{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" LUAPESAED","gend":0,"add":"NEH NHOJ 2711DAOR NWORB YR","city":"CLOVER","state":"VA","zip":"24534-9998","dob":"1974-12-17","age":"","mstatus":"","insh":"7382110*80","cliId":"","pno":"22\/4349416-2","cno":"","email":"","ename":"","eno":"","pphy":"CORBETT, TIMOTHY W MD","ppno":"434\/392-9366","pcpadd":"324 COMMERCE ROAD","pcpcity":"FARMVILLE","pcpstate":"VA","pcpzip":23901,"pcpcounty":"","pcpid":"","pcpname":"SOUTHSIDE AREA FAMILY MEDICINE","plan":"OHP","program":"MEDICAID","lob":"M4","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":["F11.20","R52.","E55.9","Z12.5","M19.90","E78.5","R94.5","F32.9","K25.3","K31.89","K74.60","Z86.19","Z79.1","I38.","L40.9","J44.9","I10.","L40.50","Z76.0","Z73.3","F41.9","F19.10","I50.9","L01.00","I08.8","Z01.89","Z01.810","Z01.812","F41.8","K76.6","K25.9","F41.1","F60.9","R45.1","F39.","B18.2","K21.9","F17.210","R73.03","I34.2","I42.9","N52.9","G47.33","R06.09","S61.412A","S93.402A","M25.571","E66.9","Z98.890","F33.2","M25.541","M25.542","F32.1","F41.0","Z29.8","I05.9","E78.2","F17.200","F33.1","M79.671","NO DATA","R00.0","H66.92","H60.92","R40.0","Z86.79","M79.641","M79.642","G25.81","F90.9","M79.604","I42.0","I08.1","R60.0","I05.0","R06.02","M19.171","Z23.","Z00.00","Z13.6","M25.50","Z71.3","R79.89","S61.221A","R53.83","H60.502","Z88.5","Z79.899","H92.02","K59.09","J01.90","D64.9","H92.01","L03.119","S22.42XA","S72.391A","S22.31XA","S81.012A","V47.5XXA","Y92.410","S72.351A","R06.00","R10.9","R41.0","R09.02","V49.40XA","S81.011A","S40.812A","V47.0XXA","S40.811A","T14.90XA","G89.18","G89.11","R76.8","R74.01","F19.20","Z20.822","N39.0","E11.9","E03.9","N40.0","R94.6","Z51.81","S72.301A","V54.15","V54.19","V58.89","J45.909","G47.30","Q66.6","G89.29","I45.10","T14.8XXD","S22.43XA","S27.321A","V89.9XXA","Z79.891","M25.552","V89.2XXD","S71.111A","S30.1XXA","N17.9","J98.11","D62.","E44.1","F11.23","S01.81XA","S61.411A","R94.31","D72.829","V57.5XXA","G62.9"],"date":["2022-11-01","2022-11-01","2022-11-01","2022-11-01","2020-06-09","2022-11-01","2022-11-01","2022-04-25","2020-03-11","2020-03-11","2022-04-25","2020-03-11","2020-03-11","2022-02-07","2021-01-11","2022-04-22","2022-10-17","2022-01-06","2022-11-01","2020-04-17","2022-11-01","2022-04-22","2022-02-07","2020-06-09","2021-12-27","2020-02-26","2020-02-26","2020-02-26","2020-12-11","2020-03-04","2020-08-04","2022-04-25","2020-06-17","2020-06-17","2022-04-25","2022-04-25","2021-11-08","2022-11-01","2022-01-06","2022-01-07","2022-11-01","2022-01-06","2022-01-06","2022-06-06","2022-03-04","2020-02-12","2021-12-07","2021-11-08","2021-06-07","2020-02-24","2020-02-24","2020-02-24","2020-05-22","2022-04-25","2020-03-30","2021-11-09","2022-06-06","2022-01-11","2020-05-22","2020-08-04","2022-04-22","2021-01-11","2019-02-18","2019-02-18","2019-06-25","2022-02-18","2019-01-24","2019-01-24","2022-04-25","2022-04-25","2019-05-17","2019-07-15","2019-07-15","2019-10-15","2019-11-13","2022-02-03","2019-09-12","2019-01-28","2019-01-28","2019-01-28","2019-09-09","2019-09-09","2019-09-09","2019-11-03","2019-11-13","2019-02-18","2019-02-18","2019-02-18","2019-02-18","2019-02-26","2019-02-26","2019-02-26","2019-04-18","2019-09-19","2022-03-04","2022-03-04","2022-03-04","2022-03-04","2022-03-07","2022-03-11","2022-03-15","2022-02-03","2022-03-03","2022-03-03","2022-03-03","2022-03-03","2022-03-11","2022-03-03","2022-03-03","2022-03-03","2022-03-14","2022-03-14","2022-03-13","2022-03-11","2022-03-11","2022-03-11","2022-03-04","2022-02-07","2022-02-07","2022-02-07","2022-02-07","2022-02-07","2022-03-25","2022-03-04","2022-10-27","2022-04-25","2022-04-25","2022-04-25","2022-04-25","2022-04-25","2022-11-01","2022-01-11","2022-03-25","2022-03-11","2022-03-11","2022-03-11","2022-03-25","2022-04-22","2022-04-11","2022-03-03","2022-03-03","2022-03-04","2022-03-04","2022-03-04","2022-03-04","2022-03-04","2022-03-04","2022-03-04","2022-03-13","2022-03-13","2022-03-03","2022-11-01"],"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":[["","00310621030","FARXIGA","TAB 