{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHERI  C CHANDLER","gend":1,"add":"340 FERRY ST APT 99","city":"SOUTH BOSTON","state":"VA","zip":"24592-9998","dob":"1976-09-03","age":"","mstatus":"","insh":"20025211*01","cliId":"","pno":"434\/454-6151","cno":"434\/454-6151","email":"","ename":"","eno":"","pphy":"OZOUDE, VIRGILUS DO","ppno":"434\/517-3879","pcpadd":"101 AUBREYS LOOP","pcpcity":"SOUTH BOSTON","pcpstate":"VA","pcpzip":24592,"pcpcounty":"","pcpid":144661,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"434\/421-8613","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":["F31.9","M54.18","G56.03","G62.89","Z11.59","R05.","R06.02","R00.2","E11.9","Z79.4","H52.4","N76.0","M54.5","K21.9","R11.10","K59.00","R06.00","I10.","E78.2","R07.89","R19.00","B96.89","F31.31","F60.6","F43.22","R13.10","E66.01","K76.0","J18.9","N39.0","R65.10","R50.9","R53.1","N83.8","R10.2","Z68.44","G47.33","Z90.710","A41.9","R09.02","R60.0","R10.84","R11.0","K31.84","I11.9","R01.1","M79.7","I47.1","R10.31","F31.5","K56.41","F43.21","Z63.4","F10.10","G47.10","A41.59","J98.11","B96.1","E78.5","N83.292","D27.1","N73.6","F33.0","I51.7","R19.09","K66.0","R00.0","I37.1","I07.1"],"date":["2021-06-15","2021-06-30","2020-04-09","2021-06-30","2020-09-10","2020-09-10","2020-09-15","2021-07-12","2021-06-30","2021-06-30","2020-10-22","2021-05-27","2020-05-04","2021-07-21","2020-07-29","2021-07-21","2021-07-26","2021-07-12","2021-07-12","2021-07-26","2021-01-26","2021-01-26","2021-03-31","2021-06-15","2021-06-15","2021-07-21","2021-08-03","2021-07-21","2020-09-10","2020-09-16","2020-09-10","2020-09-10","2020-09-16","2021-08-03","2021-08-03","2021-08-03","2021-06-30","2021-06-30","2020-09-16","2020-09-16","2021-07-12","2021-05-19","2021-07-21","2021-07-21","2021-07-12","2021-07-26","2021-06-30","2020-09-10","2021-06-30","2020-01-24","2020-04-29","2020-09-10","2020-07-16","2020-07-23","2021-08-02","2020-09-10","2020-09-10","2020-09-10","2020-09-10","2021-02-05","2021-08-03","2021-08-03","2021-07-22","2021-07-28","2021-08-03","2021-08-03","2021-07-26","2021-07-26","2021-07-26"],"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":[["","00169633910","NOVOLOG","FLEXPEN","27","Select","Select",""],["","00456120130","LINZESS ","145MCG","30","Select","Select",""],["","55111029336","SUMATRIPTAN ","100MG","9","Select","Select",""],["","51991081403","AZELASTINE ","0.10%","30","Select","Select",""],["","23155000810","HYDROCHLOROT ","25MG","30","Select","Select",""],["","65862085901","FAMOTIDINE ","20MG","30","Select","Select",""],["","00228212810","CLONIDINE ","0.2MG","30","Select","Select",""],["","00088221905","LANTUS ","100\/ML","21","Select","Select",""],["","08290320109","BD  PEN NEEDL","31GX8MM","100","Select","Select",""],["","62175061743","PANTOPRAZOLE ","40MG","60","Select","Select",""],["","70377002711","ATORVASTATIN ","10MG","30","Select","Select",""],["","50428166363","BISACODYL ","5MG EC","32","Select","Select",""],["","00093816601","QUETIAPINE ","50MG","30","Select","Select",""],["","65862020390","LOSARTAN ","100MG","30","Select","Select",""],["","47781055301","LABETALOL ","200MG","120","Select","Select",""],["","53885027210","ONETOUCH ","VERIO","100","Select","Select",""],["","10370010250","BUPROPN ","300MG XL","30","Select","Select",""],["","00169633910","NOVOLOG ","FLEXPEN","27","Select","Select",""],["","66685100200","AMOX\/K ","500-125","14","Select","Select",""],["","50111033401","METRONIDAZOL ","500MG","14","Select","Select",""],["","00169406012","VICTOZA ","18MG\/3ML","6","Select","Select",""],["","70710122701","AMITRIPTYLIN ","50MG","30","Select","Select",""],["","69097094312","GABAPENTIN ","300MG","90","Select","Select",""],["","65862052890","VENLAFAXINE ","75MG ER","30","Select","Select",""],["","00143312601","DICYCLOMINE ","10MG","60","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","4","Select","Select",""],["","68462010530","ONDANSETRON ","4MG","60","Select","Select",""],["","59779030602","CVS ","","238","Select","Select",""],["","50428085942","PREP ","","100","Select","Select",""],["","52536018003","ERYTHROMYCIN ","250MG EC","21","Select","Select",""],["","53746051101","SPIRONOLACT ","25MG","30","Select","Select",""],["","45802086866","POLYETH ","3350 NF","60","Select","Select",""],["","08222440006","ULTICARE ","ALCOHOL","100","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","45802000403","HYDROCORT ","2.50%","28","Select","Select",""],["","00173085910","BREO ","100-25","60","Select","Select",""],["","50428209452","MAG ","LEMON","296","Select","Select",""],["","16784011132","","","200","Select","Select",""],["","65862053750","LEVOFLOXACIN ","500MG","5","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","65162044210","MECLIZINE ","25MG","30","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","50428034618","ALCOHOL ","70%","100","Select","Select",""],["","63304069301","CLINDAMYCIN ","300MG","14","Select","Select",""],["","00186037020","SYMBICORT ","160-4.5","10","Select","Select",""],["","51672404806","CLOTRIM\/BETA ","DIPROP","45","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","SENSOR","2","Select","Select",""],["","00054414622","CLOTRIMAZOLE ","10MG","70","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","READER","1","Select","Select",""],["","99073014002","FREESTYLE    LIQ CONTROL","CONTROL","1","Select","Select",""],["","49483034010","ACETAMIN ","325MG","120","Select","Select",""],["","70710113908","FLUCONAZOLE ","150MG","1","Select","Select",""],["","10702001801","OXYCODONE ","5MG","12","Select","Select",""],["","49483060350","IBUPROFEN ","600MG","120","Select","Select",""],["","13107015790","PAROXETINE ","40MG","30","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}