{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" LINDA B GUILL","gend":1,"add":"1144 BEULAH ROAD","city":"NATHALIE","state":"VA","zip":"24577-9998","dob":"1966-05-16","age":"","mstatus":"","insh":"2015618*01","cliId":"","pno":"434\/470-5127","cno":"434\/470-5127, ","email":"","ename":"","eno":"","pphy":"BUCKMAN, PAUL S MD","ppno":"434\/349-3113","pcpadd":"15210 L P BAILEY MEMORIAL HIGHWAY","pcpcity":"NATHALIE","pcpstate":"VA","pcpzip":"24577-9998","pcpcounty":"","pcpid":105510,"pcpname":"","plan":"OHP - OPTIMA","program":"ACA","lob":"Individual","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":["M06.9","Z13.9","S81.811A","J44.9","Z90.49","Z98.51","F17.210","L03.115","Z88.0","Z88.5","S81.801A","M05.29","M12.9","E53.8","R91.1","Z79.52","Z79.899","Z11.59","L03.90","M05.20","J42.","M05.79","M16.7","M87.052","R60.0","S89.91XS","T14.8XXS","M25.552","L97.812","R63.0","Z68.1","F17.200","D64.9","Z88.1","I87.2","M85.861","L08.9","S80.819S","M16.10","M16.12","I95.9","E87.6","Z79.01","S72.22XA","M34.1","G56.00","R70.0","M54.5","M81.0","R53.83","M25.561","M25.562","E66.3","Z72.0","R06.00","I10.","I31.3","R00.0","J43.9","M79.652","R22.42","G47.09","I82.409","Z96.642","S81.811D","J20.9","J44.1","R05.","M79.89","S80.11XA","M79.671","M79.672","E55.9","E53.1","E53.9","M97.02XA","M25.559","I26.93","I82.412","I82.90","K21.9","R11.0","R52.","I26.99","I82.402","M79.605","Z88.6","R06.2","Z85.41","M25.50","M87.00","R10.30","T14.90XA","Z01.810","Z01.812","M05.752","Z20.828","R07.89","Z96.659","Z80.1","A41.9","K86.89","K44.9","K43.0","Z86.59","M79.661","S81.812D","T14.8XXD","D50.9","L97.815","M05.9","F17.218","B37.0","S89.91XA","A49.02","M16.9","T84.89XA","M97.8XXD","Z96.649","E46.","M48.56XA","D63.8","K76.0","S81.802D","S81.801D","Z51.89","Z79.51","Z91.81","M06.89","B95.62","L60.0","L03.031","Z09.","K29.71","D62.","M97.9XXA","Z88.2","R50.9","K92.2","K92.1","Z13.220","Z47.1","R10.9","R06.02","J96.01","E78.5","K29.70","R53.1","R60.9","J18.9","E86.0","L97.819","N28.1","Z87.440","Z82.49","Z80.0","R11.2","R10.10","K46.9","K76.9","L97.821","J98.4","S81.001A","S91.001A","Z12.11","S80.819A","S81.809A","S91.301A","M87.9","M85.80","R91.8","R07.9","S72.25XD","M97.02XD","M06.09","E44.1","I95.0","J90.","N18.9","M79.662","S81.812A","Z29.9","T14.8XXA","S72.25XA","K31.89","K29.50","Z01.89"],"date":["2021-06-09","2020-04-27","2021-05-05","2021-06-03","2021-04-14","2021-02-03","2021-06-03","2020-07-28","2021-06-03","2021-06-03","2020-07-30","2021-01-11","2020-05-26","2020-09-23","2021-02-19","2021-02-19","2021-06-09","2020-05-26","2020-05-30","2021-02-19","2021-02-19","2021-02-19","2020-12-11","2021-02-13","2020-12-11","2020-08-25","2020-08-25","2021-02-24","2020-11-17","2020-10-07","2021-02-19","2021-01-13","2021-06-03","2021-06-03","2021-06-03","2020-10-13","2020-10-14","2020-10-14","2021-06-03","2021-01-08","2021-01-19","2021-02-24","2021-03-04","2020-12-11","2021-01-08","2021-01-08","2021-01-08","2021-01-08","2021-01-08","2021-01-08","2021-01-08","2021-01-08","2021-01-08","2021-05-28","2021-02-02","2021-02-21","2021-02-02","2021-02-02","2021-02-19","2021-02-24","2021-04-30","2021-06-09","2021-06-09","2021-06-09","2021-06-09","2020-02-22","2021-02-24","2020-12-11","2020-05-26","2020-05-28","2020-07-24","2020-07-24","2020-09-23","2020-09-23","2020-09-23","2020-12-11","2020-12-14","2021-02-22","2021-03-08","2021-03-08","2021-06-04","2021-03-09","2021-03-09","2021-06-04","2021-04-28","2021-05-12","2020-02-22","2020-02-22","2021-01-26","2020-09-16","2020-09-24","2020-01-17","2020-10-02","2020-12-03","2020-12-07","2020-12-11","2021-01-11","2021-01-11","2021-02-03","2021-02-03","2021-01-19","2021-02-22","2021-02-22","2021-04-28","2021-04-28","2021-05-20","2021-05-12","2021-05-12","2021-06-04","2021-06-03","2021-05-28","2020-05-30","2020-07-27","2020-07-27","2020-11-17","2020-12-08","2020-12-14","2021-01-26","2021-01-26","2021-02-19","2021-02-19","2021-02-19","2021-02-19","2021-06-03","2021-06-03","2020-05-15","2021-01-11","2020-12-19","2020-10-02","2020-11-17","2020-12-03","2020-12