{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JACQUELINE   N SAMUEL","gend":1,"add":"340 TIMBERLAND LN APT 206","city":"CHARLOTTESVILLE","state":"VA","zip":"22903-9998","dob":"1988-07-26","age":"","mstatus":"","insh":"7357338*01","cliId":"","pno":"434\/465-3394","cno":"434\/465-3394","email":"","ename":"","eno":"","pphy":"MORIKAWA, MASAHIRO MD","ppno":"434\/924-5348","pcpadd":"1221 LEE STREET FL 1","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22908,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/924-8798","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E16.2","O35.8XX0","O24.119","Z3A.23","V23.41","O24.113","E11.9","O10.913","Z3A.29","Z39.2","E11.65","N76.0","Z79.4","Z45.89","B86.","L30.9","O23.599","Z3A.00","Z36.87","Z3A.01","O24.319","Z36.3","R21.","Z53.21","O99.891","L50.0","I10.","Z3A.16","L50.9","E08.10","K21.9","E87.6","Z79.84","E66.01","Z68.39","K52.9","O10.919","V23.89","V23.9","O99.210","O99.019","O24.112","O99.012","D64.9","V23.5","O10.912","Z3A.17","O99.810","O23.92","R82.71","Z3A.20","Z20.822","Z3A.21","O09.43","Z3A.28","G44.209","R30.0","N89.8","E10.65","K05.219","B37.3","O24.111","O10.911","O99.211","O09.291","O09.211","Z3A.10","O24.912","E11.649","O23.42","Z3A.27","Z3A.34","O69.89X0","O24.12","Z3A.37","Z37.0","O10.03","O24.13","Z79.899","Z30.2","E66.9","K85.10","R10.13","O35.9XX0","Z3A.32","Z09.","Z23.","J06.9","B97.89","J10.1","R35.0","E13.65","Z3A.19","Z3A.33","O99.02","O10.92","O99.214","O62.3","O69.81X0","O11.4","Z34.83","Z68.41","N76.1","Z98.890","R42.","E11.69","R11.0","R05.9","R09.89","O99.013","D50.9","Z3A.35","O24.913","R73.9","K86.1","J02.9","O99.212","Z3A.15","Z36.89","Z00.00","R51.","M25.362","Z3A.14","O10.013","O11.5","O10.93"],"date":["2021-12-10","2021-09-30","2021-12-28","2021-10-05","2021-12-03","2021-12-28","2022-09-07","2021-12-28","2021-11-16","2022-05-11","2022-09-30","2022-09-07","2022-09-30","2020-10-05","2020-10-28","2020-10-28","2021-06-02","2021-06-02","2021-06-10","2021-06-10","2021-06-10","2021-06-10","2021-08-13","2021-08-13","2021-08-14","2021-08-14","2022-02-21","2021-08-14","2021-08-14","2020-03-22","2020-03-23","2020-03-23","2022-02-21","2021-08-10","2020-06-19","2021-03-15","2021-12-28","2021-09-21","2021-12-28","2021-08-24","2021-12-28","2021-11-02","2021-10-05","2022-01-07","2021-12-28","2021-10-05","2021-08-24","2021-09-10","2021-09-10","2021-09-10","2021-09-10","2022-01-07","2021-09-21","2021-11-09","2021-11-09","2022-02-02","2021-04-21","2020-02-21","2020-03-23","2020-06-26","2021-04-21","2021-07-02","2021-07-02","2021-07-02","2021-07-02","2021-07-02","2021-07-02","2021-09-10","2022-01-07","2021-09-10","2021-11-02","2021-12-21","2022-01-07","2022-01-07","2022-01-07","2022-01-07","2022-01-18","2022-01-18","2022-01-18","2022-02-17","2022-09-30","2022-09-30","2021-03-19","2021-09-30","2021-12-03","2022-03-16","2022-09-30","2020-02-10","2020-02-10","2020-03-01","2020-03-13","2020-03-22","2021-09-07","2021-12-10","2022-01-07","2022-01-07","2022-01-07","2022-01-07","2022-01-07","2022-01-07","2022-01-07","2022-02-17","2022-05-11","2022-05-11","2020-03-21","2020-03-23","2021-03-15","2021-11-19","2022-09-21","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2022-02-21","2022-05-05","2022-09-21","2021-08-10","2021-08-10","2021-09-07","2020-01-24","2020-01-24","2020-01-24","2021-07-29","2021-12-21","2022-01-09","2022-01-09"],"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":[["","57896048914","POLYETH","POW 