{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CRYSTAL L GLASS","gend":1,"add":"1069 HALIFAX ROAD","city":"DANVILLE","state":"VA","zip":"24540-9998","dob":"1990-09-18","age":"","mstatus":"","insh":"1080405*01","cliId":"","pno":4342261988,"cno":4342261988,"email":"","ename":"","eno":"","pphy":"CONDER, BRYAN DO","ppno":4347994488,"pcpadd":"109 BRIDGE STREET SUITE 201,","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":"24541-9998","pcpcounty":"","pcpid":"","pcpname":"Sovah Family Medical Residency Clinic","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4347736977,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.60","N93.9","N87.9","R53.83","I10.","E66.01","Z68.42","F17.210","J30.2","B00.89","Z16.33","F31.4","F43.10","Z20.822","J06.9","F33.3","N88.8","F10.10","R06.00","R07.9","Z36.89","R74.01","O20.9","Z3A.12","N76.0","R10.9","R39.9","K59.00","K21.9","Z53.20","Z33.1","Z13.32","F33.0","R30.0","N89.8","Z3A.20","O26.899","F31.9","G47.00","F41.1","Z13.89","Z72.51","O20.0","Z3A.14","Z01.10","Z30.40","R87.610","R87.810","Z32.02","R19.09","F32.1","M94.0","G47.30","F25.0","F43.12","G50.1","G89.18","Z3A.01","O10.911","R73.03","O20.8","Z23.","O11.4","F14.10","O99.324","Z37.0","O24.425","O10.92","O99.214","O99.344","Z3A.37","O80.","Z3A.38","Z30.42","Z91.81","Z3A.00","Z30.41","H00.013","N61.1","E78.2","Z20.828","R58.","R52.","M54.9","O03.9","H52.13","O24.410","D31.31","Z34.92","O24.119","O99.332","R10.30","R10.84","O47.9","NO DATA","H04.563","E55.9","J02.9","E11.9","R25.2"],"date":["2021-01-10","2021-03-25","2021-03-25","2023-07-24","2023-09-12","2022-05-12","2021-09-30","2021-10-29","2023-05-23","2021-08-16","2021-08-16","2023-08-03","2023-08-03","2022-10-19","2022-10-19","2023-02-24","2021-03-25","2021-03-01","2021-03-01","2021-03-01","2022-03-16","2021-11-11","2021-11-25","2021-11-25","2021-12-17","2023-05-23","2021-12-17","2021-12-17","2021-12-17","2021-12-21","2021-12-21","2022-01-11","2022-01-11","2022-01-11","2022-01-11","2022-01-11","2022-04-28","2023-01-12","2023-01-12","2023-01-12","2023-01-12","2021-10-29","2021-11-30","2021-11-30","2022-05-15","2022-08-11","2023-06-01","2023-06-01","2023-06-01","2021-01-13","2022-08-07","2021-04-14","2021-09-20","2022-01-11","2022-01-11","2021-03-27","2021-03-27","2021-11-03","2021-11-03","2021-11-03","2021-11-25","2022-03-16","2022-05-12","2022-05-12","2022-05-12","2022-05-14","2022-05-12","2022-05-12","2022-05-12","2022-05-12","2022-05-12","2022-05-14","2022-05-14","2022-11-28","2021-08-18","2022-05-13","2023-01-26","2023-01-26","2021-09-30","2021-09-30","2021-10-19","2021-11-25","2021-11-25","2022-04-28","2021-11-25","2022-01-13","2022-01-13","2022-01-13","2022-02-02","2022-02-02","2022-02-02","2022-04-28","2022-04-28","2022-04-28","2023-05-23","2023-09-22","2023-09-12","2023-09-25","2023-07-24","2023-07-24"],"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":[["","57237000511","FLUCONAZOLE TAB","150MG","2","Select","Select",""],["","00536106210","STOOL SOFTNR CAP","100MG","60","Select","Select",""],["","00904586960","DOK TAB","100MG","60","Select","Select",""],["","08290236850","LACTINEX CHW","","30","Select","Select",""],["","63402030230","LATUDA TAB","20MG","30","Select","Select",""],["","54629001156","ACIDOPHILUS CHW","","30","Select","Select",""],["","00536589688","NICOTINE TD DIS","21MG\/24H","28","Select","Select",""],["","00113025968","ASPIRIN CHW","81MG","30","Select","Select",""],["","64380073706","VITAMIN D CAP","50000UNT","4","Select","Select",""],["","00904533960","PRENATAL TAB PLUS FE","","30","Select","Select",""],["","42937070518","PRENATAL+FE TAB","29-1MG","30","Select","Select",""],["","74312002843","FOLIC ACID TAB","800MCG","30","Select","Select",""],["","68462015713","ONDANSETRON TAB","4MG ODT","30","Select","Select",""],["","53885027210","ONETOUCH TES VERIO","","100","Select","Select",""],["","00172572880","FAMOTIDINE TAB","20MG","60","Select","Select",""],["","51660052631","ALLERGY RELF TAB","10MG","30","Select","Select",""],["","60505082901","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","51224002206","AZITHROMYCIN TAB","250MG","4","Select","Select",""],["","53885014301","ONETOUCH MIS LANCETS","","100","Select","Select",""],["","31722077701","ACYCLOVIR TAB","400MG","60","Select","Select",""],["","51991096257","POLYETH GLYC POW","3350 NF","510","Select","Select",""],["","67877021905","CEPHALEXIN CAP","500MG","14","Select","Select",""],["","59651029501","NIFEDIPINE TAB","30MG ER","30","Select","Select",""],["","00536718101","ACIDOPHILUS TAB L-SPORO","","60","Select","Select",""],["","60258017101","MAG OXIDE TAB","400MG","30","Select","Select",""],["","00904531360","PRENATAL TAB","27-0.8MG","30","Select","Select",""],["","00113027565","LORATADINE