{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" AICELAEEL D ","gend":1,"add":"CAJ 906TS NOSK","city":"LYNCHBURG","state":"VA","zip":24504,"dob":"1984-05-04","age":"","mstatus":"","insh":"90300210*99","cliId":"","pno":"84\/4340769-5","cno":"","email":"","ename":"","eno":"","pphy":"Route,  barbara","ppno":"434\/200-3366","pcpadd":"5424 Discovery Park Blvd BLDB A STE 201","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":24504,"pcpcounty":"","pcpid":"","pcpname":"COMMUNITY ACCESS NETWORK","plan":"OHP","program":"Medicaid","lob":"OHCC","region":"WESTERN\/ CHARLOTTESVILLE","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":["F25.0","R20.2","J30.89","R06.2","F31.62","R53.82","Z13.6","R73.9","F31.30","F16.10","F12.10","I10.","Z72.0","J45.909","B34.9","F32.9","V62.84","K08.89","N39.0","F31.63","F60.3","F16.24","R40.0","F51.01","F41.8","F20.9","E66.01","F31.9","F17.210","Z79.899","Z88.0","Z88.1","F29.","R06.02","R53.83","R53.1","R53.81","NO DATA","Z20.822","Z71.6","F31.4","G43.119","J45.20","F12.20","R51.9","M79.604","L53.9","L03.119","U07.1","V62.85","K21.9","T88.7XXA","R00.0","F31.32","F19.10","F41.9","J45.40","M94.0","Z09.","Z88.8","M79.605","R63.5","E78.2","E55.9","R70.0","M54.5","R60.0","R25.2","Z81.8","Z82.3","R44.0","J06.9","Z20.828","S50.12XA","Y04.8XXA","R79.89","S86.899A","L84.","X58.XXXA","G43.909","R05.","K04.7","R05.9","R43.2","J30.2","F25.1","F41.1","F25.9","M77.9","M72.2","M79.672","L03.115","M21.41","M21.42","F19.20","Z76.5","G89.29","R07.9","Z01.419","Z20.2","B96.89","N76.0","M25.572","G47.10","R40.4","R55.","F16.20","R51.","E66.9","R03.0","R06.9","F30.9","N30.00","R30.9","F99.","R06.00","M79.673","M79.89","M79.671","S05.02XA","M25.569","R41.89","D64.9","F12.980","R52.","R60.1","E88.09","F39.","Z01.89","R23.8","M79.659","R79.82","Z87.440","R46.89","F12.90","R47.81","R07.89","M67.01","M76.822","M76.821","J40.","S09.90XA","S43.101A","M79.652","M79.651","R69.","G47.33","G47.8","M54.89","H57.13","Z53.21","M54.41","Z87.898","F31.2","F20.89","I87.309","F31.5","R42.","R30.0","N89.8","Z68.41","R41.82","R68.89","G47.30","R06.83","L70.0","L85.3","M62.838","R10.9","K59.00","F31.13","F14.10","E11.9","Z79.84","R10.30","N94.6","R44.2","L98.9","F16.29","F17.200","F13.20","F70."],"date":["2022-11-28","2022-03-29","2020-06-03","2022-02-15","2020-06-03","2022-01-24","2020-06-03","2020-06-03","2022-03-26","2022-06-19","2022-06-16","2022-08-13","2021-12-27","2022-08-13","2022-08-13","2021-08-02","2022-06-14","2021-07-28","2022-06-14","2021-01-27","2021-12-23","2021-01-27","2021-11-29","2021-11-29","2020-09-02","2022-04-18","2021-12-27","2022-08-13","2022-05-06","2021-12-23","2021-12-23","2020-09-02","2022-04-17","2022-05-03","2021-08-02","2021-08-02","2022-05-03","2021-08-02","2022-08-13","2022-03-26","2020-05-25","2020-06-04","2022-05-18","2022-06-20","2021-12-16","2022-04-02","2021-12-21","2021-12-21","2022-01-03","2021-12-27","2022-05-18","2020-03-26","2020-03-26","2022-02-15","2022-03-14","2020-07-15","2020-07-15","2020-07-15","2020-07-15","2021-06-29","2022-04-02","2020-09-14","2020-09-14","2020-09-14","2021-02-11","2021-02-11","2022-04-02","2021-12-21","2021-12-23","2021-12-23","2021-12-27","2020-10-12","2020-10-12","2021-12-16","2021-12-16","2021-12-27","2021-12-12","2021-12-12","2021-12-12","2020-03-26","