{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ASERETYALC ","gend":1,"add":"ILRETAW 7622C TPA DR KC","city":"LYNCHBURG","state":"VA","zip":"24501-9998","dob":"1964-11-05","age":"","mstatus":"","insh":"45200210*75","cliId":"","pno":"87\/8139901-0","cno":"434\/209-1112","email":"","ename":"","eno":"","pphy":"ADAMS, SCOTT B MD","ppno":"434\/525-4722","pcpadd":"SUITE B 15421 FOREST RD","pcpcity":"FOREST","pcpstate":"VA","pcpzip":24551,"pcpcounty":"","pcpid":"","pcpname":"GRACE FAMILY MEDICINE PLC","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":["F31.81","M75.42","M25.512","M47.812","M50.30","F60.3","F12.20","F41.1","F19.20","S91.331A","Z23.","R32.","K58.9","M12.9","Z12.11","S29.9XXA","F17.200","J06.9","Z20.828","M79.7","F51.02","R63.5","H25.11","H25.13","H53.002","J01.90","H61.23","H65.199","M26.609","H61.22","F32.9","M79.2","F31.9","Z00.00","H90.2","F33.2","R07.89","R06.02","R05.","R61.","J44.9","F17.210","K21.9","K04.7","N95.0","G89.29","H66.92","F41.9","R09.81","N32.81","M54.2","M54.5","Z51.81","Z72.0","R30.9","N92.0","M19.91","J44.0","N39.46","F90.9","H65.02","H25.813","M75.91","H25.12","M31.6","M67.843","H92.01","F19.10","NO DATA","M43.6","M62.838","F33.1","F43.10","F12.10","S62.609A","S06.0X0A","S16.1XXA","M54.9","M54.6","V89.2XXA","Z63.4","N30.10","N39.0","Z02.9","I73.9","R60.9","Z71.9","M76.32","M79.645","M54.12","K29.80","R45.89","K08.9","R51.9","Z20.822","M25.511","R53.83"],"date":["2020-07-22","2020-03-16","2020-03-16","2021-05-18","2020-03-16","2020-09-01","2020-09-01","2022-03-07","2020-05-28","2021-08-16","2021-08-16","2022-11-01","2022-11-01","2022-09-06","2021-12-01","2021-12-01","2021-12-29","2021-04-12","2021-04-12","2022-11-07","2021-05-12","2022-01-13","2021-11-02","2021-08-02","2021-08-02","2020-04-14","2020-04-14","2020-04-22","2021-09-29","2020-04-22","2022-03-28","2022-04-04","2020-01-22","2020-02-12","2020-02-12","2020-03-23","2021-02-16","2022-11-07","2021-09-20","2021-02-16","2021-02-16","2021-02-16","2021-07-08","2021-07-08","2021-09-16","2022-11-07","2020-10-28","2020-10-28","2020-10-28","2021-02-17","2022-11-07","2021-05-18","2021-05-18","2021-05-18","2021-11-01","2021-11-01","2021-11-01","2020-01-13","2020-01-22","2020-01-22","2020-05-06","2021-07-24","2021-09-29","2021-11-30","2021-09-20","2021-09-20","2021-09-20","2019-07-13","2022-11-07","2019-10-24","2022-08-20","2019-05-18","2019-04-04","2019-04-04","2019-09-09","2019-01-02","2019-10-03","2019-10-03","2019-10-03","2019-10-03","2019-05-09","2022-10-05","2022-11-03","2022-10-05","2022-02-10","2022-03-07","2022-04-21","2022-09-29","2022-07-21","2022-03-14","2022-04-04","2022-08-23","2022-09-20","2022-11-07","2022-11-07","2022-11-07","2022-11-03"],"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":[["","50458057760","XARELTO","TAB 2.5MG","60","Select","Select",""],["","00378668977","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","42192080201","PHENAZOPYRID","TAB 200MG","6","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00378064110","PREDNISONE","TAB 10MG","40","Select","Select",""],["","29300012410","MELOXICAM","TAB 7.5MG","10","Select","Select",""],["","65162010350","GABAPENTIN","CAP 400MG","90","Select","Select",""],["","00406012405","HYDROCO\/APAP","TAB 7.5-325","30","Select","Select",""],["","65162062711","TRAMADOL","TAB 