{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LATASHA   N BLAND","gend":1,"add":"123 MOFFETT ST","city":"DANVILLE","state":"VA","zip":24541,"dob":"1987-02-19","age":"","mstatus":"","insh":"20049834*01","cliId":"","pno":"434\/836-0545","cno":"434\/836-0545","email":"","ename":"","eno":"","pphy":"TRIPATHI, KAVITA MD","ppno":"434\/791-1345","pcpadd":"125 EXECUTIVE DRIVE #H","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"pcpcounty":"","pcpid":175182,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/799-6865","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M99.01","M99.02","M99.03","F25.0","E66.9","R07.9","R06.02","M54.2","M50.20","F31.9","R10.2","Z71.9","F43.10","F32.9","F90.2","Z79.899","R13.10","R10.13","K21.9","K44.9","K29.70","M62.838","R60.0","M54.5","F43.12","NO DATA","Z20.828","R10.84","K59.09","I45.6","R00.2","M54.12","R51.9","M94.0","Z20.822","B34.9","R51.","G62.9","G43.019","F33.1","Z91.14","M79.2","R20.2","H04.123","G93.2","R05.","J02.9","Z00.01","K13.79","R00.0","B97.89","K46.9","M54.9","G89.29","J42.","L03.211","Z88.2","Z88.8","Z91.040","J34.89","K59.00","K43.9","R11.2","Z80.0","Z12.11","Z79.1","H52.223","H52.13","M54.89","R52.","I10.","B37.3","R07.2","J44.1","F41.9","K31.89","K22.8","R19.8","L25.9","Z01.419","N92.6","N90.7","L29.2","Z11.8","I47.1","Z01.810","R07.89","R42.","U07.1","R43.9","F41.1","R10.11","K76.0","D18.03","K76.9","J01.80","V89.2XXS","M25.9","R10.9","K76.89","Z32.02","Z88.1","Z91.048","Z87.891","S13.9XXA","S33.8XXA","F31.64"],"date":["2020-03-24","2020-03-24","2020-03-24","2020-09-13","2020-08-25","2021-09-13","2020-09-16","2020-11-12","2020-10-13","2021-07-29","2021-05-19","2021-09-14","2021-07-29","2021-07-29","2021-07-29","2021-07-29","2021-09-15","2021-09-15","2021-09-15","2021-07-22","2021-07-22","2020-04-14","2020-04-14","2020-05-29","2021-09-28","2020-10-15","2021-06-16","2021-06-10","2020-08-04","2021-09-13","2020-10-08","2020-11-12","2021-06-02","2021-08-16","2021-06-02","2021-06-16","2020-09-03","2020-08-26","2020-08-26","2021-08-22","2020-08-26","2020-08-26","2020-08-26","2021-08-26","2021-08-26","2021-06-10","2020-06-29","2021-03-31","2021-03-31","2021-03-31","2021-03-31","2021-03-31","2020-09-03","2020-09-03","2020-09-03","2021-01-24","2021-01-24","2021-01-24","2021-09-21","2021-01-24","2021-09-15","2021-08-10","2021-08-10","2021-06-10","2021-06-10","2021-06-10","2021-08-26","2021-08-26","2020-05-29","2020-05-29","2020-05-29","2021-09-14","2020-08-25","2020-08-25","2021-09-28","2020-10-02","2020-10-02","2020-02-06","2020-05-04","2020-11-19","2020-11-19","2021-06-07","2020-01-14","2020-01-14","2020-09-11","2020-09-16","2021-06-02","2021-06-02","2021-06-10","2021-06-10","2021-07-29","2021-09-15","2021-09-10","2021-09-15","2021-09-10","2021-08-18","2021-08-18","2021-08-18","2021-09-21","2021-09-15","2021-09-21","2021-09-21","2021-09-21","2021-09-21","2021-08-23","2021-08-23","2021-09-28"],"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":[["","53746046605","IBUPROFEN ","800MG","60","Select","Select",""],["","00603763417","ORSYTHIA ","","28","Select","Select",""],["","61442012110","FAMOTIDINE ","20MG","60","Select","Select",""],["","69238153106","LARISSIA ","","28","Select","Select",""],["","13668021805","ARIPIPRAZOLE ","10MG","30","Select","Select",""],["","68462019005","NAPROXEN ","500MG","12","Select","Select",""],["","00168016330","CLOBETASOL ","0.05%","30","Select","Select",""],["","00456120130","LINZESS ","145MCG","30","Select","Select",""],["","10572030201","PEG-3350\/KCL ","\/SODIUM","4000","Select","Select",""],["","50383077932","LACTULOSE ","10GM\/15","180","Select","Select",""],["","59746032430","VALACYCLOVIR ","500MG","30","Select","Select",""],["","47781030301","NITROFURANTN ","100MG","14","Select","Select",""],["","65862000605","CITALOPRAM ","20MG","30","Select","Select",""],["","65162062711","TRAMADOL ","50MG","15","Select","Select",""],["","00378064210","PREDNISONE ","20MG","21","Select","Select",""],["","65862052899","VENLAFAXINE ","75MG ER","30","Select","Select",""],["","65862056099","PANTOPRAZOLE ","40MG","30","Select","Select",""],["","43386031208","GAVILAX ","","238","Select","Select",""],["","62332042671","BENZONATATE ","100MG","15","Select","Select",""],["","54629060001","DOCUSATE ","100MG","30","Select","Select",""],["","69452017104","AZITHROMYCIN ","250MG","6","Select","Select",""],["","00186037220","SYMBICORT ","80-4.5","10","Select","Select",""],["","59148001013","ABILIFY ","20MG","30","Select","Select",""],["","57237000511","FLUCONAZOLE ","150MG","1","Select","Select",""],["","00832102450","BACLOFEN ","10MG","90","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","00002143611","EMGALITY ","120MG\/ML","1","Select","Select",""],["","65649040001","PLENVU ","","3","Select","Select",""],["","68462029855","CLOTRIM\/BETA ","DIPROP","45","Select","Select",""],["","63304069205","CLINDAMYCIN ","150MG","63","Select","Select",""],["","00450049660","","","100","Select","Select",""],["","00472008216","ACYCLOVIR ","200\/5ML","150","Select","Select",""],["","00904671980","ACETAMINOPHE ","325MG","100","Select","Select",""],["","70000041503","CLEARLAX ","","510","Select","Select",""],["","00904640761","BISACODYL ","5MG EC","2","Select","Select",""],["","65862018730","ONDANSETRON ","4MG","10","Select","Select",""],["","00363013338","MAG ","GRAPE","296","Select","Select",""],["","00904198280","MAPAP ","325MG","100","Select","Select",""],["","59618012511","BISCOLAX ","5MG EC","2","Select","Select",""],["","00781223401","OMEPRAZOLE ","40MG","30","Select","Select",""],["","42192034001","HYOSCYAMINE ","0.125MG","90","Select","Select",""],["","65862001501","AMOXICILLIN ","875MG","10","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","64980017005","HYDROXYZ ","50MG","30","Select","Select",""],["","00093031401","KETOROLAC ","10MG","15","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00228255196","DICLOFENAC ","75MG DR","60","Select","Select",""],["","64380080308","RANITIDINE ","150MG","60","Select","Select",""],["","69097084615","CYCLOBENZAPR ","10MG","12","Select","Select",""],["","00603763417","ORSYTHIA","","28","Select","Select",""],["","59746032430","VALACYCLOVIR","500MG","30","Select","Select",""],["","68462019005","NAPROXEN","500MG","12","Select","Select",""],["","00168016330","CLOBETASOL","0.05%","30","Select","Select",""],["","64380080308","RANITIDINE","150MG","60","Select","Select",""],["","68462010340","FLUCONAZOLE","150MG","1","Select","Select",""],["","13668021805","ARIPIPRAZOLE","10MG","30","Select","Select",""],["","53746046605","IBUPROFEN","800MG","60","Select","Select",""],["","61442012110","FAMOTIDINE","20MG","60","Select","Select",""],["","50383077932","LACTULOSE","10GM\/15","180","Select","Select",""],["","10572030201","PEG-3350\/KCL","\/SODIUM","4000","Select","Select",""],["","00456120130","LINZESS","145MCG","30","Select","Select",""],["","69238153106","LARISSIA","","28","Select","Select",""],["","00378623205","CITALOPRAM","20MG","30","Select","Select",""],["","00378064210","PREDNISONE","20MG","21","Select","Select",""],["","54629060001","DOCUSATE","100MG","30","Select","Select",""],["","43386031208","GAVILAX","","238","Select","Select",""],["","62332042671","BENZONATATE","100MG","15","Select","Select",""],["","47781030301","NITROFURANTN","100MG","14","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","00186037220","SYMBICORT","80-4.5","10","Select","Select",""],["","00832102450","BACLOFEN","10MG","90","Select","Select",""],["","59148001013","ABILIFY","20MG","30","Select","Select",""],["","65649040001","PLENVU","","3","Select","Select",""],["","68180016011","AZITHROMYCIN","250MG","4","Select","Select",""],["","00002143611","EMGALITY","120MG\/ML","1","Select","Select",""],["","65162062711","TRAMADOL","50MG","15","Select","Select",""],["","68462029855","CLOTRIM\/BETA","DIPROP","45","Select","Select",""],["","63304069205","CLINDAMYCIN","150MG","63","Select","Select",""],["","00904671980","ACETAMINOPHE","325MG","100","Select","Select",""],["","68382003416","VENLAFAXINE","37.5 ER","30","Select","Select",""],["","00904640761","BISACODYL","5MG EC","2","Select","Select",""],["","65862056099","PANTOPRAZOLE","40MG","30","Select","Select",""],["","59618012511","BISCOLAX","5MG EC","2","Select","Select",""],["","00363013338","MAG","GRAPE","296","Select","Select",""],["","70000041503","CLEARLAX","","510","Select","Select",""],["","65862018730","ONDANSETRON","4MG","10","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","42192034001","HYOSCYAMINE","0.125MG","90","Select","Select",""],["","00781223401","OMEPRAZOLE","40MG","30","Select","Select",""],["","00904198280","MAPAP","325MG","100","Select","Select",""],["","64980017005","HYDROXYZ","50MG","30","Select","Select",""],["","10702000650","CYCLOBENZAPR","5MG","30","Select","Select",""],["","00228255196","DICLOFENAC","75MG DR","60","Select","Select",""],["","65862001501","AMOXICILLIN","875MG","10","Select","Select",""],["","51672130200","TERCONAZOLE","0.80%","20","Select","Select",""],["","00093031401","KETOROLAC","10MG","15","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","00536338110","STIM","5MG EC","24","Select","Select",""],["","51079030630","POLYETH","3350 NF","56","Select","Select",""],["","00472008216","ACYCLOVIR","200\/5ML","150","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","",""],["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":""}]}]}