{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMBER   N MORRIS","gend":1,"add":"1963   SEQUOIA STREET                                       ","city":"CHARLOTTESVILLE               ","state":"VA","zip":"22911-5826","dob":"1992-12-29","age":"","mstatus":"","insh":10052996,"cliId":"","pno":4349627390,"cno":4348255266,"email":"","ename":"","eno":"","pphy":"CHRISTENSEN, MARISA                                         ","ppno":"","pcpadd":"1242 Cedars Ct","pcpcity":"Charlottesville               ","pcpstate":"VA","pcpzip":229034800,"pcpcounty":"","pcpid":"P0132725","pcpname":"IVY COMPREHENSIVE CARE LLC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"LOT 56                                                      ","add3":"","madd1":"1963   SEQUOIA STREET                                       ","madd2":"LOT 56                                                      ","madd3":"","mcity":"CHARLOTTESVILLE               ","mstate":"VA","mzip":"22911-5826","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M16.11","M79.604","G40.409","Z87.39","Z79.899","Z88.8","M16.31","G40.909","M54.40","G89.29","R56.9","G43.709","M25.551","G89.4","M21.851","E66.9","Z68.30","O21.9","Z3A.00","O26.899","R11.0","Z34.81","Z36.87","O99.351","G40.B19","O99.341","F32.9","O09.291","Z86.32","O34.219","Z3A.09","E66.09","Z34.91","Z68.31","O99.89","Z3A.12","Z36.3","Z13.79","G40.919","Z39.1","O23.592","B37.3","O34.211","O09.292","Z3A.21","Z34.82","Z98.891","Z87.59","B37.9","O09.891","Z3A.22","O99.352","J06.9","E87.6","O98.512","R05","J02.9","O99.282","O99.512","J45.909","Z3A.26","R42","O99.350","R29.700","Z88.6","K04.7","K08.89","O36.8130","O99.283","O09.293","Z3A.32","Z34.83","M79.89","M79.605","O14.13","O14.14","O75.4","N99.4","Z3A.35","Z37.0","O99.284","O99.354","O99.12","D69.6","G40.B09","Z91.19","O99.344","F41.9","O09.33","O14.15","O90.81","O99.285","O99.355","M25.561","M16.0","M16.12","M23.91","M87.051","M87.052","M25.361","M25.461","H60.501","H92.01","Z79.3","D72.829"],"date":["2020-10-13","2020-05-21","2020-04-01","2019-01-21","2021-05-18","2021-05-18","2020-07-15","2020-04-30","2019-03-25","2020-10-13","2021-08-04","2019-04-02","2020-10-13","2019-11-07","2019-11-07","2019-09-30","2019-09-30","2019-10-10","2020-04-01","2020-04-01","2019-10-10","2019-12-13","2019-11-12","2019-12-13","2020-05-24","2019-12-13","2020-05-21","2019-11-21","2020-04-30","2019-12-13","2019-11-21","2019-11-21","2019-11-21","2019-11-21","2020-03-17","2019-12-13","2019-12-13","2019-12-13","2019-12-13","2019-12-31","2020-02-12","2020-02-12","2020-05-21","2020-02-12","2020-02-12","2020-02-18","2020-05-21","2020-04-30","2020-02-12","2020-02-18","2020-02-18","2020-03-17","2020-03-17","2021-08-04","2020-03-17","2020-03-17","2020-03-17","2020-03-17","2020-03-17","2021-05-18","2020-03-17","2020-04-01","2020-04-01","2020-04-01","2020-04-01","2020-04-03","2020-04-03","2020-05-21","2020-04-30","2020-04-30","2020-04-30","2020-04-30","2020-05-21","2020-05-21","2020-05-21","2020-05-21","2020-05-21","2020-05-21","2020-05-21","2020-05-21","2020-05-21","2020-05-21","2020-05-21","2020-05-21","2020-05-21","2020-05-21","2020-05-21","2020-05-21","2020-05-21","2020-05-24","2020-05-24","2020-05-24","2020-05-24","2021-04-20","2020-10-13","2020-10-13","2020-10-13","2020-10-13","2020-10-13","2020-10-13","2020-10-13","2021-05-18","2021-05-18","2021-05-18","2021-08-04"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","00555901658","SPRINTEC","28 