{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PATSY  B BROGDEN","gend":1,"add":"4242 PATRICK HENRY HWY","city":"CHARLOTTE COURT HOUSE","state":"VA","zip":"23923-9998","dob":"1970-11-04","age":"","mstatus":"","insh":"7756968*01","cliId":"","pno":"434\/470-1054","cno":"434\/470-1054","email":"","ename":"","eno":"","pphy":"HUNDLEY, SUSAN DUPUY MD","ppno":"434\/738-6420","pcpadd":"380 WASHINGTON STREET","pcpcity":"BOYDTON","pcpstate":"VA","pcpzip":23917,"pcpcounty":"","pcpid":125561,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/738-6054","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R55.","N32.81","R35.1","R35.0","F33.9","K21.0","K58.1","Z83.71","Z86.010","K22.2","R13.19","Z01.89","Z01.810","Z01.812","M79.7","R45.89","F41.9","F06.32","E11.3213","R07.89","R39.15","R39.12","K21.9","R06.02","I37.1","M54.5","G89.29","R11.2","N39.41","L50.8","J30.89","J32.9","Z91.018","J31.0","K29.70","I10.","E11.9","Z23.","M54.9","E11.65","H18.613","H04.123","L02.224","E78.2","R06.00","G43.009","H72.92","H92.12","H92.02","L29.8","G47.33","G47.10","F11.20","M96.1","K59.01","E11.3293","Z01.411","N93.9","R12.","K29.50","H17.89","H18.233","H18.623","H47.213","M79.622","Z20.828","M54.41","M54.42","R51.","R39.16","G89.4","M20.21","V58.89","L50.1","L29.9","Z01.419","E03.9","E66.9","Z68.38"],"date":["2020-02-05","2021-04-23","2021-01-29","2021-04-23","2021-07-28","2020-06-29","2021-07-27","2021-07-27","2021-07-27","2021-07-27","2021-07-27","2020-06-29","2020-08-03","2020-08-03","2021-03-04","2020-08-31","2020-08-31","2020-08-31","2021-01-18","2021-03-18","2021-04-23","2021-04-23","2021-07-27","2021-08-09","2020-01-13","2021-05-25","2021-08-26","2020-02-05","2020-08-03","2021-08-09","2021-08-09","2021-08-09","2020-06-08","2020-12-07","2020-08-05","2021-04-01","2021-03-04","2021-05-20","2020-02-04","2020-06-16","2021-07-26","2020-06-16","2020-06-25","2021-04-01","2021-04-01","2021-07-02","2021-07-12","2021-07-12","2021-07-12","2020-01-06","2020-03-09","2020-03-25","2021-08-26","2021-08-26","2021-08-26","2020-01-27","2020-02-19","2021-07-14","2020-08-05","2020-08-05","2021-01-18","2021-01-18","2021-03-22","2021-03-22","2020-07-07","2020-08-03","2020-11-11","2020-11-11","2020-05-12","2020-11-06","2021-04-01","2020-06-17","2020-12-07","2020-12-07","2021-08-09","2021-07-14","2021-07-14","2021-07-14","2021-07-14"],"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":[["","43547027010","ROPINIROLE ","1MG","30","Select","Select",""],["","00603020922","MAG ","400MG","30","Select","Select",""],["","69097042107","CELECOXIB ","200MG","30","Select","Select",""],["","00378803005","LANSOPRAZOLE ","30MG DR","30","Select","Select",""],["","00597014030","TRADJENTA ","5MG","30","Select","Select",""],["","64380080438","RANITIDINE ","300MG","60","Select","Select",""],["","45802086803","POLYETH ","3350 NF","510","Select","Select",""],["","62037083101","METOPROL ","50MG ER","30","Select","Select",""],["","68462026390","ROSUVASTATIN ","20MG","30","Select","Select",""],["","31722072610","MONTELUKAST ","10MG","15","Select","Select",""],["","00143211250","DOXYCYCL ","100MG","32","Select","Select",""],["","42858010401","OXYCOD\/APAP ","10-325MG","120","Select","Select",""],["","00591079501","DICYCLOMINE ","20MG","60","Select","Select",""],["","31722055190","LEVOCETIRIZI ","5MG","30","Select","Select",""],["","63739047848","DOCUSATE ","100MG","30","Select","Select",""],["","68382065101","ISOSORB ","60MG ER","30","Select","Select",""],["","00054004641","IPRATROPIUM ","0.06%","30","Select","Select",""],["","51991081403","AZELASTINE ","0.10%","30","Select","Select",""],["","00310197030","MOVANTIK ","25MG","30","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","16","Select","Select",""],["","43598081115","CETIRIZINE ","10MG","30","Select","Select",""],["","00185067401","HYDROXYZ ","25MG","60","Select","Select",""],["","65162083366","DICLOFENAC ","1%","100","Select","Select",""],["","64380073706","VITAMIN ","50000UNT","4","Select","Select",""],["","51991074890","DULOXETINE ","60MG","60","Select","Select",""],["","69238131609","PREGABALIN ","225MG","60","Select","Select",""],["","00023916360","RESTASIS ","0.05%","60","Select","Select",""],["","00378180077","LEVOTHYROXIN ","25MCG","30","Select","Select",""],["","31722070190","LOSARTAN ","50MG","60","Select","Select",""],["","16729018317","HYDROCHLOROT ","25MG","30","Select","Select",""],["","00781223410","OMEPRAZOLE ","40MG","30","Select","Select",""],["","70010077005","METHOCARBAM ","750MG","60","Select","Select",""],["","00555077902","MEDROXYPR ","10MG","30","Select","Select",""],["","68585000612","MAGNESIUM-OX ","400MG","30","Select","Select",""],["","00115169449","EPINEPHRINE ","0.3MG","2","Select","Select",""],["","00469260230","MYRBETRIQ ","50MG","30","Select","Select",""],["","45963067696","METOPROLOL ","50MG ER","30","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","72618300002","NURTEC ","75MG ODT","8","Select","Select",""],["","00172572880","FAMOTIDINE ","20MG","60","Select","Select",""],["","00088221905","LANTUS ","100\/ML","15","Select","Select",""],["","65162027250","SMZ\/TMP ","800-160","20","Select","Select",""],["","53885027150","ONETOUCH ","VERIO","50","Select","Select",""],["","68382072216","NATEGLINIDE ","120MG","90","Select","Select",""],["","16729017101","AMITRIPTYLIN ","10MG","30","Select","Select",""],["","69097012815","AMLODIPINE ","10MG","30","Select","Select",""],["","08496310601","EASY ","31GX5\/16","50","Select","Select",""],["","00904671110","FEXOFENADINE ","180MG","30","Select","Select",""],["","00023649802","UBRELVY ","50MG","10","Select","Select",""],["","00536375610","STOOL ","100MG","60","Select","Select",""],["","00069024430","TOVIAZ ","8MG","30","Select","Select",""],["","63304069201","CLINDAMYCIN ","150MG","30","Select","Select",""],["","24208029505","TOBRA\/DEXAME ","0.3-0.1%","5","Select","Select",""],["","43598032675","CIPRO\/DEXA ","0.3-0.1%","8","Select","Select",""],["","62332051805","TOBRAMYCIN ","0.3% OP","5","Select","Select",""],["","60758018805","GENTAMICIN ","0.3% OP","5","Select","Select",""],["","04142000024","FLORASTOR ","250MG","20","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","",""],["N\/A","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":""}]}]}