2021-01-22","2021-07-28","2021-12-15","2021-12-19","2022-01-24","2019-01-23","2019-01-23","2022-05-06","2019-07-10","2019-07-15","2019-08-31","2019-08-03","2019-08-23","2019-08-06","2019-08-09","2019-08-06","2019-08-11","2019-09-02","2019-09-27","2019-09-27","2019-09-27","2019-09-27","2019-07-22","2022-01-24","2019-08-09","2019-08-09","2022-07-13","2019-07-30","2019-06-12","2022-03-16","2019-07-29","2022-03-14","2019-07-18","2019-07-18","2019-08-12","2019-08-20","2019-08-20","2019-08-22","2019-08-31","2019-10-11","2019-07-06","2019-07-27","2019-07-27","2019-08-01","2021-12-23","2019-09-10","2019-09-10","2019-01-21","2019-06-11","2019-06-11","2019-07-15","2019-07-19","2019-07-28","2019-07-28","2019-08-02","2019-08-02","2019-08-22","2019-08-23","2019-08-23","2019-08-23","2019-08-27","2019-11-03","2019-11-03","2019-07-15","2019-07-15","2019-07-24","2022-05-06","2019-08-09","2019-07-31","2019-10-11","2019-07-30","2019-07-31","2022-01-03","2022-05-18","2022-05-03","2022-05-06","2022-05-06","2022-08-13","2022-03-29","2022-03-29","2022-06-20","2022-03-13","2022-05-03","2022-05-18","2022-01-24","2022-02-15","2022-02-15","2022-02-15","2022-03-18","2022-01-01","2022-03-16","2022-06-20","2022-03-16","2022-03-16","2022-03-17","2022-03-17","2022-04-17","2022-06-10","2022-06-16","2022-06-20","2022-06-20","2022-06-20"],"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":[["","00536589653","NICOTINE","DIS 21MG\/24H","7","Select","Select",""],["","00904759180","FEROSUL","TAB 325MG","30","Select","Select",""],["","65162089803","ARIPIPRAZOLE","TAB 10MG","10","Select","Select",""],["","","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","50111044102","TRAZODONE","TAB 150MG","30","Select","Select",""],["","00536100901","FERROUS","TAB 325MG","30","Select","Select",""],["","59148007280","ABILIFY","INJ 400MG","1","Select","Select",""],["","00536105556","ACNE","GEL 0.05","42","Select","Select",""],["","76385010410","BENZTROPINE","TAB 1MG","90","Select","Select",""],["","","ALLERGY","TAB 10MG","","Select","Select",""],["","42806008660","BUSPIRONE","TAB 30MG","60","Select","Select",""],["","57237001930","DULOXETINE","CAP 60MG","30","Select","Select",""],["","47335032688","NALTREXONE","TAB 50MG","30","Select","Select",""],["","50228043605","NAPROXEN","TAB 500MG","10","Select","Select",""],["","57896098110","ASPIRIN","TAB 81MG EC","30","Select","Select",""],["","65862001305","SERTRALINE","TAB 100MG","30","Select","Select",""],["","","BUPROPION","TAB 200MG SR","","Select","Select",""],["","65757040203","ARISTADA","INJ 662MG\/2","2","Select","Select",""],["","16729041401","DOXAZOSIN","TAB 2MG","60","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","43547035311","LISINOPRIL","TAB 10MG","30","Select","Select",""],["","16477034007","UREA","CRE 0.4","198","Select","Select",""],["","69315011610","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","50458056301","INVEGA","INJ 156MG\/ML","1","Select","Select",""],["","00904673080","ACETAMIN","TAB 500MG","240","Select","Select",""],["","67877025010","QUETIAPINE","TAB 100MG","30","Select","Select",""],["","29300022010","MONTELUKAST","TAB 10MG","15","Select","Select",""],["","16729018317","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","00115180401","HYDROXYZ","CAP 