","23155000301","HYDRALAZINE","TAB 50MG","90","Select","Select",""],["","00185041560","BUPROPION","TAB 150MG SR","30","Select","Select",""],["","00173088210","BREO","INH 200-25","60","Select","Select",""],["","63481068447","VOLTAREN","GEL 0.01","500","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","11534018701","BUT\/APAP\/CAF","CAP ","16","Select","Select",""],["","64679073502","METOPROLOL","TAB 50MG ER","30","Select","Select",""],["","23155000810","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","00536116361","MUCUS","TAB 600MG ER","14","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":""}]}]}