{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" S   NERAKDOOWLEZAH","gend":1,"add":"NACIREMA 961DVLB NOIGEL ","city":"DANVILLE","state":"VA","zip":"24540-9998","dob":"1959-06-30","age":"","mstatus":"","insh":"78300210*06","cliId":"","pno":"22\/4347091-8","cno":"","email":"","ename":"","eno":"","pphy":"SHARP, CASEY NP","ppno":"434\/835-4876","pcpadd":"949 PINEY FOREST ROAD","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"pcpcounty":"","pcpid":"","pcpname":"GO DOCS","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":["N20.1","M13.0","M53.3","M81.0","E03.9","E55.9","N18.9","E53.8","E66.3","Z28.89","Z79.899","I10.","F32.9","R73.03","R51.","E78.1","B35.1","K58.0","G25.81","F41.9","M54.9","E11.29","D51.9","H81.03","H91.90","R51.9","M79.641","M79.642","L60.0","E11.41","M20.11","M20.12","M20.41","M20.42","NO DATA","M54.5","I13.10","M79.671","N18.3","Z79.1","I65.23","R42.","M79.672","R39.12","Z87.442","J06.9","H66.002","Z20.822","R55.","Z76.89","R60.0","E87.6","N30.01","E87.1","E86.0","J30.2","R52.","R53.83","K59.00","I67.9","R90.89","G43.009","M54.81","R10.13","R82.998","I73.9","J41.0","R25.1","G47.00","R06.09","Z72.0","R06.02","G47.30","E66.9","Z91.81","M47.896","M47.898","J34.89","J18.9","R63.2","E08.65","Z71.3","Z71.82","R30.0","N13.2","N23.","V58.89","I87.2","M79.89","R13.10","K21.9","R19.7","M25.562","R73.9","E11.21","Z87.891","Z28.21","N13.39","E11.9","M51.36","G89.29","R05.","E78.5","H81.09","Z13.820","R68.2","Z68.33","N20.0","M79.674","M79.675","F17.210","K29.70","K44.9","Z79.891","K58.1","M70.61","M16.0","K59.09","Z79.84","R07.9","M62.81","R26.89","H04.123","K59.04","Z53.20"],"date":["2020-01-14","2022-10-31","2021-07-28","2022-08-01","2022-09-26","2022-06-30","2022-03-02","2020-11-04","2022-01-20","2020-11-04","2022-10-31","2022-09-26","2022-09-26","2021-04-14","2020-07-13","2022-06-30","2021-05-21","2021-10-13","2022-09-26","2022-09-26","2022-09-26","2022-09-26","2022-06-30","2022-09-26","2020-10-15","2021-10-13","2022-08-01","2022-08-01","2022-02-09","2022-02-09","2022-02-09","2022-02-09","2022-02-09","2022-02-09","2022-08-01","2021-08-11","2022-03-02","2021-10-13","2020-06-10","2021-02-08","2020-07-24","2020-07-24","2020-11-04","2021-06-25","2021-04-02","2021-11-26","2021-11-26","2021-11-26","2020-12-02","2021-08-11","2022-08-24","2020-09-09","2020-09-09","2020-09-09","2020-09-09","2020-01-20","2020-01-20","2020-07-13","2021-04-14","2021-05-27","2021-05-27","2021-05-27","2021-05-27","2021-05-28","2021-07-14","2022-08-24","2021-12-06","2021-03-22","2022-09-26","2022-08-24","2019-07-11","2019-08-26","2019-09-27","2022-06-30","2019-07-11","2019-03-19","2019-03-19","2019-05-24","2019-07-11","2019-08-26","2019-08-26","2019-08-29","2019-08-29","2019-11-05","2019-11-11","2019-11-11","2019-12-11","2019-04-17","2019-01-02","2019-09-09","2022-10-11","2019-06-07","2019-08-26","2019-08-26","2022-04-05","2019-08-26","2019-11-14","2019-12-03","2022-05-05","2019-02-15","2022-04-05","2019-07-17","2022-04-05","2019-02-27","2019-03-13","2019-05-06","2019-01-18","2019-10-17","2019-02-27","2019-02-27","2019-04-17","2019-06-12","2019-06-12","2022-10-31","2022-04-06","2022-08-01","2022-08-01","2022-06-16","2022-09-26","2022-08-24","2022-09-26","2022-09-26","2022-05-05","2022-10-11","2022-10-11"],"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":[["","16729000517","SIMVASTATIN","TAB 20MG","30","Select","Select",""],["","35515095210","CALCIUM\/D3","TAB 500\/200","60","Select","Select",""],["","16714013201","DOXEPIN","CAP 10MG","30","Select","Select",""],["","","LIDOCAINE","SOL 2% VISC","","Select","Select",""],["","55111015810","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","59762372104","ALPRAZOLAM","TAB 1MG","120","Select","Select",""],["","69543013611","TRAMADOL","TAB 50MG","60","Select","Select",""],["","16714045201","QUETIAPINE","TAB 25MG","30","Select","Select",""],["","00254302902","LUBIPROSTONE","CAP 24MCG","60","Select","Select",""],["","70954001910","PRAZOSIN","CAP 1MG","30","Select","Select",""],["","00597015561","STIOLTO","AER 2.5-2.5","4","Select","Select",""],["","62037055901","POT  CHLORIDE","CAP 8MEQ ER","120","Select","Select",""],["","00172208380","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","16714004301","VENLAFAXINE","CAP 37.5 ER","30","Select","Select",""],["","00115165202","METOCLOPRAM","TAB 