{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HALLIE L WARNER","gend":1,"add":"117 WARNER LN","city":"SHIPMAN","state":"VA","zip":"22971-9998","dob":"1994-03-19","age":"","mstatus":"","insh":"1206305*01","cliId":"","pno":4349626662,"cno":4349626662,"email":"","ename":"","eno":"","pphy":"BOND, MELISSA FNP","ppno":4342634000,"pcpadd":"4038 THOMAS NELSON HWY,","pcpcity":"ARRINGTON","pcpstate":"VA","pcpzip":"22922-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4342634160,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R43.2","R43.9","R89.2","N20.1","Z93.6","Z96.0","N10.","N20.0","R52.","R10.84","R11.0","V58.89","N13.30","N39.0","O99.891","R10.9","Q61.5","Z87.442","Z3A.11","Z43.6","Z3A.15","R00.0","R10.32","R11.2","B96.29","D72.829","Z3A.16","O23.02","N12.","V23.5","N28.89","O26.892","Z3A.23","Z34.92","Z3A.22","Z36.3","V23.7","Z3A.30","Z3A.32","Z39.1","Z34.82","Z34.83","Z3A.35","R60.9","O13.4","O69.89X0","O99.892","Z3A.37","Z37.0","M79.89","M79.604","M79.605","N30.00","Z20.822","I95.9","Z79.899","N13.2","R31.9","R10.12","O23.11","O98.511","B02.30","NO DATA","O99.341","F41.9","O99.011","Z3A.10","Z87.891","Z3A.09","Z76.89","O23.42","O26.832","T83.512A","O99.012","O99.342","F39.","B95.2","Z88.8","Z87.59","N23.","Z34.90","Z16.24","N13.6","B96.20","E83.59","Z3A.19","O99.282","Z80.42","Z82.49","Z86.32","M54.9","Z3A.29","Z3A.31","R23.1","R10.30","G44.89","Z46.6","N13.1","O26.831","E86.0","V23.9","Z3A.27","Z36.2","O47.9","O15.9","I10.","O13.3","Z3A.34","R53.83","Z33.1","Z16.12","T83.84XA","O99.322","F11.90","O26.833","Z3A.33","T85.848A","Z45.2","R82.71","Z3A.36","Z30.2","O86.20","O90.89","R58.","T83.022A","G47.00","A41.9","O23.03","D64.9","O99.013","R06.9","R09.02","G43.909","Z39.2","G89.29","F11.29","Q62.0","M54.89","O26.893","S37.012A","O23.01","E87.1","N11.8","F41.8","Z79.2","Z79.891","Z87.440","F11.20","O99.324","O99.344","O69.81X0","Z80.9","Z81.8","Z82.5","Z83.3","R10.2","R06.89","N30.01","R07.89","R07.9","F32.9","N21.8","N29.","I49.9","R53.81"],"date":["2021-03-08","2021-03-08","2021-05-28","2021-06-28","2022-03-22","2022-03-25","2022-03-30","2023-09-05","2023-08-12","2023-08-12","2023-09-05","2021-08-27","2022-03-10","2023-08-12","2022-08-14","2023-09-05","2023-08-16","2022-07-18","2022-02-14","2022-03-10","2022-03-15","2023-09-05","2023-08-16","2022-05-10","2022-04-01","2022-03-22","2022-04-01","2022-04-02","2022-04-03","2022-08-19","2022-08-19","2022-05-10","2022-05-10","2022-05-10","2022-05-10","2022-06-07","2022-08-01","2022-07-04","2022-07-15","2022-07-20","2022-07-20","2022-07-20","2022-08-01","2022-08-09","2022-08-14","2022-08-14","2022-08-14","2022-08-14","2022-08-14","2022-08-17","2022-08-17","2022-08-17","2022-11-11","2022-11-11","2023-04-16","2022-06-30","2021-05-29","2023-08-12","2021-06-30","2022-01-31","2022-01-31","2022-01-31","2023-04-19","2022-02-14","2022-03-28","2022-01-31","2022-02-05","2022-03-28","2022-02-07","2022-02-10","2022-03-08","2022-07-25","2022-03-08","2022-03-08","2022-03-28","2022-03-08","2022-03-08","2022-03-08","2022-07-18","2022-04-01","2022-04-01","2022-03-28","2022-03-28","2022-03-28","2023-09-05","2022-03-30","2022-03-28","2022-03-28","2022-03-28","2022-03-28","2023-04-16","2022-06-19","2022-07-04","2023-03-04","2023-08-16","2022-08-01","2023-08-14","2021-09-08","2022-02-17","2022-02-14","2022-07-13","2022-06-07","2022-07-25","2022-07-13","2022-07-13","2023-08-16","2022-08-19","2022-07-29","2021-07-16","2022-03-15","2022-03-21","2022-03-21","2022-05-03","2022-05-03","2022-07-25","2022-07-18","2021-05-30","2022-03-25","2022-03-21","2022-08-19","2022-08-15","2022-08-18","2022-08-18","2021-06-02","2021-07-16","2021-07-16","2021-07-19","2022-06-30","2022-06-30","2022-06-30","2022-08-01","2023-09-05","2022-07-29","2022-08-19","2023-04-19","2022-08-17","2022-02-07","2022-06-08","2022-08-01","2021-06-09","2022-02-14","2022-02-14","2022-03-25","2022-03-25","2022-03-25","2022-03-25","2022-08-01","2022-08-14","2022-08-14","2022-08-14","2022-08-14","2022-08-14","2022-08-14","2022-08-14","2022-08-14","2022-08-30","2023-08-12","2023-04-13","2023-04-16","2023-04-16","2021-06-30","2023-08-12","2023-09-05","2023-08-12","2023-08-16"],"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":[["","65862001305","SERTRALINE","TAB 