{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JANET   L VOGES","gend":1,"add":"1 MILTON AVE","city":"DANVILLE","state":"VA","zip":"24541-9998","dob":"1969-05-29","age":"","mstatus":"","insh":"20043652*01","cliId":"","pno":"434\/483-8221","cno":"434\/483-8221","email":"","ename":"","eno":"","pphy":"WINFIELD, ALBERT C MD","ppno":"434\/791-4110","pcpadd":"173 EXECUTIVE DRIVE","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"pcpcounty":"","pcpid":134296,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"434\/228-6361","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/791-4003","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.4","T43.212A","M70.62","V58.89","N82.3","K50.013","Z93.2","F31.12","F41.1","F60.9","R52.","R10.84","K94.13","N17.9","E11.22","I95.9","E87.1","K21.9","N18.1","J44.9","M06.9","Z79.4","F17.210","E78.00","F32.9","K58.9","Z43.2","H10.31","T14.91XA","F31.9","F12.90","Z91.5","H91.91","Z72.89","Z88.0","Z79.899","Z62.810","Z86.73","Z81.1","Z81.8","Z93.3","Z79.01","N18.2","Z88.8","Z90.49","Z53.31","N73.6","K50.00","E11.9","N18.9","B37.0","Z12.31","K62.4","K50.90","R10.31","K51.90","N82.4","A41.9","NO DATA","J01.90","K50.919","K51.919","S31.109A","L03.311","L03.90","Z72.0","R06.02","J42.","Z86.718","H10.9","R45.7","F33.1","Z01.419","Z12.4","I10.","R11.11","F60.3","F39."],"date":["2021-11-08","2021-04-18","2020-01-09","2020-02-19","2021-08-30","2021-08-30","2021-08-30","2021-01-08","2021-07-20","2020-11-13","2020-02-29","2020-02-29","2020-03-01","2020-03-01","2020-03-01","2020-04-15","2020-03-01","2021-06-25","2020-03-01","2021-07-15","2020-04-15","2020-03-01","2021-04-19","2021-01-08","2020-03-01","2020-03-01","2020-08-10","2020-11-06","2021-04-18","2021-04-20","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2020-02-14","2020-02-14","2020-02-14","2020-02-14","2020-02-14","2020-02-14","2020-02-24","2020-02-24","2020-02-24","2021-01-08","2021-01-08","2021-01-22","2021-01-22","2021-01-22","2021-01-22","2020-07-22","2020-03-01","2020-03-01","2020-11-20","2020-11-20","2020-11-20","2020-02-17","2020-02-29","2020-03-01","2020-12-04","2020-12-04","2020-08-10","2020-08-10","2020-11-05","2021-04-16","2021-07-20","2021-06-25","2021-06-25","2020-02-19","2020-02-19","2021-07-20","2021-04-20"],"priorHcc":[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":[["","00591544305","PREDNISONE ","20MG","10","Select","Select",""],["","13668008105","MONTELUKAST ","10MG","30","Select","Select",""],["","68180059206","DESVENLAFAX ","50MG ER","30","Select","Select",""],["","50111043403","TRAZODONE ","100MG","60","Select","Select",""],["","00527133001","BACLOFEN ","10MG","20","Select","Select",""],["","70010075405","METHOCARBAM ","500MG","28","Select","Select",""],["","10702001801","OXYCODONE ","5MG","12","Select","Select",""],["","00378456105","POT  CHLORIDE","10MEQ ER","60","Select","Select",""],["","11917017262","MULTIV ","50+","30","Select","Select",""],["","00536404610","MULTI-VITAMN ","","30","Select","Select",""],["","00363039752","OMEPRAZOLE ","20.6MGDR","30","Select","Select",""],["","69543013611","TRAMADOL ","50MG","20","Select","Select",""],["","65162036111","FOLIC ","1MG","30","Select","Select",""],["","68180098003","LISINOPRIL ","10MG","30","Select","Select",""],["","51645070310","ACETAMIN ","325MG","28","Select","Select",""],["","57896050401","ONE-DAILY ","MULT VIT","30","Select","Select",""],["","67877022305","GABAPENTIN ","300MG","21","Select","Select",""],["","00245021311","MIDODRINE ","10MG","90","Select","Select",""],["","80681002000","MULTIVITAMIN ","","30","Select","Select",""],["","46122043240","GNP ","CHERRY","150","Select","Select",""],["","00085720601","DULERA ","100-5MCG","13","Select","Select",""],["","59762040101","SUCRALFATE ","1GM","60","Select","Select",""],["","11917007453","MULTIPLE ","","30","Select","Select",""],["","00093314705","CEPHALEXIN ","500MG","14","Select","Select",""],["","00310737020","BUDES\/FORMOT ","160-4.5","10","Select","Select",""],["","66689000802","NYSTATIN ","100000","120","Select","Select",""],["","00310461612","BREZTRI ","SPHERE","11","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00591079601","SULFASALAZIN ","500MG","540","Select","Select",""],["","11917011211","BP ","AUTO