5MG","120","Select","Select",""],["","29300011610","TOPIRAMATE","TAB 50MG","30","Select","Select",""],["","00456120330","LINZESS","CAP 72MCG","30","Select","Select",""],["","43547027010","ROPINIROLE","TAB 1MG","120","Select","Select",""],["","00603020922","MAG","TAB 400MG","60","Select","Select",""],["","47781064610","LEVOTHYROXIN","TAB 75MCG","30","Select","Select",""],["","64980043810","ATENOLOL","TAB 50MG","30","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","23155010210","METFORMIN","TAB 500MG","60","Select","Select",""],["","57237001899","DULOXETINE","CAP 30MG","30","Select","Select",""],["","69848000609","ALLERGY","TAB 10MG","30","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00185061505","HYDROXYZ","CAP 50MG","120","Select","Select",""],["","","ONDANSETRON","TAB 8MG ODT","","Select","Select",""],["","59746012106","MECLIZINE","TAB 25MG","120","Select","Select",""],["","76385012450","METHOCARBAM","TAB 750MG","120","Select","Select",""],["","16714071302","TAMSULOSIN","CAP 0.4MG","30","Select","Select",""],["","53885013610","ONETOUCH","MIS LANCETS","100","Select","Select",""],["","16729011917","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","64980034214","ALENDRONATE","TAB 70MG","4","Select","Select",""],["","00378306677","FENOFIBRATE","TAB 145MG","30","Select","Select",""],["","67405060403","FLUCONAZOLE","TAB 200MG","14","Select","Select",""],["","45963043965","CONSTULOSE","SOL 10GM\/15","900","Select","Select",""],["","57237004105","PENICILLN","TAB 500MG","30","Select","Select",""],["","45802091987","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","","B-12","SUB 2500MCG","","Select","Select",""],["","65649000330","TRULANCE","TAB 3MG","30","Select","Select",""],["","00093227534","AMOX\/K","TAB 875-125","20","Select","Select",""],["","58604021430","ADDYI","TAB 100MG","30","Select","Select",""],["","","AMOXICILLIN","CAP 500MG","","Select","Select",""],["","00591544310","PREDNISONE","TAB 20MG","18","Select","Select",""],["","00904546080","OYST","TAB 500MG","60","Select","Select",""],["","00115681110","BUPROPN","TAB 150MG XL","30","Select","Select",""],["","00527058601","DICYCLOMINE","CAP 10MG","120","Select","Select",""],["","16571066401","METRONIDAZOL","TAB 500MG","30","Select","Select",""],["","","OZEMPIC","INJ 2\/1.5ML","","Select","Select",""],["","72606000601","PREGABALIN","CAP 75MG","60","Select","Select",""],["","00093221005","SUCRALFATE","TAB 1GM","28","Select","Select",""],["","10267155107","OSCAL","TAB 200 D-3","180","Select","Select",""],["","60505015801","BUPROPION","TAB 75MG","30","Select","Select",""],["","42192033901","HYOSCYAMINE","SUB 0.125MG","20","Select","Select",""],["","80777027310","MODERNA","INJ COVID-19","0","Select","Select",""],["","65162068090","PROMETHAZINE","SOL DM","120","Select","Select",""],["","00487020160","IPRATROPIUM\/","SOL ALBUTER","270","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","3","Select","Select",""],["","51525029403","AZELASTINE","SPR 0.001","30","Select","Select",""],["","","BYDUREON","INJ 2\/0.85ML","","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","","REXULTI","TAB 0.5MG","","Select","Select",""],["","70069000510","CYANOCOBALAM","INJ 1000MCG","1","Select","Select",""],["","00378015001","CHLOROTHIAZ","TAB 250MG","30","Select","Select",""],["","70275062930","SALIVAMAX","POW ","240","Select","Select",""],["","13107004605","OXYCOD\/APAP","TAB 10-325MG","30","Select","Select",""],["","67877057505","BENZONATATE","CAP 200MG","15","Select","Select",""],["","58657045001","PHENAZOPYRID","TAB 100MG","30","Select","Select",""],["","66758011001","KLOR-CON","TAB 8MEQ ER","120","Select","Select",""],["","08290309581","3ML","MIS 25GX1\"","3","Select","Select",""],["","51672530200","CICLOPIROX","SOL 0.08","7","Select","Select",""],["","68180016113","AZITHROMYCIN","TAB 500MG","3","Select","Select",""],["","08214384034","UNIFINE","MIS 32GX5\/32","100","Select","Select",""],["","00115201101","ORPHENADRINE","TAB 100MG ER","20","Select","Select",""],["","00185012201","NITROFURANTN","CAP 100MG","28","Select","Select",""],["","31722077701","ACYCLOVIR","TAB 400MG","14","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","10702020110","OXYBUTYNIN","TAB 5MG","30","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":""}]}]}