{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRIDGETTE WARNER","gend":1,"add":"11602 JAMES CT","city":"ORANGE","state":"VA","zip":"22960-9998","dob":"2001-05-06","age":"","mstatus":"","insh":"1452186*01","cliId":"","pno":5403954291,"cno":5403954291,"email":"","ename":"","eno":"","pphy":"COURTNEY, ANDREA U MD","ppno":4349794440,"pcpadd":",","pcpcity":"MADISON","pcpstate":"VA","pcpzip":"22727-9998","pcpcounty":"","pcpid":"","pcpname":"AHG - Orange Family Physicians","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5405433294,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L98.9","R10.9","R10.2","R11.0","R19.7","R10.13","R74.01","R10.10","Z01.818","R74.8","K52.9","Z20.822","K76.0","F43.12","J06.9","Z01.419","R21.","G47.10","G47.30","E66.01","D50.9","R04.0","K92.1","D72.829","R30.0","N32.81","R31.29","N39.3","K59.00","F60.3","Z87.891","R12.","K30.","R93.3","F33.1","M99.05","N39.46","R35.0","R10.84","R42.","N80.5","F90.2","K31.84","Z23.","J34.89","J30.89","K35.80","NO DATA","Z03.818","N30.10","F41.1","R39.9","G89.29","N94.89","N80.0","N80.1","N80.8","N80.3","Z98.890","N92.5","J30.9","I10.","Z74.3","J02.9","Z30.41","R79.89","N80.9","K21.9","R07.89","Z88.8","R07.9","G47.33","R10.33","R31.21","R03.0","Z00.00","M62.838","N94.10","R39.89","M79.672","I73.00","Z68.41","R93.89","I80.8","E66.9","G47.00","R11.2","Z68.42","F32.9","E16.2","N32.89","Z79.899","Z91.51","Z83.3","Z82.49","Z80.8","E61.1","J01.90","F17.290","R39.82"],"date":["2021-05-26","2022-12-05","2022-07-22","2023-03-23","2022-10-04","2022-11-08","2022-06-16","2022-06-07","2022-07-12","2022-07-12","2022-07-28","2022-07-28","2022-09-13","2023-08-22","2022-12-21","2023-01-17","2023-01-17","2023-02-02","2023-02-02","2023-04-18","2021-06-29","2021-06-29","2021-06-29","2021-06-29","2023-08-24","2022-03-08","2022-03-08","2022-03-08","2022-03-08","2022-03-22","2022-12-06","2022-06-03","2022-11-29","2022-11-29","2023-08-01","2022-05-03","2022-05-03","2022-04-19","2022-06-16","2022-06-02","2022-07-13","2022-10-25","2023-08-24","2021-05-14","2021-08-24","2021-08-24","2021-09-07","2021-09-07","2021-12-28","2022-12-27","2022-03-01","2022-03-08","2022-04-01","2022-04-25","2022-07-22","2022-07-22","2022-07-22","2022-07-22","2022-09-20","2021-01-06","2021-01-06","2021-09-07","2021-09-07","2022-05-28","2022-05-28","2022-06-06","2022-09-20","2022-06-06","2022-12-06","2022-12-06","2022-12-06","2023-04-18","2021-09-07","2022-04-19","2022-06-01","2022-12-27","2023-02-07","2023-02-07","2023-08-24","2021-05-04","2021-05-04","2023-03-20","2022-07-13","2023-03-28","2023-03-20","2023-03-20","2022-06-03","2022-06-03","2022-06-03","2022-06-03","2022-06-03","2022-06-03","2022-06-03","2022-06-03","2022-06-03","2022-06-03","2023-07-18","2023-05-05","2023-05-05","2023-08-24"],"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":[["","00555902858","JUNEL FE","1.5-30(21)","84","Select","Select",""],["","49483060350","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00172392670","DIAZEPAM","5 MG","30","Select","Select",""],["","59651000305","OMEPRAZOLE","40 MG","60","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","70710122901","AMITRIPTYLIN","TAB 100MG","30","Select","Select",""],["","13668018930","TOLTERODINE","CAP 2MG ER","90","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","00469260130","MYRBETRIQ","TAB 25MG","30","Select","Select",""],["","68462038730","SOLIFENACIN","TAB 10MG","30","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","5","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","20","Select","Select",""],["","51991081403","AZELASTINE","SPR 0.001","30","Select","Select",""],["","70710113908","FLUCONAZOLE","150 MG","2","Select","Select",""],["","59267100002","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","80777027399","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","42806016005","HYDROXYZ HCL","TAB 25MG","60","Select","Select",""],["","00000000000","COMPOUND"," ","45","Select","Select",""],["","68462010630","ONDANSETRON","TAB 8MG","60","Select","Select",""],["","00093220401","METOCLOPRAM","TAB 5MG","30","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","3","Select","Select",""],["","50742050504","SCOPOLAMINE","DIS 1MG\/3DAY","4","Select","Select",""],["","61919088430","TRIMETHOBENZ","CAP 300MG","90","Select","Select",""],["","00143122701","DICYCLOMINE","TAB 20MG","15","Select","Select",""],["","13107008305","LORAZEPAM","TAB 0.5MG","2","Select","Select",""],["","59746011506","PROCHLORPER","TAB 10MG","15","Select","Select",""],["","66689000816","NYSTATIN","SUS 100000","480","Select","Select",""],["","65162052110","PROMETHAZINE","TAB 25MG","60","Select","Select",""],["","00093557256","ERYTHROMYCIN","TAB 500MG","6","Select","Select",""],["","57896010410","ACETAMINOPHE","TAB 