50MG","12","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","68382009601","HYDROXYCHLOR","TAB 200MG","60","Select","Select",""],["","27241009903","DULOXETINE","CAP 60MG","30","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","30","Select","Select",""],["","","CIPROFLOXACN","TAB 500MG","","Select","Select",""],["","00406851001","OXYCODONE","TAB 10MG","15","Select","Select",""],["","50458009801","ELMIRON","CAP 100MG","90","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","65862014736","SUMATRIPTAN","TAB 50MG","10","Select","Select",""],["","","VENLAFAXINE","CAP 150MG ER","","Select","Select",""],["","43598029390","PREGABALIN","CAP 75MG","90","Select","Select",""],["","45802086803","POLYETH","POW 3350 NF","510","Select","Select",""],["","","BUPROPION","TAB 100MG SR","","Select","Select",""],["","00115166003","PROPRANOLOL","TAB 20MG","90","Select","Select",""],["","","OXYBUTYNIN","TAB 5MG","","Select","Select",""],["","65162055310","METAXALONE","TAB 800MG","45","Select","Select",""],["","59651000305","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","00093117410","PENICILLN","TAB 500MG","56","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","65862021401","ZALEPLON","CAP 5MG","15","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","65862018501","CLINDAMYCIN","CAP 150MG","28","Select","Select",""],["","00781185220","AMOX\/K","TAB 875-125","14","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","21","Select","Select",""],["","00078074303","ILEVRO","DRO 0.3% OP","3","Select","Select",""],["","24208060203","PROLENSA","SOL 0.0007","3","Select","Select",""],["","61314063710","PREDNISOLONE","SUS 1% OP","10","Select","Select",""],["","60758061525","GATIFLOXACIN","SOL 0.005","2","Select","Select",""],["","00781713593","MOXIFLOXACIN","SOL HCL 0.5%","3","Select","Select",""],["","64380071307","BENZONATATE","CAP 200MG","40","Select","Select",""],["","00067815202","VOLTAREN","GEL 0.01","100","Select","Select",""],["","","DICLOFENAC","TAB 75MG DR","","Select","Select",""],["","00406123601","DIPHEN\/ATROP","TAB 2.5\/.025","30","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","43547030403","ARIPIPRAZOLE","TAB 10MG","30","Select","Select",""],["","68180099706","FLUOXETINE","TAB 60MG","30","Select","Select",""],["","","LEVOCETIRIZI","TAB 5MG","","Select","Select",""],["","","CEFDINIR","CAP 300MG","","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","10","Select","Select",""],["","","MECLIZINE","TAB 25MG","","Select","Select",""],["","65862022701","LAMOTRIGINE","TAB 25MG","60","Select","Select",""],["","00378021610","FUROSEMIDE","TAB 40MG","30","Select","Select",""],["","00093742698","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","00378932132","WIXELA","AER 250\/50","60","Select","Select",""],["","00173069600","ADVAIR","AER 250\/50","60","Select","Select",""],["","53489011905","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","71093014005","METHOCARBAM","TAB 500MG","40","Select","Select",""],["","00832105410","BACLOFEN","TAB 10MG","30","Select","Select",""],["","69097084507","CYCLOBENZAPR","TAB 5MG","15","Select","Select",""],["","65862018730","ONDANSETRON","TAB 4MG","10","Select","Select",""],["","00228300350","CLONAZEPAM","TAB 0.5MG","21","Select","Select",""],["","00536110788","NICOTINE","DIS 14MG\/24H","28","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":""}]}]}