TAB","10MG","30","Select","Select",""],["","68382000810","LAMOTRIGINE TAB","100MG","30","Select","Select",""],["","43547036011","LOSARTAN POT TAB","25MG","30","Select","Select",""],["","11917019262","MUCUS RELIEF TAB","600MG ER","20","Select","Select",""],["","00169280015","SAXENDA INJ","18MG\/3ML","15","Select","Select",""],["","59267102504","PFIZER VACC INJ ADLT RTU","","0","Select","Select",""],["","49884072501","BUSPIRONE TAB","7.5MG","60","Select","Select",""],["","00904679480","ASPIRIN LOW CHW","81MG","30","Select","Select",""],["","66993037179","MEDROXYPR AC INJ","150MG\/ML","1","Select","Select",""],["","23155065205","METRONIDAZOL TAB","500MG","14","Select","Select",""],["","45802005935","NYSTATIN CRE","100000","15","Select","Select",""],["","08290320882","BD PEN NEEDL MIS","31GX5MM","100","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","67877031905","IBUPROFEN","400 MG","180","Select","Select",""],["","45802057178","FEXOFENADINE HCL","180 MG","30","Select","Select",""],["","00280006502","ASTEPRO ALLERGY","205.5 MCG","23","Select","Select",""],["","00115180302","HYDROXYZINE PAMOATE","25 MG","120","Select","Select",""],["","59267030402","PFIZER COVID BIVAL (","12Y UP)EUA 30 MCG\/0.3","0.3","Select","Select",""],["","00378427677","VALACYCLOVIR","1000 MG","30","Select","Select",""],["","00904531346","PRENATAL VITAMIN","27MG-0.8MG","30","Select","Select",""],["","31722070010","LOSARTAN POTASSIUM","25 MG","30","Select","Select",""],["","00093506005","HYDROXYZINE HCL","10 MG","120","Select","Select",""],["","63402030230","LATUDA","20 MG","30","Select","Select",""],["","71351001250","LACTOBACILLUS","1MM CELL","60","Select","Select",""],["","11917012697","VITAMIN D","3 50 MCG","30","Select","Select",""],["","61874011530","VRAYLAR","1.5 MG","30","Select","Select",""],["","00093226301","AMOXICILLIN","500 MG","21","Select","Select",""],["","66993037179","MEDROXYPROGESTERONE ACETATE","150 MG\/ML","1","Select","Select",""],["","31722055190","LEVOCETIRIZINE DIHYDROCHLORIDE","5 MG","90","Select","Select",""],["","67877041305","METFORMIN HCL ER","500 MG","30","Select","Select",""],["","00172572860","FAMOTIDINE","20 MG","60","Select","Select",""],["","51660052631","ALLERGY RELIEF","10 MG","30","Select","Select",""],["","00781507701","LORATADINE","10 MG","30","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","00536106210","STOOL SOFTNR","CAP 100MG","60","Select","Select",""],["","42937070518","PRENATAL+FE","TAB 29-1MG","30","Select","Select",""],["","80681007400","FOLIC ACID","TAB 800MCG","30","Select","Select",""],["","00904586960","DOK","TAB 100MG","60","Select","Select",""],["","08290236850","LACTINEX","CHW ","30","Select","Select",""],["","54629001156","ACIDOPHILUS","CHW ","30","Select","Select",""],["","00536589688","NICOTINE TD","DIS 21MG\/24H","28","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","30","Select","Select",""],["","00113025968","ASPIRIN","CHW 81MG","30","Select","Select",""],["","00904531360","PRENATAL","TAB 27-0.8MG","30","Select","Select",""],["","51660052631","ALLERGY RELF","TAB 10MG","30","Select","Select",""],["","53885014301","ONETOUCH","MIS LANCETS","100","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00781149668","AZITHROMYCIN","TAB 250MG","4","Select","Select",""],["","51991096257","POLYETH GLYC","POW 3350 NF","510","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","59267102504","PFIZER VACC","INJ ADLT RTU","0","Select","Select",""],["","11917019262","MUCUS RELIEF","TAB 600MG ER","20","Select","Select",""],["","00904679480","ASPIRIN LOW","CHW 81MG","30","Select","Select",""],["","60258017101","MAG OXIDE","TAB 400MG","30","Select","Select",""],["","23155065205","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","59651029501","NIFEDIPINE","TAB 30MG ER","30","Select","Select",""],["","00169280015","SAXENDA","INJ 18MG\/3ML","15","Select","Select",""],["","45802005935","NYSTATIN","CRE 100000","15","Select","Select",""],["","49884072501","BUSPIRONE","TAB 7.5MG","60","Select","Select",""],["","68382000610","LAMOTRIGINE","TAB 25MG","44","Select","Select",""],["","31722077701","ACYCLOVIR","TAB 400MG","60","Select","Select",""],["","43547036011","LOSARTAN POT","TAB 25MG","30","Select","Select",""],["","66993037179","MEDROXYPR AC","INJ 150MG\/ML","1","Select","Select",""],["","08290320882","BD PEN NEEDL","MIS 31GX5MM","100","Select","Select",""],["","69097012815","AMLODIPINE BESYLATE","10 MG","30","Select","Select",""],["","59267030402","PFIZER COVID BIVAL (12Y UP)","EUA","0.3","Select","Select",""],["","00574402435","ERYTHROMYCIN","5 MG\/GRAM","3.5","Select","Select",""],["","24208029505","TOBRAMYCIN-DEXAMETHASONE","0.3 %-0.1%","5","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":""}]}]}