{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DENNIS J TICE","gend":0,"add":"1918 BEDFORD AVE","city":"ALTAVISTA","state":"VA","zip":"24517-9998","dob":"1977-07-16","age":"","mstatus":"","insh":"1814798*01","cliId":"","pno":4342080419,"cno":4342080419,"email":"","ename":"","eno":"","pphy":"DODD, JEFFREY MD","ppno":8048972159,"pcpadd":"2891 ANDERSON HWY","pcpcity":"POWHATAN","pcpstate":"VA","pcpzip":"23139-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8042505774,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K62.5","R10.9","R00.0","R03.0","K86.1","M79.2","F32.9","R07.9","A41.9","NO DATA","K85.90","D72.829","F10.10","R10.13","G47.00","R19.7","F17.200","K52.9","K29.70","Z85.038","Z90.49","K91.89","T78.40XA","J20.9","J45.21","D62.","K92.1","G40.909","R56.9","V62.84","F10.929","R44.0","Z20.822","F10.21","F41.9","G89.29","J45.20","K59.00","Z79.2","R10.30","F10.99","R14.0","R11.0","E78.00","R51.9","F31.9","R10.32","G43.809","K92.2","D64.9","K26.9","R11.2","Z79.899","F41.1","Z98.0","L72.3","K29.90","F33.1","F10.20","F32.3","M54.30","H61.23","R10.84","R10.10","F11.20","Z04.9","N50.812","R05.1","U07.1","J44.1","J44.0","F17.210","R05.9","R07.89","K26.4","D75.89","K21.9","Z88.5","E53.8","Z87.11","G43.909","Z85.9","R50.9","R19.8","R10.11","K25.3","N50.811","N50.89"],"date":["2021-04-09","2022-12-27","2021-04-09","2021-04-09","2023-05-13","2022-12-27","2021-07-06","2023-05-15","2022-03-27","2022-03-27","2022-08-15","2022-04-01","2022-04-01","2023-01-29","2022-04-15","2022-08-21","2023-05-15","2023-01-30","2023-01-30","2023-01-02","2023-01-30","2022-08-21","2022-09-26","2023-05-15","2023-05-15","2021-04-12","2021-04-13","2021-07-01","2021-07-01","2022-03-27","2021-07-01","2021-07-01","2022-03-27","2021-07-20","2022-03-27","2022-03-27","2022-03-27","2022-03-27","2022-03-27","2022-09-26","2022-04-01","2022-04-01","2022-09-18","2022-11-29","2022-12-27","2022-11-29","2023-01-30","2023-04-20","2021-04-14","2021-04-14","2021-04-14","2023-01-29","2023-05-13","2022-03-17","2022-09-26","2022-12-27","2023-04-10","2021-07-02","2022-01-29","2021-08-10","2022-06-27","2022-06-27","2022-09-26","2023-04-10","2022-08-15","2022-05-10","2021-07-03","2023-01-10","2023-01-10","2023-05-13","2023-05-13","2023-05-13","2023-05-13","2021-09-27","2021-04-09","2021-04-09","2021-04-09","2021-04-09","2021-04-09","2023-01-02","2022-02-02","2021-09-27","2021-09-27","2023-01-29","2023-01-29","2021-04-13","2021-07-03","2021-07-03"],"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":[["","71093011105","GABAPENTIN","600 MG","120","Select","Select",""],["","00093005805","TRAMADOL HCL","TAB 50MG","20","Select","Select",""],["","65162052110","PROMETHAZINE","TAB 25MG","20","Select","Select",""],["","13668013501","ESCITALOPRAM","TAB 5MG","30","Select","Select",""],["","13668000805","ZOLPIDEM","TAB 10MG","30","Select","Select",""],["","00093221001","SUCRALFATE","1 G","120","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","70436005801","BUPROPION","TAB 100MG SR","30","Select","Select",""],["","52268001201","SUPREP BOWEL","SOL PREP KIT","354","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00143122701","DICYCLOMINE","TAB 20MG","20","Select","Select",""],["","00093226301","AMOXICILLIN","TAB 500MG","56","Select","Select",""],["","16571041250","CIPROFLOXACN","TAB 500MG","10","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","20","Select","Select",""],["","43386006019","GAVILYTE-C","SOL ","4000","Select","Select",""],["","70377000712","ROSUVASTATIN","TAB 10MG","90","Select","Select",""],["","43598029690","PREGABALIN","200 MG","90","Select","Select",""],["","69097012303","TOPIRAMATE","50 MG","60","Select","Select",""],["","67877026218","RIZATRIPTAN","10 MG","9","Select","Select",""],["","10702001801","OXYCODONE HCL","5 MG","3","Select","Select",""],["","00093101042","MUPIROCIN","2 %","22","Select","Select",""],["","59746000103","METHYLPREDNISOLONE","4 MG","21","Select","Select",""],["","64380071307","BENZONATATE","200 MG","21","Select","Select",""],["","00378064205","PREDNISONE","20 MG","12","Select","Select",""],["","68180086111","AZITHROMYCIN","250 MG","6","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","90 MCG","36","Select","Select",""],["","33342002208","LEVOFLOXACIN","500 MG","7","Select","Select",""],["","13668013601","ESCITALOPRAM OXALATE","10 MG","30","Select","Select",""],["","00054418625","DEXAMETHASONE","6 MG","7","Select","Select",""],["","65862059501","DIVALPROEX SODIUM ER","500 MG","90","Select","Select",""],["","69842080601","MUCUS ER","600 MG","20","Select","Select",""],["","00069034530","PAXLOVID (EUA)","300-100 MG","30","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":""}]}]}