3350 NF","238","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","15","Select","Select",""],["","08290320122","BD  PEN NEEDL","MIS 32GX4MM","90","Select","Select",""],["","70010049110","METFORMIN","TAB 500MG ER","360","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","4","Select","Select",""],["","00904699880","DOCUSATE","CAP 100MG","30","Select","Select",""],["","49483034010","ACETAMIN","TAB 325MG","30","Select","Select",""],["","00904645780","DOK","CAP 100MG","30","Select","Select",""],["","67877032005","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","12","Select","Select",""],["","08290328418","INSULIN","MIS 1ML\/31G","100","Select","Select",""],["","68382079805","LABETALOL","TAB 100MG","60","Select","Select",""],["","00904671980","ACETAMINOPHE","TAB 325MG","30","Select","Select",""],["","00002614527","BAQSIMI","POW 3MG\/DOSE","2","Select","Select",""],["","53885000810","ONETOUCH","MIS PLUS 33G","300","Select","Select",""],["","68382013510","LOSARTAN","TAB 25MG","30","Select","Select",""],["","16729018317","HYDROCHLOROT","TAB 25MG","90","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","7","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","00904576960","ARTHRTS","TAB 650MG","15","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","00045083824","TYLENOL","TAB 650MG","15","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","00006027754","JANUVIA","TAB 100MG","60","Select","Select",""],["","00597015290","JARDIANCE","TAB 10MG","30","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","30","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","00472022041","CLOTRIMAZOLE","CRE 0.01","45","Select","Select",""],["","00193658621","MICROLET","MIS LANCETS","100","Select","Select",""],["","10135013301","ALLERGY","TAB 4MG","20","Select","Select",""],["","59779046378","CVS","TAB 4MG","20","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","16571040250","CETIRIZINE","TAB 10MG","14","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","19","Select","Select",""],["","64380080307","RANITIDINE","TAB 150MG","60","Select","Select",""],["","59779014139","ACID","TAB 10MG","30","Select","Select",""],["","69238126601","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","59651000305","OMEPRAZOLE","CAP 40MG","90","Select","Select",""],["","51801001130","EFFER-K","TAB 20MEQ","30","Select","Select",""],["","00002771559","BASAGLAR","INJ 100UNIT","15","Select","Select",""],["","99073070822","FREESTYLE    TES LITE","TES LITE","300","Select","Select",""],["","08214385034","UNIFINE","MIS 31GX3\/16","100","Select","Select",""],["","00527221637","METOLAZONE","TAB 5MG","60","Select","Select",""],["","65702043810","ACCU-CHEK","TES AVIVA PL","300","Select","Select",""],["","00002771459","HUMALOG","INJ 100\/ML","3","Select","Select",""],["","00169643810","LEVEMIR","INJ FLEXTOUC","9","Select","Select",""],["","00169266015","TRESIBA","INJ 100UNIT","9","Select","Select",""],["","00115165201","METOCLOPRAM","TAB 5MG","60","Select","Select",""],["","00002143380","TRULICITY","INJ 0.75\/0.5","2","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","28","Select","Select",""],["","00310653004","BYDUREON","INJ 2MG","4","Select","Select",""],["","00169406012","VICTOZA","INJ 18MG\/3ML","6","Select","Select",""],["","21922002107","PERMETHRIN","CRE 0.05","60","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":""}]}]}