10MG","30","Select","Select",""],["","49483060350","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","42858030101","HYDROMORPHON","TAB 2MG","32","Select","Select",""],["","00093031101","LOPERAMIDE","CAP 2MG","30","Select","Select",""],["","00781723864","BUPREN\/NALOX","MIS 8-2MG","60","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","60","Select","Select",""],["","12496120803","SUBOXONE","MIS 8-2MG","60","Select","Select",""],["","","OMEPRAZOLE","CAP 40MG","","Select","Select",""],["","00378020810","FUROSEMIDE","TAB 20MG","60","Select","Select",""],["","00378932232","WIXELA","AER 500\/50","60","Select","Select",""],["","00173069700","ADVAIR","AER 500\/50","60","Select","Select",""],["","00093081201","NORTRIPTYLIN","CAP 50MG","30","Select","Select",""],["","49884093547","DICLOFENAC","GEL 0.01","500","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","69584061150","METHOCARBAM","TAB 500MG","40","Select","Select",""],["","68382002310","ATENOLOL","TAB 50MG","30","Select","Select",""],["","13668010410","ISOSORB","TAB 30MG ER","90","Select","Select",""],["","00781717612","NALOXONE","SPR ","2","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","20","Select","Select",""],["","67877012450","SILVER","CRE 0.01","50","Select","Select",""],["","00548560200","ENOXAPARIN","INJ 40\/0.4ML","12","Select","Select",""],["","58160081552","TWINRIX","INJ ","1","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","00310461639","BREZTRI","AER SPHERE","6","Select","Select",""],["","43386009660","CLOBETASOL","OIN 0.0005","15","Select","Select",""],["","00093117410","PENICILLN","TAB 500MG","30","Select","Select",""],["","00093301856","TADALAFIL","TAB 10MG","30","Select","Select",""],["","","HYDROXYZ","TAB 25MG","","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","60","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","","HYDROCHLOROT","TAB 25MG","","Select","Select",""],["","","BUSPIRONE","TAB 5MG","","Select","Select",""],["","00228212750","CLONIDINE","TAB 0.1MG","60","Select","Select",""],["","59746036290","VALSARTAN","TAB 160MG","30","Select","Select",""],["","","VENLAFAXINE","TAB 75MG","","Select","Select",""],["","13668013701","ESCITALOPRAM","TAB 20MG","30","Select","Select",""],["","69097015907","MELOXICAM","TAB 15MG","30","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","00234057508","HIBICLENS","LIQ 0.04","236","Select","Select",""],["","","SULINDAC","TAB 200MG","","Select","Select",""],["","","DESVENLAFAX","TAB 50MG ER","","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","2","Select","Select",""],["","","ARIPIPRAZOLE","TAB 5MG","","Select","Select",""],["","","MIRTAZAPINE","TAB 15MG","","Select","Select",""],["","","VIIBRYD","TAB 40MG","","Select","Select",""],["","","DOXYCYCL","TAB 100MG","","Select","Select",""],["","","SAXENDA","INJ 18MG\/3ML","","Select","Select",""],["","63481068447","VOLTAREN","GEL 0.01","500","Select","Select",""],["","00456120130","LINZESS","CAP 145MCG","30","Select","Select",""],["","17478071311","OFLOXACIN","DRO 0.3% OP","10","Select","Select",""],["","00228202950","ALPRAZOLAM","TAB 0.5MG","75","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","68382095501","AMPHET\/DEXTR","TAB 20MG","60","Select","Select",""],["","00093816201","QUETIAPINE","TAB 100MG","30","Select","Select",""],["","23155019201","BUPROPION","TAB 100MG","90","Select","Select",""],["","68382091634","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","00781185220","AMOX\/K","TAB 875-125","20","Select","Select",""],["","59762500801","MISOPROSTOL","TAB 200MCG","120","Select","Select",""],["","68180016113","AZITHROMYCIN","TAB 500MG","3","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":""}]}]}