ARM","1","Select","Select",""],["","00173071920","FLOVENT ","110MCG","12","Select","Select",""],["","67877043103","ARIPIPRAZOLE ","5MG","30","Select","Select",""],["","23155050105","HYDROXYZ ","25MG","60","Select","Select",""],["","00173088710","TRELEGY ","ELLIPTA","60","Select","Select",""],["","76204060030","IPRATROPIUM\/ ","ALBUTER","360","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0","Select","Select",""],["","69097014260","ALBUTEROL ","HFA","7","Select","Select",""],["","00143980305","DOXYCYCL ","100MG","20","Select","Select",""],["","00703006301","METHYLPR ","80MG\/ML","5","Select","Select",""],["","00173086910","ANORO ","62.5-25","60","Select","Select",""],["","61314062810","POLYMYXIN ","TRIMETHP","10","Select","Select",""],["","00378161001","DICYCLOMINE ","10MG","60","Select","Select",""],["","00085113204","PROVENTIL ","HFA","7","Select","Select",""],["","00186037020","SYMBICORT ","160-4.5","10","Select","Select",""],["","47469016068","MELATONIN ","3MG","30","Select","Select",""],["","00761036120","MULTI ","D-3","90","Select","Select",""],["","29300011101","LAMOTRIGINE ","25MG","30","Select","Select",""],["","00781286810","OMEPRAZOLE","20MG DR","30","Select","Select",""],["","65162036111","FOLIC","1MG","30","Select","Select",""],["","00378456105","POT CHLORIDE","10MEQ ER","60","Select","Select",""],["","00054060313","DESVENLAFAX","25MG ER","30","Select","Select",""],["","00527133001","BACLOFEN","10MG","20","Select","Select",""],["","00591544305","PREDNISONE","20MG","10","Select","Select",""],["","13668008105","MONTELUKAST","10MG","30","Select","Select",""],["","65162062711","TRAMADOL","50MG","12","Select","Select",""],["","10702001801","OXYCODONE","5MG","12","Select","Select",""],["","68180098003","LISINOPRIL","10MG","30","Select","Select",""],["","50111043403","TRAZODONE","100MG","60","Select","Select",""],["","67877022305","GABAPENTIN","300MG","21","Select","Select",""],["","70010075405","METHOCARBAM","500MG","28","Select","Select",""],["","00536404610","MULTI-VITAMN","","30","Select","Select",""],["","11917017262","MULTIV","50+","30","Select","Select",""],["","46122043240","GNP","CHERRY","150","Select","Select",""],["","00245021311","MIDODRINE","10MG","90","Select","Select",""],["","59762040101","SUCRALFATE","1GM","60","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","14","Select","Select",""],["","11917007453","MULTIPLE","","30","Select","Select",""],["","80681002000","MULTIVITAMIN","","30","Select","Select",""],["","00085720601","DULERA","100-5MCG","13","Select","Select",""],["","11917011211","BP","AUTO ARM","1","Select","Select",""],["","13668021730","ARIPIPRAZOLE","5MG","30","Select","Select",""],["","00143980305","DOXYCYCL","100MG","20","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","Select","Select",""],["","00173088710","TRELEGY","ELLIPTA","60","Select","Select",""],["","76204060030","IPRATROPIUM\/","ALBUTER","360","Select","Select",""],["","00085113204","PROVENTIL","HFA","7","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00310737020","BUDES\/FORMOT","160-4.5","10","Select","Select",""],["","00378161001","DICYCLOMINE","10MG","60","Select","Select",""],["","59762500005","SULFASALAZIN","500MG","180","Select","Select",""],["","66689000802","NYSTATIN","100000","120","Select","Select",""],["","61314062810","POLYMYXIN","TRIMETHP","10","Select","Select",""],["","23155050105","HYDROXYZ","25MG","60","Select","Select",""],["","00310461612","BREZTRI","SPHERE","11","Select","Select",""],["","00186037020","SYMBICORT","160-4.5","10","Select","Select",""],["","00173086910","ANORO","62.5-25","60","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","29300011101","LAMOTRIGINE","25MG","30","Select","Select",""],["","00173071920","FLOVENT","110MCG","12","Select","Select",""],["","31604002741","MELATONIN","3MG","30","Select","Select",""],["","00761036120","MULTI","D-3","90","Select","Select",""],["","57896050401","ONE-DAILY","MULT VIT","30","Select","Select",""],["","51645070310","ACETAMIN","325MG","28","Select","Select",""],["","00703006301","METHYLPR","80MG\/ML","5","Select","Select",""],["","55111012205","ATORVASTATIN ","TAB 20MG","90","Select","Select",""],["","68462022001","LITHIUM ","CAP 150MG","60","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":""}]}]}