{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CYNTHIA   M HAMMOCK","gend":1,"add":"900 N WHITE HORN RD LOT 32","city":"CHATHAM","state":"VA","zip":"24531-9998","dob":"1967-05-13","age":"","mstatus":"","insh":"20028525*01","cliId":"","pno":"434\/509-9435","cno":"434\/509-9435","email":"","ename":"","eno":"","pphy":"BUCZYNSKI, PATRICK MD","ppno":"434\/200-3908","pcpadd":"125 NATIONWIDE DR","pcpcity":"LYNCHBURG","pcpstate":"VA","pcpzip":24502,"pcpcounty":"","pcpid":182209,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/200-1677","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J32.9","B96.89","E11.9","E78.5","H66.91","J44.9","F20.9","F11.20","F33.1","F41.1","Z72.0","H90.5","H90.71","R13.13","K11.7","D10.30","R07.0","F17.200","K13.70","N39.490","N39.3","R26.9","R15.9","Z79.4","I10.","F17.210","F31.9","G89.29","M79.7","Z79.899","Z88.6","R05.","H92.01","H72.11","S00.411A","H93.11","H61.22","F20.89","K59.09","R32.","J02.9","R51.","NO DATA","Z20.828","Z82.49","H90.3","F10.10","L98.419","K58.9","F12.10","N39.0","B34.2","M79.661","M79.662","M79.604","R25.2","L53.8","K13.0","F43.12","F19.20","E10.9","D75.1","M20.41","M20.42","L60.0","B35.1","L11.0","L57.0","E11.3293","H25.13","H52.13","E55.9","R22.9","Z11.59","B34.9"],"date":["2020-01-31","2020-01-31","2020-11-08","2020-11-08","2020-02-08","2021-06-02","2020-11-08","2021-10-28","2021-10-28","2021-10-28","2021-10-28","2020-06-10","2020-06-10","2020-06-10","2020-06-10","2020-06-10","2020-06-10","2020-06-10","2020-06-10","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2020-11-08","2020-02-08","2020-11-08","2020-11-08","2020-07-14","2020-11-08","2020-11-08","2020-02-03","2020-08-26","2020-02-08","2020-02-08","2020-02-20","2020-02-20","2020-02-20","2021-02-11","2020-08-19","2020-08-19","2020-08-26","2020-08-26","2020-08-26","2020-08-26","2020-11-08","2020-02-20","2020-07-02","2020-11-08","2020-11-08","2021-10-28","2020-07-14","2020-08-27","2021-05-18","2021-05-18","2021-05-18","2021-05-18","2021-05-18","2021-05-18","2021-07-01","2020-01-14","2020-06-04","2020-06-04","2020-05-08","2020-05-08","2020-05-08","2020-05-08","2020-05-08","2020-05-08","2021-01-29","2021-01-29","2021-01-29","2020-02-21","2020-02-21","2021-08-05","2021-08-05"],"priorHcc":["","","","","","","",null,null,null,null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","43068010602","FANAPT ","6MG","30","Select","Select",""],["","70592800100","","","1","Select","Select",""],["","12496120803","SUBOXONE ","8-2MG","56","Select","Select",""],["","16729017217","AMITRIPTYLIN ","25MG","30","Select","Select",""],["","43547035050","PAROXETINE ","40MG","45","Select","Select",""],["","57237007710","ONDANSETRON ","4MG ODT","10","Select","Select",""],["","00088221905","LANTUS ","100\/ML","15","Select","Select",""],["","53885027150","ONETOUCH ","VERIO","100","Select","Select",""],["","11523716201","CLARITIN-D ","5-120MG","10","Select","Select",""],["","08222095831","PEN  NEEDLES  ","31GX8MM","100","Select","Select",""],["","42571016201","AMOX\/K ","875-125","20","Select","Select",""],["","60505036301","OFLOXACIN ","0.3%OTIC","5","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","16","Select","Select",""],["","00093100301","BUSPIRONE ","15MG","60","Select","Select",""],["","00054001729","PREDNISONE ","10MG","19","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","13","Select","Select",""],["","71093011104","GABAPENTIN ","600MG","90","Select","Select",""],["","00169633910","NOVOLOG ","FLEXPEN","15","Select","Select",""],["","27241015504","OXYBUTYNIN ","5MG ER","30","Select","Select",""],["","00781723864","BUPREN\/NALOX ","8-2MG","56","Select","Select",""],["","00185061501","HYDROXYZ ","50MG","60","Select","Select",""],["","68462029855","CLOTRIM\/BETA ","DIPROP","45","Select","Select",""],["","55111018015","TIZANIDINE ","4MG","90","Select","Select",""],["","45802008801","ALBUTEROL ","HFA","8","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","68180012201","CEPHALEXIN ","500MG","14","Select","Select",""],["","73070010315","INSULIN ","FLEXPEN","15","Select","Select",""],["","33342032915","TRIAMCINOLON ","0.10%","30","Select","Select",""],["","45963043864","ENULOSE ","10GM\/15","473","Select","Select",""],["","45802004835","NYSTATIN ","100000","60","Select","Select",""],["","67405060301","FLUCONAZOLE ","150MG","2","Select","Select",""],["","57237003105","AMOXICILLIN ","500MG","21","Select","Select",""],["","53885004401","ONE ","VERIO FL","1","Select","Select",""],["","70436001002","BUPROPN ","150MG XL","30","Select","Select",""],["","00904652261","SENNA-LAX ","8.6MG","30","Select","Select",""],["","51224002218","AZITHROMYCIN ","250MG","6","Select","Select",""],["","12496120803","SUBOXONE","8-2MG","56","Select","Select",""],["","00093100301","BUSPIRONE","15MG","60","Select","Select",""],["","43547035050","PAROXETINE","40MG","45","Select","Select",""],["","16729017217","AMITRIPTYLIN","25MG","30","Select","Select",""],["","43068010602","FANAPT","6MG","30","Select","Select",""],["","53885027150","ONETOUCH","VERIO","100","Select","Select",""],["","00088221905","LANTUS","100\/ML","15","Select","Select",""],["","71093011104","GABAPENTIN","600MG","90","Select","Select",""],["","11523716201","CLARITIN-D","5-120MG","10","Select","Select",""],["","08222095831","PEN NEEDLES","31GX8MM","100","Select","Select",""],["","42571016201","AMOX\/K","875-125","20","Select","Select",""],["","60505036301","OFLOXACIN","0.3%OTIC","5","Select","Select",""],["","69452015120","VITAMIN","50000UNT","4","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","16","Select","Select",""],["","00054001729","PREDNISONE","10MG","19","Select","Select",""],["","00169633910","NOVOLOG","FLEXPEN","15","Select","Select",""],["","00781723864","BUPREN\/NALOX","8-2MG","56","Select","Select",""],["","73070010315","INSULIN","FLEXPEN","15","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","10","Select","Select",""],["","68180012201","CEPHALEXIN","500MG","14","Select","Select",""],["","27241015504","OXYBUTYNIN","5MG ER","30","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","45802008801","ALBUTEROL","HFA","8","Select","Select",""],["","45963043864","ENULOSE","10GM\/15","473","Select","Select",""],["","45802004835","NYSTATIN","100000","60","Select","Select",""],["","33342032915","TRIAMCINOLON","0.10%","30","Select","Select",""],["","67405060301","FLUCONAZOLE","150MG","2","Select","Select",""],["","57237003105","AMOXICILLIN","500MG","21","Select","Select",""],["","53885004401","ONE","VERIO FL","1","Select","Select",""],["","70436001002","BUPROPN","150MG XL","30","Select","Select",""],["","00904652261","SENNA-LAX","8.6MG","30","Select","Select",""],["","68462029855","CLOTRIM\/BETA","DIPROP","45","Select","Select",""],["","55111018015","TIZANIDINE","4MG","90","Select","Select",""],["","51224002218","AZITHROMYCIN","250MG","6","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","00185061501","HYDROXYZ","50MG","60","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","91237000170","EASY ","MIS 31GX5\/16","100","Select","Select",""],["","51991031190","DESVENLAFAX ","TAB 50MG ER","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","",""],["Yes","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":""}]}]}