{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"VICKIE   D PALMER","gend":1,"add":"2184 MEADVILLE ROAD","city":"HALIFAX","state":"VA","zip":"24558-9998","dob":"1963-07-18","age":"","mstatus":"","insh":"20033058*01","cliId":"","pno":"434\/579-6243","cno":"434\/579-6243","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,"pcpcounty":"","pcpid":105510,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"434\/446-8230","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/349-2172","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R22.2","M25.512","M54.12","L50.8","J30.89","J30.2","L29.9","L50.1","J30.1","G56.21","R10.9","M25.551","R10.31","J31.0","G89.29","F11.20","M51.36","M96.1","M50.30","Z68.37","Z98.890","E87.6","D25.1","I10.","C64.2","V58.89","V49.50XA","M25.511","M54.2","M54.10","Z88.9","R52.","V89.2XXA","S16.1XXA","Z11.59","V87.7XXA","G56.03","G56.23","M79.7","M19.90","E66.9","J00.","R19.09","R10.30","J06.9","M79.81","G56.20","E78.2","R06.00","Z09.","L76.32","M79.601","M19.012","M75.02","Z68.36","Z98.84","R20.0","R20.2","M48.02","Z01.818","B37.0","Z47.89","Z48.89","C64.9","N20.0","M25.552","R42.","I36.1","E03.8","R73.03","Z71.3","E66.01","Z68.35","M62.838","M54.5"],"date":["2020-03-31","2020-08-03","2020-09-17","2021-06-02","2021-02-10","2021-02-10","2021-06-02","2021-02-10","2021-02-24","2021-01-29","2021-02-22","2021-05-18","2021-02-22","2021-06-02","2021-07-22","2021-07-22","2021-07-22","2021-07-22","2021-04-29","2021-07-22","2020-01-16","2020-03-24","2020-03-27","2021-08-02","2020-06-05","2020-07-02","2020-07-02","2020-07-02","2020-10-06","2020-08-26","2020-08-26","2020-06-27","2020-06-27","2020-06-27","2020-06-27","2020-06-27","2021-03-10","2021-03-10","2021-07-22","2021-07-22","2021-07-22","2020-01-20","2020-01-20","2020-01-20","2020-01-20","2020-03-10","2020-10-19","2021-08-02","2021-01-22","2020-08-28","2020-03-23","2020-05-06","2020-05-13","2020-05-13","2020-08-28","2020-10-30","2020-11-05","2020-11-05","2020-10-06","2021-01-25","2021-02-04","2021-02-08","2021-02-08","2021-05-03","2021-05-03","2021-05-18","2021-08-02","2021-08-02","2021-08-02","2021-08-02","2020-10-30","2020-10-30","2020-10-30","2021-07-31","2021-07-31"],"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":[["","00093317431","ALBUTEROL ","HFA","17","Select","Select",""],["","00054429731","FUROSEMIDE ","20MG","30","Select","Select",""],["","74312052805","VITAMIN ","1000MCG","30","Select","Select",""],["","00363045887","WAL-ZYR ","10MG","30","Select","Select",""],["","53885000810","ONETOUCH ","PLUS 33G","100","Select","Select",""],["","43598081115","CETIRIZINE ","10MG","30","Select","Select",""],["","68180029606","DULOXETINE ","60MG","30","Select","Select",""],["","00591505221","PREDNISONE ","5MG","21","Select","Select",""],["","50111043401","TRAZODONE ","100MG","30","Select","Select",""],["","00406052301","OXYCOD\/APAP ","10-325MG","120","Select","Select",""],["","60432060416","PROMETHAZINE ","DM","240","Select","Select",""],["","55111012305","ATORVASTATIN ","40MG","30","Select","Select",""],["","59310057922","PROAIR ","","17","Select","Select",""],["","00054004641","IPRATROPIUM ","0.06%","15","Select","Select",""],["","00456120230","LINZESS ","290MCG","30","Select","Select",""],["","69097084905","ESCITALOPRAM ","20MG","30","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","16","Select","Select",""],["","60432053716","NYSTATIN ","100000","120","Select","Select",""],["","31722072690","MONTELUKAST ","10MG","30","Select","Select",""],["","59746012106","MECLIZINE ","25MG","60","Select","Select",""],["","43598029590","PREGABALIN ","150MG","60","Select","Select",""],["","65162024709","CHLORTHALID ","25MG","30","Select","Select",""],["","55111018015","TIZANIDINE ","4MG","135","Select","Select",""],["","69238183107","LEVOTHYROXIN ","50MCG","30","Select","Select",""],["","62037099901","POT  CL MICRO","20MEQ ER","4","Select","Select",""],["","65862085901","FAMOTIDINE ","20MG","60","Select","Select",""],["","00574041207","POLYETH ","3350 NF","12","Select","Select",""],["","68462034690","LEVOCETIRIZI ","5MG","180","Select","Select",""],["","23155050001","HYDROXYZ ","10MG","100","Select","Select",""],["","60505083305","AZELASTINE ","0.10%","30","Select","Select",""],["","10702007106","OXYMORPHONE ","HCL 10MG","90","Select","Select",""],["","57841130101","MOVANTIK ","25MG","30","Select","Select",""],["","63304007601","POT  CHLORIDE","10MEQ ER","30","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","30","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","00115174801","METAXALONE ","800MG","15","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","51224000760","METFORMIN ","500MG ER","30","Select","Select",""],["","68180029606","DULOXETINE","60MG","30","Select","Select",""],["","59310057922","PROAIR","","17","Select","Select",""],["","00093317431","ALBUTEROL","HFA","17","Select","Select",""],["","53885000810","ONETOUCH","PLUS 33G","100","Select","Select",""],["","43598081115","CETIRIZINE","10MG","30","Select","Select",""],["","60432060416","PROMETHAZINE","DM","240","Select","Select",""],["","00591505210","PREDNISONE","5MG","21","Select","Select",""],["","00054429731","FUROSEMIDE","20MG","30","Select","Select",""],["","50111043401","TRAZODONE","100MG","30","Select","Select",""],["","69238183107","LEVOTHYROXIN","50MCG","30","Select","Select",""],["","55111012305","ATORVASTATIN","40MG","30","Select","Select",""],["","00054004641","IPRATROPIUM","0.06%","15","Select","Select",""],["","69097084905","ESCITALOPRAM","20MG","30","Select","Select",""],["","31722072690","MONTELUKAST","10MG","30","Select","Select",""],["","00456120230","LINZESS","290MCG","30","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","16","Select","Select",""],["","60432053716","NYSTATIN","100000","120","Select","Select",""],["","65162024709","CHLORTHALID","25MG","30","Select","Select",""],["","74312052805","VITAMIN","1000MCG","30","Select","Select",""],["","59746012106","MECLIZINE","25MG","60","Select","Select",""],["","00363045887","WAL-ZYR","10MG","30","Select","Select",""],["","00093762698","PREGABALIN","150MG","60","Select","Select",""],["","55111018015","TIZANIDINE","4MG","45","Select","Select",""],["","00406052301","OXYCOD\/APAP","10-325MG","120","Select","Select",""],["","62037099901","POT CL MICRO","20MEQ ER","4","Select","Select",""],["","63304007601","POT CHLORIDE","10MEQ ER","30","Select","Select",""],["","60505083305","AZELASTINE","0.10%","30","Select","Select",""],["","23155050001","HYDROXYZ","10MG","60","Select","Select",""],["","00172572860","FAMOTIDINE","20MG","60","Select","Select",""],["","68180072003","AMLODIPINE","5MG","30","Select","Select",""],["","57841130101","MOVANTIK","25MG","30","Select","Select",""],["","00574041207","POLYETH","3350 NF","12","Select","Select",""],["","68462034690","LEVOCETIRIZI","5MG","30","Select","Select",""],["","10702007006","OXYMORPHONE","HCL 5MG","90","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","70010049105","METFORMIN","500MG ER","30","Select","Select",""],["","00054414622","CLOTRIMAZOLE","10MG","70","Select","Select",""],["","00115174801","METAXALONE","800MG","15","Select","Select",""],["","00054414622","CLOTRIMAZOLE ","TRO 10MG","70","Select","Select",""],["","58160082311","SHINGRIX ","INJ 50\/0.5ML","1","Select","Select",""],["","33332032101","AFLURIA ","INJ 2021-22","0","Select","Select",""],["","00006483703","PNEUMOVAX ","INJ 25\/0.5","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","",""],["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":""}]}]}