100MG","90","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","120","Select","Select",""],["","00093314705","CEPHALEXIN","500 MG","28","Select","Select",""],["","57237007530","ONDANSETRON","TAB 4MG","20","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","20","Select","Select",""],["","42571016201","AMOX\/K CLAV","TAB 875-125","13","Select","Select",""],["","00904674780","IBUPROFEN","200 MG","9","Select","Select",""],["","10702020150","OXYBUTYNIN","TAB 5MG","270","Select","Select",""],["","23155050110","HYDROXYZ HCL","TAB 25MG","30","Select","Select",""],["","16729017101","AMITRIPTYLIN","TAB 10MG","90","Select","Select",""],["","51293061201","PHENAZOPYRID","TAB 200MG","20","Select","Select",""],["","57237001405","TAMSULOSIN","CAP 0.4MG","60","Select","Select",""],["","62756052269","SUMATRIPTAN","TAB 100MG","9","Select","Select",""],["","55289002328","AMPICILLIN","CAP 250MG","56","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","6","Select","Select",""],["","00406324301","HYDROMORPHON","TAB 2MG","10","Select","Select",""],["","49483034010","ACETAMIN","TAB 325MG","30","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","65162062711","TRAMADOL HCL","TAB 50MG","15","Select","Select",""],["","13811071910","NITROFURANTN","CAP 100MG","30","Select","Select",""],["","45802086802","POLYETH GLYC","POW 3350 NF","238","Select","Select",""],["","43547040011","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","57896010410","ACETAMINOPHE","TAB 325MG","60","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","12","Select","Select",""],["","70000043401","GAS RELIEF","CHW 80MG","30","Select","Select",""],["","00115164301","NITROFUR MAC","CAP 50MG","60","Select","Select",""],["","16729016917","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","66993043185","PRAZOSIN HCL","CAP 1MG","30","Select","Select",""],["","00143992701","CIPROFLOXACN","TAB 250MG","40","Select","Select",""],["","10702001801","OXYCODONE HCL","5 MG","15","Select","Select",""],["","65862018730","ONDANSETRON HCL","4 MG","20","Select","Select",""],["","57237001405","TAMSULOSIN HCL","0.4 MG","14","Select","Select",""],["","57896048914","POLYETHYLENE GLYCOL","3350 17 G\/DOSE","238","Select","Select",""],["","50111033402","METRONIDAZOLE","500 MG","14","Select","Select",""],["","49483034010","ACETAMINOPHEN","325 MG","63","Select","Select",""],["","10702001801","OXYCODONE TAB","5MG","5","Select","Select",""],["","13811071910","NITROFURANTN CAP","100MG","30","Select","Select",""],["","43547040011","CYCLOBENZAPR TAB","10MG","30","Select","Select",""],["","57237001405","TAMSULOSIN CAP","0.4MG","30","Select","Select",""],["","10702020150","OXYBUTYNIN TAB","5MG","90","Select","Select",""],["","00603188016","LIDOCAINE PAD","5%","30","Select","Select",""],["","00115164301","NITROFUR MAC CAP","50MG","60","Select","Select",""],["","00781261305","AMOXICILLIN CAP","500MG","12","Select","Select",""],["","57237007530","ONDANSETRON TAB","4MG","20","Select","Select",""],["","57896048914","POLYETH GLYC POW","3350 NF","238","Select","Select",""],["","57896010201","ACETAMINOPHE TAB","325MG","30","Select","Select",""],["","49483034010","ACETAMIN TAB","325MG","30","Select","Select",""],["","00093314705","CEPHALEXIN CAP","500MG","60","Select","Select",""],["","70000043401","GAS RELIEF CHW","80MG","30","Select","Select",""],["","68308014501","OXYCODONE CAP","5MG","10","Select","Select",""],["","16729016917","ESCITALOPRAM TAB","10MG","30","Select","Select",""],["","66993043185","PRAZOSIN HCL CAP","1MG","30","Select","Select",""],["","00143992701","CIPROFLOXACN TAB","250MG","40","Select","Select",""],["","43547022650","METHOCARBAMOL","750 MG","20","Select","Select",""],["","49483008010","SENNA","8.6 MG","30","Select","Select",""],["","65162068110","PHENAZOPYRIDINE HCL","100 MG","9","Select","Select",""],["","54799090415","TEARS AGAIN","1.4 %","30","Select","Select",""],["","43547039950","CYCLOBENZAPRINE HCL","5 MG","45","Select","Select",""],["","45802081184","NALOXONE HCL","4 MG","2","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":""}]}]}