50MG","60","Select","Select",""],["","67877019910","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","29300022705","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","59762532001","PRAZOSIN","CAP 2MG","30","Select","Select",""],["","60505264807","TIZANIDINE","CAP 2MG","14","Select","Select",""],["","65862042001","SMZ\/TMP","TAB 800-160","2","Select","Select",""],["","71247015201","HALOPERIDOL","TAB 2MG","60","Select","Select",""],["","61874013030","VRAYLAR","CAP 3MG","30","Select","Select",""],["","57896048930","POLYETH","POW 3350 NF","510","Select","Select",""],["","13107003134","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","66993068030","OLANZAPINE","TAB 2.5MG","30","Select","Select",""],["","68682036890","DILTIAZEM","CAP 180MG\/24","30","Select","Select",""],["","00904573411","NICORELIEF","GUM 2MG ORIG","110","Select","Select",""],["","00054001729","PREDNISONE","TAB 10MG","15","Select","Select",""],["","00378668910","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","10370010250","BUPROPN","TAB 300MG XL","30","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","64980032005","TRIAMCINOLON","PST DEN 0.1%","10","Select","Select",""],["","31722052110","HYDRALAZINE","TAB 50MG","90","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","27808003502","HYDROCO\/APAP","TAB 5-325MG","10","Select","Select",""],["","76329336901","NALOXONE","INJ 1MG\/ML","4","Select","Select",""],["","42571025201","CLINDAMYCIN","CAP 300MG","30","Select","Select",""],["","42571016201","AMOX\/K","TAB 875-125","20","Select","Select",""],["","68382031910","TRAMADOL","TAB 50MG","20","Select","Select",""],["","00135015707","NICORETTE","GUM 2MG ORIG","110","Select","Select",""],["","00172572880","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","59746024501","LAMOTRIGINE","TAB 25MG","42","Select","Select",""],["","69315090410","LORAZEPAM","TAB 0.5MG","60","Select","Select",""],["","61442010310","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","","LORATADINE","TAB 10MG","","Select","Select",""],["","00186037220","SYMBICORT","AER 80-4.5","10","Select","Select",""],["","67877032005","IBUPROFEN","TAB 600MG","28","Select","Select",""],["","","PROMETHAZINE","SYP DM","","Select","Select",""],["","","ONDANSETRON","TAB 4MG","","Select","Select",""],["","","BENZONATATE","CAP 100MG","","Select","Select",""],["","67877022405","GABAPENTIN","CAP 400MG","90","Select","Select",""],["","51991083801","CYPROHEPTAD","TAB 4MG","30","Select","Select",""],["","16729017301","AMITRIPTYLIN","TAB 50MG","60","Select","Select",""],["","00173071820","FLOVENT","AER 44MCG","11","Select","Select",""],["","00173071520","ADVAIR","AER 45\/21","12","Select","Select",""],["","29300012410","MELOXICAM","TAB 7.5MG","30","Select","Select",""],["","31722053001","TORSEMIDE","TAB 10MG","60","Select","Select",""],["","00904530760","BANOPHEN","CAP 50MG","60","Select","Select",""],["","65862014636","SUMATRIPTAN","TAB 25MG","12","Select","Select",""],["","33342002208","LEVOFLOXACIN","TAB 500MG","10","Select","Select",""],["","55111012705","CIPROFLOXACN","TAB 500MG","10","Select","Select",""],["","13668026805","CARBAMAZEPIN","TAB 200MG","14","Select","Select",""],["","64380073706","VITAMIN","CAP 50000UNT","2","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":""}]}]}