{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WILLIAM   F LIPSCOMB","gend":0,"add":"701 EUCLID AVE APT 5","city":"LYNCHBURG","state":"VA","zip":"24501-9998","dob":"1945-10-27","age":"","mstatus":"","insh":"20031169*01","cliId":"","pno":"434\/401-9290","cno":"","email":"","ename":"","eno":"","pphy":"BORDERS, MERRITT VERNON FNP","ppno":"434\/929-1400","pcpadd":"134 ELON RD","pcpcity":"MADISON HEIGHTS","pcpstate":"VA","pcpzip":24572,"pcpcounty":"","pcpid":"","pcpname":"JOHNSON HEALTH CENTER","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/929-0410","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N39.41","R53.81","J43.9","R91.8","R09.02","I48.91","J44.9","A41.9","J96.11","N39.0","I48.0","G40.909","Z87.891","R33.9","T83.9XXA","N40.1","R00.2","F03.90","G40.901","I10.","E11.9","N31.9","J18.9","J44.0","I25.10","J41.0","K21.9","E55.9","F10.21","K42.9","R19.4","R14.0","R19.8","Z71.9","K80.20","R93.5","N28.1","R07.9","A04.1","F10.10","Z79.01","N48.89","T83.098A","R31.9","E78.5","E66.9","Y84.6","Z23.","M17.12","M25.562","Z95.818","Z53.8","Z82.49","Z20.828","Z79.84","D64.9","Z86.010","Z72.89","Z99.81","B96.20","Z68.26","Z79.899","R93.89","Z72.0","R33.8","NO DATA","F17.201","N13.8","N32.89","M65.342","M79.645","G47.33","D12.0","D12.2","D12.4","D12.5","K43.2","Z87.09","Z87.19","M17.0","M25.561","I25.119","E11.42","L60.3","B35.1","E11.69","Z98.890","R39.9","M17.11","G47.30","R06.83","G47.10","R59.0","M79.89","G47.34","R91.1","R53.83","J44.1","R60.0","G89.29","M19.079","M71.20"],"date":["2022-11-03","2022-11-03","2022-06-28","2022-06-28","2022-06-28","2022-06-13","2022-11-22","2021-03-07","2021-03-08","2021-10-05","2022-07-01","2021-03-08","2022-11-22","2021-10-05","2021-03-19","2021-10-05","2022-11-18","2021-03-07","2020-03-02","2022-02-16","2021-04-28","2020-03-02","2020-02-17","2020-02-17","2022-07-01","2020-06-04","2021-04-28","2020-06-04","2020-06-04","2020-09-18","2020-09-17","2020-09-03","2020-09-03","2020-09-03","2020-09-18","2020-09-18","2020-09-18","2021-03-08","2021-03-08","2022-07-01","2022-10-30","2021-03-19","2021-03-19","2021-03-19","2021-03-19","2021-03-19","2021-03-19","2021-05-17","2022-05-05","2022-08-19","2020-12-11","2021-01-04","2021-01-04","2021-01-04","2021-01-04","2022-10-30","2021-01-04","2021-01-04","2021-03-07","2021-03-07","2021-03-07","2022-07-01","2021-05-17","2020-09-28","2021-08-27","2022-11-10","2021-02-10","2021-07-12","2021-07-12","2021-11-03","2021-11-03","2022-08-04","2020-09-17","2020-09-17","2020-09-17","2020-09-17","2020-09-28","2021-04-28","2021-04-28","2022-10-31","2022-11-10","2020-09-17","2022-06-22","2022-06-22","2022-06-22","2022-06-22","2022-07-01","2020-06-05","2022-11-10","2022-07-27","2022-07-27","2022-07-27","2022-10-24","2022-10-24","2022-11-22","2022-11-22","2022-11-22","2022-10-24","2022-10-30","2022-11-10","2022-10-30","2022-10-30"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","00603020922","MAG","TAB 400MG","60","Select","Select",""],["","68382013201","TAMSULOSIN","CAP 0.4MG","90","Select","Select",""],["","76204020060","ALBUTEROL","NEB 0.00083","180","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","90","Select","Select",""],["","00003089421","ELIQUIS","TAB 5MG","60","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","55111012205","ATORVASTATIN","TAB 20MG","90","Select","Select",""],["","00378001805","METOPROL","TAB 25MG","180","Select","Select",""],["","69315012710","FOLIC","TAB 1000MCG","90","Select","Select",""],["","60505008000","SOTALOL","TAB 80MG","60","Select","Select",""],["","00085461001","DULERA","AER 200-5MCG","26","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","90","Select","Select",""],["","51224000760","METFORMIN","TAB 500MG ER","90","Select","Select",""],["","64980033912","MAGNESIUM-OX","TAB 400MG","60","Select","Select",""],["","00378668899","PANTOPRAZOLE","TAB 20MG","90","Select","Select",""],["","31722052530","FINASTERIDE","TAB 5MG","90","Select","Select",""],["","71930006352","LEVETIRACETA","TAB 500MG","180","Select","Select",""],["","67618010760","SLOW-MAG","TAB ","90","Select","Select",""],["","00781185220","AMOX\/K","TAB 875-125","20","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","1","Select","Select",""],["","64679096101","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00054429731","FUROSEMIDE","TAB 20MG","4","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","200","Select","Select",""],["","62332025050","DOXYCYC","CAP 100MG","20","Select","Select",""],["","00574050801","FERROUS","TAB 324MG","30","Select","Select",""],["","00591544210","PREDNISONE","TAB 10MG","30","Select","Select",""],["","57237004001","PENICILLN","TAB 250MG","56","Select","Select",""],["","51293081001","PHENAZOPYRID","TAB 100MG","6","Select","Select",""],["","13107008305","LORAZEPAM","TAB 0.5MG","270","Select","Select",""],["","53885027150","ONETOUCH","TES VERIO","50","Select","Select",""],["","60846050101","PYRIDIUM","TAB 100MG","6","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","14","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","6","Select","Select",""],["","51862094305","DIAZEPAM","TAB 10MG","1","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","10","Select","Select",""],["","49281012165","FLUZONE","INJ 2021-22","1","Select","Select",""],["","54629041120","VITAMIN","TAB 2000UNIT","30","Select","Select",""],["","00173069600","ADVAIR","AER 250\/50","60","Select","Select",""],["","00378932132","WIXELA","AER 250\/50","60","Select","Select",""],["","13811071910","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","10572010001","PEG-3350","SOL ELECTROL","4000","Select","Select",""],["","43386009019","GAVILYTE-G","SOL ","4000","Select","Select",""],["","43598044874","NICOTINE","DIS 21MG\/24H","28","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}