DAY","28","Select","Select",""],["","65862024608","LEVETIRACETA","500MG","540","Select","Select",""],["","62332049141","TIZANIDINE","2MG","30","Select","Select",""],["","53746010901","HYDROCO\/APAP","5-325MG","90","Select","Select",""],["","59651000305","OMEPRAZOLE","40MG","30","Select","Select",""],["","00245010810","FERROUS","325MG EC","90","Select","Select",""],["","10006073034","FOLIC","400MCG","30","Select","Select",""],["","13668013701","ESCITALOPRAM","20MG","30","Select","Select",""],["","00254100752","ALBUTEROL","HFA","6.7","Select","Select",""],["","59746011506","PROCHLORPER","10MG","30","Select","Select",""],["","65862022801","LAMOTRIGINE","100MG","270","Select","Select",""],["","00006483703","PNEUMOVAX","25\/0.5","0.5","Select","Select",""],["","59267100003","PFIZER","COVID-19","0.3","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","1","Select","Select",""],["","65162019050","NAPROXEN","500MG","30","Select","Select",""],["","68462030929","NORGEST\/ETHI","0.25\/35","28","Select","Select",""],["","65162074510","PROMETHAZINE","12.5MG","15","Select","Select",""],["","65862001501","AMOXICILLIN","875MG","20","Select","Select",""],["","59779076678","PAIN","325MG","30","Select","Select",""],["","10702001801","OXYCODONE","5MG","15","Select","Select",""],["","69097012403","TOPIRAMATE","100MG","60","Select","Select",""],["","24208063110","NEO\/POLY\/HC","1% OTIC","10","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","20","Select","Select",""],["","00603188016","LIDOCAINE","5%","30","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","00555901658","SPRINTEC ","TAB 28 DAY","28","Select","Select",""],["","65862024608","LEVETIRACETA ","TAB 500MG","540","Select","Select",""],["","62332049141","TIZANIDINE ","CAP 2MG","30","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","90","Select","Select",""],["","59651000305","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","40","Select","Select",""],["","00245010810","FERROUS ","TAB 325MG EC","90","Select","Select",""],["","10006073034","FOLIC ","TAB 400MCG","30","Select","Select",""],["","13668013701","ESCITALOPRAM ","TAB 20MG","30","Select","Select",""],["","68462030929","NORGEST\/ETHI ","TAB 0.25\/35","28","Select","Select",""],["","00254100752","ALBUTEROL ","AER HFA","6.7","Select","Select",""],["","59746011506","PROCHLORPER ","TAB 10MG","30","Select","Select",""],["","65862022801","LAMOTRIGINE ","TAB 100MG","270","Select","Select",""],["","00006483703","PNEUMOVAX ","INJ 25\/0.5","0.5","Select","Select",""],["","59267100003","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","30","Select","Select",""],["","65162074510","PROMETHAZINE ","TAB 12.5MG","15","Select","Select",""],["","65862001501","AMOXICILLIN ","TAB 875MG","20","Select","Select",""],["","00116200116","CHLORHEX ","SOL 0.0012","473","Select","Select",""],["","59779076678","PAIN ","TAB 325MG","30","Select","Select",""],["","10702001801","OXYCODONE ","TAB 5MG","15","Select","Select",""],["","69097012403","TOPIRAMATE ","TAB 100MG","60","Select","Select",""],["","24208063110","NEO\/POLY\/HC ","SOL 1% OTIC","10","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","20","Select","Select",""],["","00603188016","LIDOCAINE ","PAD 0.05","30","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}