-03","2021-01-26","2021-01-11","2021-01-11","2021-01-11","2021-01-11","2021-01-11","2021-01-19","2021-01-26","2021-01-26","2021-02-03","2021-02-03","2021-02-19","2021-02-24","2021-02-24","2021-06-04","2021-04-23","2021-04-23","2020-02-20","2020-02-20","2020-12-02","2021-01-13","2021-02-03","2021-02-03","2021-02-03","2021-02-03","2021-04-14","2021-04-14","2021-04-14","2021-06-03","2021-01-11","2020-07-30","2020-07-30","2020-08-31","2020-10-14","2020-10-14","2020-10-14","2020-12-08","2020-12-11","2021-02-19","2021-01-11","2020-12-19","2020-12-19","2020-12-19","2020-12-19","2021-01-05","2021-01-11","2021-03-04","2021-05-05","2021-05-05","2021-05-05","2021-05-05","2020-12-11","2021-01-11","2021-01-11","2021-06-04"],"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":[["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","65162019050","NAPROXEN","500MG","30","Select","Select",""],["","51224001060","BENZONATATE","100MG","30","Select","Select",""],["","68180016113","AZITHROMYCIN","500MG","3","Select","Select",""],["","00603233832","APAP\/CODEINE","300-30MG","12","Select","Select",""],["","00527133850","DOXYCYC","100MG","20","Select","Select",""],["","16729027730","METHOTREXATE","50MG\/2ML","4","Select","Select",""],["","69315011610","FUROSEMIDE","20MG","30","Select","Select",""],["","69315012710","FOLIC","1000MCG","30","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","8","Select","Select",""],["","00591544221","PREDNISONE","10MG","21","Select","Select",""],["","43386048024","ORPHENADRINE","100MG ER","30","Select","Select",""],["","68462035705","POT CHLORIDE","10MEQ ER","30","Select","Select",""],["","00527512170","NYSTATIN","100000","200","Select","Select",""],["","45802004635","GENTAMICIN","0.10%","-15","Select","Select",""],["","70710113801","FLUCONAZOLE","100MG","14","Select","Select",""],["","50111043302","TRAZODONE","50MG","30","Select","Select",""],["","42571025101","CLINDAMYCIN","150MG","80","Select","Select",""],["","61442012101","FAMOTIDINE","20MG","60","Select","Select",""],["","65862018730","ONDANSETRON","4MG","20","Select","Select",""],["","69543013611","TRAMADOL","50MG","20","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","16729022517","SPIRONOLACT","25MG","30","Select","Select",""],["","00904645780","DOK","100MG","40","Select","Select",""],["","55513071001","PROLIA","60MG\/ML","1","Select","Select",""],["","55111015810","OMEPRAZOLE","20MG","30","Select","Select",""],["","70010077001","METHOCARBAM","750MG","30","Select","Select",""],["","00093221005","SUCRALFATE","1GM","60","Select","Select",""],["","00003089421","ELIQUIS","5MG","60","Select","Select",""],["","08290309626","1ML","25GX5\/8\"","12","Select","Select",""],["","00904546080","OYST","500MG","60","Select","Select",""],["","75987002201","RAYOS","5MG","60","Select","Select",""],["","69918030130","TRANEX","650MG","3","Select","Select",""],["","58160088552","FLUARIX","2020-21","0","Select","Select",""],["","43547039950","CYCLOBENZAPR","5MG","63","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","65862055990","PANTOPRAZOLE","20MG","30","Select","Select",""],["","42806031205","DOXYCYCL","100MG","20","Select","Select",""],["","00591079021","METHYLPRED","4MG","21","Select","Select",""],["","50484001030","SANTYL","250\/GM","30","Select","Select",""],["","00832532511","POT CL MICRO","20MEQ ER","30","Select","Select",""],["","08290309572","3ML","22GX1\"","8","Select","Select",""],["","10542009512","BIOTIN","5MG","180","Select","Select",""],["","47781019605","OXYCOD\/APAP","5-325MG","40","Select","Select",""],["","49483060450","IBUPROFEN","800MG","14","Select","Select",""],["","31722072250","LEVOFLOXACIN","500MG","4","Select","Select",""],["","50458058030","XARELTO","10MG","28","Select","Select",""],["","43598072101","HYDROXYCHLOR","200MG","60","Select","Select",""],["","88888888887","DMR","","1","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","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","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":""}]}]}