{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JESSICA   D OSBORNE","gend":1,"add":"PO BOX 27","city":"EVINGTON","state":"VA","zip":"24550-0027","dob":"1991-08-08","age":"","mstatus":"","insh":10053078,"cliId":"","pno":4349442233,"cno":4342159941,"email":"","ename":"","eno":"","pphy":"BOLOURIAN, HOUMAN","ppno":4342005200,"pcpadd":"2323 Memorial Ave Ste 10, ","pcpcity":"Lynchburg","pcpstate":"VA","pcpzip":245012652,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":5408740276,"add2":"                                                            ","add3":"","madd1":"PO BOX 27","madd2":"                                                            ","madd3":"","mcity":"EVINGTON","mstate":"VA","mzip":"24550-0027","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G47.33","E66.9","N64.9","J45.909","J33.9","Z88.6","R68.89","J45.50","J32.8","R10.9","R11.0","Z34.90","N89.8","O21.9","Z34.02","J45.41","H53.032","S00.83XA","Z79.82","Z79.899","V43.52XA","A41.9","N12","N20.1","N13.30","R39.89","R06.89","R00.0","R11.2","R11.11","R53.81","O21.1","O99.281","E86.1","E86.0","D72.829","O99.111","O98.311","A59.9","Z3A.12","O99.011","D64.9","O99.351","Z91.19","O99.511","Z34.01","Z36.89","Z36.5","Z11.4","Z12.4","Z11.3","Z13.1","Z36.3","R10.11","Z36.2","J45.40","J15.9","N20.0","O21.0","Z3A.16","Z01.419","J32.4","J98.4","T39.015A","J45.51","J33.0","H66.001","N13.2","R82.71","Z3A.01","R11.10","O23.91","O99.891","R10.2","Z88.8","B34.9","N39.0","M79.10","I10","Z20.822","O21.2","O98.312","Z3A.25","S09.90XA","Y93.89","Y92.488","J20.9","M25.561","N13.6","Z91.011","Z91.018","Z91.048","Z82.49","Z23","O99.512","O98.512","B00.9","O23.42","J40","Z87.01","Z34.91","Z3A.11","O26.892","Z3A.13","J32.9","K21.9","Z01.411","N13.4","E87.6","E87.1","Z91.89","O99.019","R53.82","R40.0","G47.00","R51","R06.83","J18.9","L23.7","R03.0","M25.512"],"date":["2021-04-19","2019-11-22","2019-08-01","2021-04-19","2019-10-11","2021-03-09","2021-01-07","2019-10-11","2019-10-11","2021-02-18","2021-01-29","2021-01-29","2021-02-04","2021-02-17","2021-05-11","2019-10-11","2019-03-27","2019-05-15","2019-05-15","2021-04-19","2019-05-15","2020-12-07","2020-12-07","2020-12-11","2020-12-07","2020-12-23","2021-01-06","2021-01-06","2021-01-06","2021-01-06","2021-01-06","2021-02-06","2021-02-04","2021-02-04","2021-02-04","2021-02-06","2021-02-04","2021-02-04","2021-02-06","2021-02-17","2021-02-04","2021-02-04","2021-02-04","2021-02-04","2021-02-04","2021-02-19","2021-02-19","2021-02-19","2021-02-19","2021-02-19","2021-02-19","2021-02-19","2021-04-12","2021-04-19","2021-05-11","2019-05-07","2019-10-11","2020-12-07","2021-03-11","2021-03-11","2019-03-27","2019-09-10","2019-09-10","2019-09-10","2019-10-11","2019-09-10","2020-02-05","2020-12-06","2021-01-06","2021-01-06","2021-04-19","2021-01-06","2021-01-29","2021-02-17","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-05-16","2021-05-16","2021-05-16","2019-05-15","2019-05-15","2019-05-15","2020-02-26","2020-02-26","2020-12-06","2020-12-06","2020-12-06","2020-12-06","2020-12-06","2020-12-06","2021-03-09","2021-03-09","2021-03-09","2021-03-09","2019-06-17","2019-10-11","2021-02-06","2021-02-05","2021-02-18","2021-02-18","2019-02-12","2019-02-12","2020-06-17","2020-12-06","2021-02-06","2021-02-06","2021-02-06","2021-02-06","2019-02-12","2019-02-12","2019-02-12","2019-02-12","2019-02-12","2019-04-05","2020-06-10","2020-06-10","2020-10-26"],"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":[["","45802091987","CETIRIZINE ","TAB 10MG","30","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","00093220305","METOCLOPRAM ","TAB 10MG","120","Select","Select",""],["","00093742698","MONTELUKAST ","TAB 10MG","2","Select","Select",""],["","58657050016","CODEINE\/GG ","SOL 10-100\/5","120","Select","Select",""],["","68462010530","ONDANSETRON ","TAB 4MG","20","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","68382025601","OXYBUTYNIN ","TAB 10MG ER","90","Select","Select",""],["","59746017509","PREDNISONE ","TAB 20MG","20","Select","Select",""],["","00024591401","DUPIXENT ","INJ 300\/2ML","4","Select","Select",""],["","53489011905","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","00603158658","PROMETHAZINE ","SOL DM","150","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","50111033401","METRONIDAZOL ","TAB 500MG","14","Select","Select",""],["","00186091612","PULMICORT ","INH 180MCG","1","Select","Select",""],["","31722071390","PANTOPRAZOLE ","TAB 40MG","30","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","10","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","20","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","14","Select","Select",""],["","00173069600","ADVAIR ","AER 250\/50","60","Select","Select",""],["","00186037020","SYMBICORT ","AER 160-4.5","10","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","00378932132","WIXELA ","AER 250\/50","60","Select","Select",""],["","00536100901","FERROUS ","TAB 325MG","90","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","20","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","28","Select","Select",""],["","00093101042","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","62332042671","BENZONATATE ","CAP 100MG","30","Select","Select",""],["","51672128901","NYSTATIN ","CRE 100000","15","Select","Select",""],["","68180071160","CEFDINIR ","CAP 300MG","20","Select","Select",""],["","65862001501","AMOXICILLIN ","TAB 875MG","20","Select","Select",""],["","10702001801","OXYCODONE ","5MG","5","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","LITE","100","Select","Select",""],["","00093412773","PENICILLN ","250\/5ML","300","Select","Select",""],["","31722070430","VALACYCLOVIR ","500MG","180","Select","Select",""],["","99073070805","FREESTYLE    MIS LITE","LITE","1","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","LANCETS","100","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":""}]}]}