325MG","60","Select","Select",""],["","00378035101","HALOPERIDOL","TAB 0.5MG","30","Select","Select",""],["","00093117701","NEOMYCIN","TAB 500MG","6","Select","Select",""],["","68382003416","VENLAFAXINE","CAP 37.5 ER","30","Select","Select",""],["","63402030430","LATUDA","40 MG","30","Select","Select",""],["","69238207907","PROPRANOLOL","TAB 40MG","60","Select","Select",""],["","00536105224","PEG3350","POW ","238","Select","Select",""],["","43386009019","GAVILYTE-G","SOL ","4000","Select","Select",""],["","69842087651","CVS ACETAMIN","TAB 325MG","60","Select","Select",""],["","69315013601","BENZTROPINE","TAB 0.5MG","60","Select","Select",""],["","70954001910","PRAZOSIN HCL","1 MG","30","Select","Select",""],["","65862001501","AMOXICILLIN","875 MG","20","Select","Select",""],["","70461032203","FLUCLVX QUAD","INJ 2022-23","0","Select","Select",""],["","68462010530","ONDANSETRON HCL","4 MG","60","Select","Select",""],["","70710122701","AMITRIPTYLINE HCL","50 MG","30","Select","Select",""],["","69238208001","PROPRANOLOL HCL","60 MG","60","Select","Select",""],["","68382085906","LURASIDONE HCL","60 MG","30","Select","Select",""],["","65862050301","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","4","Select","Select",""],["","69315013601","BENZTROPINE MESYLATE","0.5 MG","60","Select","Select",""],["","29300014801","QUETIAPINE FUMARATE","50 MG","30","Select","Select",""],["","57237016199","OMEPRAZOLE CAP","20MG","90","Select","Select",""],["","68462038730","SOLIFENACIN TAB","10MG","30","Select","Select",""],["","00555902858","JUNEL FE TAB","1.5\/30","84","Select","Select",""],["","59267100002","PFIZER VACC INJ COVID-","19","0","Select","Select",""],["","70710122801","AMITRIPTYLIN TAB","75MG","90","Select","Select",""],["","80777027399","MODERNA VAC INJ COVID-","19","0","Select","Select",""],["","70710113908","FLUCONAZOLE TAB","150MG","1","Select","Select",""],["","42806016005","HYDROXYZ HCL TAB","25MG","60","Select","Select",""],["","59746011506","PROCHLORPER TAB","10MG","15","Select","Select",""],["","61919088430","TRIMETHOBENZ CAP","300MG","90","Select","Select",""],["","00093220401","METOCLOPRAM TAB","5MG","120","Select","Select",""],["","65162052110","PROMETHAZINE TAB","25MG","60","Select","Select",""],["","66689000816","NYSTATIN SUS","100000","480","Select","Select",""],["","50742050504","SCOPOLAMINE DIS","1MG\/3DAY","4","Select","Select",""],["","68462010530","ONDANSETRON TAB","4MG","30","Select","Select",""],["","57896010410","ACETAMINOPHE TAB","325MG","60","Select","Select",""],["","13107008305","LORAZEPAM TAB","0.5MG","2","Select","Select",""],["","00143122701","DICYCLOMINE TAB","20MG","15","Select","Select",""],["","68682045570","METRONIDAZOL GEL","0.75%VAG","70","Select","Select",""],["","68308025010","ERYTHROMYCIN CAP","250MG EC","12","Select","Select",""],["","00832151011","HALOPERIDOL TAB","0.5MG","30","Select","Select",""],["","00093557256","ERYTHROMYCIN TAB","500MG","6","Select","Select",""],["","00093117701","NEOMYCIN TAB","500MG","6","Select","Select",""],["","49483060350","IBUPROFEN TAB","600MG","30","Select","Select",""],["","00536105224","PEG","3350 POW","238","Select","Select",""],["","69842087651","CVS ACETAMIN TAB","325MG","60","Select","Select",""],["","50111033401","METRONIDAZOL TAB","500MG","3","Select","Select",""],["","43386009019","GAVILYTE-G SOL","","4000","Select","Select",""],["","68382003416","VENLAFAXINE CAP","37.5 ER","30","Select","Select",""],["","69238207707","PROPRANOLOL TAB","10MG","60","Select","Select",""],["","00093226301","AMOXICILLIN TAB","500MG","21","Select","Select",""],["","10702001801","OXYCODONE TAB","5MG","5","Select","Select",""],["","70461032203","FLUCLVX QUAD INJ","2022-23","0","Select","Select",""],["","63402030430","LATUDA TAB","40MG","30","Select","Select",""],["","70954001910","PRAZOSIN HCL CAP","1MG","30","Select","Select",""],["","69315013601","BENZTROPINE TAB","0.5MG","60","Select","Select",""],["","00093101042","MUPIROCIN OIN","2%","22","Select","Select",""],["","42806016005","HYDROXYZINE HCL","25 MG","30","Select","Select",""],["","00781194339","AMOXICILLIN-CLAVULANATE POT ER","1000-62.5","40","Select","Select",""],["","53489011905","DOXYCYCLINE HYCLATE","100 MG","20","Select","Select",""],["","67877021660","CEFUROXIME","500 MG","20","Select","Select",""],["","69452015120","VITAMIN D","2 1250 MCG","15","Select","Select",""],["","00093081101","NORTRIPTYLINE HCL","25 MG","90","Select","Select",""],["","58487001981","VITAMIN B","12-FOLIC ACID 500-400MCG","30","Select","Select",""],["","67877056110","METFORMIN HCL","500 MG","30","Select","Select",""],["","00378031701","CIMETIDINE","300 MG","180","Select","Select",""],["","75826010700","DIPHENOXYLATE-ATROPINE","2.5-.025MG","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":""}]}]}