{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KAREN   P MOORE","gend":1,"add":"PO BOX 903","city":"GRETNA","state":"VA","zip":"24557-9998","dob":"1964-06-28","age":"","mstatus":"","insh":"20052635*01","cliId":"","pno":"434\/221-0963","cno":"434\/221-0963","email":"","ename":"","eno":"","pphy":"SMITH, DAVID B PA","ppno":"434\/835-0105","pcpadd":"2767 FRANKLIN TURNPIKE","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24540,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/835-0178","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L72.0","L40.0","Z79.899","G89.4","L40.50","Z51.81","Z79.891","Z72.0","NO DATA","M79.7","R21.","J44.9","F17.210","B34.9","H66.91","H92.01","J02.9","J34.89","R51.9","Z20.822","H40.1131","M54.41","J41.8","J47.9","Z23.","J06.9","R05.9","S33.5XXA","S80.12XA","S80.11XA","W01.0XXA","U07.1","R09.81","R07.0","L03.111","R05.","R68.83","G89.29","H40.013","M26.602","Z79.51","Z88.0","R68.84","L29.8","R93.89","R06.02","J43.2","L30.4","N61.1","K12.0","F43.21","F41.9","R91.8","F41.1","F42.2","F51.01","F17.200","J42.","R06.09","J43.9","F06.30","R73.03","E78.2","L40.9","E55.9","E66.9"],"date":["2021-08-03","2022-10-06","2022-10-06","2022-07-08","2022-07-08","2022-07-08","2022-07-08","2022-04-12","2022-07-08","2022-07-08","2020-04-12","2022-06-23","2020-06-26","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2022-07-13","2021-03-30","2022-07-28","2020-08-28","2021-11-29","2022-06-23","2020-11-09","2022-05-12","2022-07-13","2022-06-14","2022-06-14","2022-06-14","2022-06-14","2022-07-13","2022-07-13","2022-07-13","2022-10-06","2020-04-03","2020-01-12","2021-07-08","2020-02-13","2020-06-26","2020-06-26","2020-06-26","2020-06-26","2022-07-06","2021-11-29","2021-11-29","2021-11-29","2022-07-06","2022-07-06","2020-03-13","2020-05-05","2020-05-05","2021-04-09","2022-01-25","2022-01-25","2022-01-25","2022-06-23","2022-06-23","2022-06-23","2022-06-23","2020-06-01","2021-02-15","2021-02-15","2021-02-15","2021-02-15","2021-02-15"],"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":[["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","68645056259","IBUPROFEN","TAB 600MG","90","Select","Select",""],["","16714008310","HYDROXYZ","TAB 50MG","90","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","90","Select","Select",""],["","70010077001","METHOCARBAM","TAB 750MG","120","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","00228331603","DOXEPIN","TAB 6MG","30","Select","Select",""],["","43547028111","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","68382080701","TRAZODONE","TAB 150MG","90","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","69452014430","BENZONATATE","CAP 200MG","90","Select","Select",""],["","49502010202","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","60505016809","PRAVASTATIN","TAB 10MG","30","Select","Select",""],["","70069042101","LATANOPROST","SOL 0.00005","2","Select","Select",""],["","60432060416","PROMETHAZINE","SYP DM","100","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","11877001140","BINAXNOW","KIT HOME TES","2","Select","Select",""],["","21922001707","CLOBETASOL","OIN 0.0005","60","Select","Select",""],["","51672129803","KETOCONAZOLE","CRE 0.02","60","Select","Select",""],["","00069110120","PAXLOVID","TAB 150-100","20","Select","Select",""],["","55513036955","OTEZLA","TAB 10\/20\/30","55","Select","Select",""],["","49281042250","FLUZONE","INJ 2022-23","0","Select","Select",""],["","13668048450","MINOCYCLINE","CAP 100MG","14","Select","Select",""],["","49884094499","VARENICLINE","TAB 0.5& 1MG","53","Select","Select",""],["","16729048601","METHOTREXATE","TAB 2.5MG","16","Select","Select",""],["","68645057154","CITALOPRAM","TAB 40MG","30","Select","Select",""],["","69315012710","FOLIC","TAB 1000MCG","30","Select","Select",""],["","16714089802","LORATADINE","TAB 10MG","90","Select","Select",""],["","00168026760","AUG","LOT 0.0005","60","Select","Select",""],["","67877025145","TRIAMCINOLON","CRE 0.001","454","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00173086910","ANORO","AER 62.5-25","60","Select","Select",""],["","50111078751","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","41100081123","AFRIN","SPR 0.0005","15","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","49035057139","ALLERGY","TAB 180MG","20","Select","Select",""],["","81131008747","SV","TAB 3MG","30","Select","Select",""],["","49281072110","FLUBLOK","INJ 2021-22","0","Select","Select",""],["","00527193206","CLARITHROMYC","TAB 500MG","28","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","47469000458","MELATONIN","TAB \/VIT-B6","90","Select","Select",""],["","70710101002","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","55111078401","FEXOFENADINE","TAB 180MG","20","Select","Select",""],["","00904675816","ROBAFEN","LIQ 10-100MG","300","Select","Select",""],["","00093026492","FLUOCINONIDE","OIN 0.0005","60","Select","Select",""],["","16714068403","SIMVASTATIN","TAB 40MG","30","Select","Select",""],["","65862069730","VENLAFAXINE","CAP 150MG ER","30","Select","Select",""],["","57896079316","GERI-TUSSIN","SYP 100\/5ML","177","Select","Select",""],["","00591505210","PREDNISONE","TAB 5MG","22","Select","Select",""],["","81131054393","D3","CHW 1000UNIT","60","Select","Select",""],["","10310028340","ORAJEL","GEL 0.2","5","Select","Select",""],["","49035007021","EQ","TAB 600MG","20","Select","Select",""],["","00713063415","MOMETASONE","CRE 0.001","15","Select","Select",""],["","05388062780","CO","CAP 100MG","30","Select","Select",""],["","57237001830","DULOXETINE","CAP 30MG","60","Select","Select",""],["","72205000490","ROSUVASTATIN","TAB 20MG","30","Select","Select",""],["","64380073706","VITAMIN","CAP 50000UNT","8","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":""}]}]}