{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"COLLEEN   KOVAC BEIGHTS","gend":1,"add":"1 CANTERBURY RD","city":"CHARLOTTESVILLE","state":"VA","zip":"22903-9998","dob":"1972-09-07","age":"","mstatus":"","insh":"2019754*02","cliId":"","pno":"434\/531-1899","cno":"434\/531-1899","email":"","ename":"","eno":"","pphy":"FRIESEN, LINDSAY D MD","ppno":"434\/244-4550","pcpadd":"310 OLD IVY WAY SUITE 201","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22903,"pcpcounty":"","pcpid":145521,"pcpname":"SMJMG - Sentara Blue Ridge Internal Medicine","plan":"OHP","program":"ACA","lob":"Individual","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"434\/531-1899","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":["M54.5","N95.1","K64.9","F43.20","F90.2","F33.2","F43.23","M99.01","M99.02","M99.03","M99.04","M53.1","G54.0","M50.321","M50.322","M50.323","M48.02","M47.812","M99.08","R19.7","D12.2","F43.10","F51.01","F41.9","M50.121","M50.122","M50.123","M43.12","M47.22","M25.512","M25.511","Z12.31","M85.89","F33.1","M25.78","M54.12","M19.011","M25.552","M79.10","M24.151","S76.011A","M67.951","M70.71","M70.62","S73.191A","S73.192A","S76.301A","S76.302A"],"date":["2021-04-08","2020-06-24","2020-03-04","2021-10-13","2021-09-10","2021-09-10","2021-09-10","2021-07-21","2021-07-21","2021-08-26","2021-08-26","2021-05-24","2021-05-24","2021-06-15","2021-06-15","2021-06-15","2021-07-13","2021-09-13","2021-07-21","2020-07-02","2021-05-13","2021-11-09","2021-11-09","2021-11-09","2021-07-13","2021-07-13","2021-07-13","2021-05-24","2021-06-12","2021-06-08","2021-06-08","2021-06-07","2020-06-29","2020-06-12","2021-06-12","2021-07-01","2021-07-01","2021-09-15","2021-08-26","2021-11-05","2021-11-05","2021-11-05","2021-11-05","2021-09-15","2021-11-05","2021-11-05","2021-11-05","2021-11-05"],"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":[["","68001019603","ESCITALOPRAM ","10MG","30","Select","Select",""],["","43547040011","CYCLOBENZAPR ","10MG","15","Select","Select",""],["","00591024110","LORAZEPAM ","1MG","30","Select","Select",""],["","65862020399","LOSARTAN ","100MG","30","Select","Select",""],["","16729018317","HYDROCHLOROT ","25MG","30","Select","Select",""],["","51862001206","MICROGESTIN ","FE 1\/20","112","Select","Select",""],["","62559043130","HYDROCORTISO ","2.50%","30","Select","Select",""],["","00093321205","CLONAZEPAM ","1MG","60","Select","Select",""],["","55111029336","SUMATRIPTAN ","100MG","9","Select","Select",""],["","51672139409","TRETINOIN ","0.05%","45","Select","Select",""],["","52565005430","FLUOCINONIDE ","0.05%","30","Select","Select",""],["","45802006405","TRIAMCINOLON ","0.10%","45","Select","Select",""],["","00093354456","ATOMOXETINE ","25MG","30","Select","Select",""],["","52268001201","SUPREP ","PREP KIT","354","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0","Select","Select",""],["","62332009730","ARIPIPRAZOLE ","2MG","30","Select","Select",""],["","68382080510","TRAZODONE ","50MG","30","Select","Select",""],["","00185084201","AMPHET\/DEXTR ","10MG","60","Select","Select",""],["","10702010801","DEXMETHYLPH ","10MG","14","Select","Select",""],["","65862020901","MINOCYCLINE ","50MG","90","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","00228285011","GUANFACINE ","1MG ER","30","Select","Select",""],["","65162062750","TRAMADOL ","50MG","20","Select","Select",""],["","68001028106","DICLOFENAC ","75MG DR","42","Select","Select",""],["","68001000501","METHYLPRED ","4MG","21","Select","Select",""],["","65162010250","GABAPENTIN ","300MG","270","Select","Select",""],["","45802000403","HYDROCORT ","2.50%","28","Select","Select",""],["","59746017509","PREDNISONE ","20MG","6","Select","Select",""],["","43547040011","CYCLOBENZAPR","10MG","15","Select","Select",""],["","68001019603","ESCITALOPRAM","10MG","30","Select","Select",""],["","16729018317","HYDROCHLOROT","25MG","30","Select","Select",""],["","65862020399","LOSARTAN","100MG","30","Select","Select",""],["","00591024110","LORAZEPAM","1MG","30","Select","Select",""],["","00093321205","CLONAZEPAM","1MG","60","Select","Select",""],["","62559043130","HYDROCORTISO","2.50%","30","Select","Select",""],["","51862001206","MICROGESTIN","FE 1\/20","112","Select","Select",""],["","55111029336","SUMATRIPTAN","100MG","9","Select","Select",""],["","51672127903","FLUOCINONIDE","0.05%","-60","Select","Select",""],["","51672139409","TRETINOIN","0.05%","45","Select","Select",""],["","45802006405","TRIAMCINOLON","0.10%","45","Select","Select",""],["","52268001201","SUPREP","PREP KIT","354","Select","Select",""],["","00093354656","ATOMOXETINE","60MG","30","Select","Select",""],["","68382080510","TRAZODONE","50MG","30","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","Select","Select",""],["","62332009730","ARIPIPRAZOLE","2MG","30","Select","Select",""],["","00185084201","AMPHET\/DEXTR","10MG","60","Select","Select",""],["","10702010801","DEXMETHYLPH","10MG","14","Select","Select",""],["","65862020901","MINOCYCLINE","50MG","60","Select","Select",""],["","00228285011","GUANFACINE","1MG ER","30","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","65162062750","TRAMADOL","50MG","20","Select","Select",""],["","68001028106","DICLOFENAC","75MG DR","42","Select","Select",""],["","65162010250","GABAPENTIN","300MG","270","Select","Select",""],["","68001000501","METHYLPRED","4MG","21","Select","Select",""],["","45802000403","HYDROCORT","2.50%","28","Select","Select",""],["","59746017509","PREDNISONE","20MG","6","Select","Select",""],["","29300024505","BUSPIRONE","10MG","90","Select","Select",""],["","68382005105","MELOXICAM","15MG","30","Select","Select",""],["","88888888887","DMR","","1","Select","Select",""],["","70461042110","FLUCLVX","2021-22","0","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","29300024505","BUSPIRONE ","TAB 10MG","90","Select","Select",""],["","88888888887","DMR ","T ","1","Select","Select",""],["","68382005105","MELOXICAM ","TAB 15MG","30","Select","Select",""],["","70461042110","FLUCLVX ","INJ 2021-22","0","Select","Select",""],["","59267100002","PFIZER ","INJ COVID-19","0","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","",""],["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":""}]}]}