{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TINA BALSER","gend":1,"add":"1225 RESERVOIR ST HARRISONBURG HEALTH AND REHAB","city":"HARRISONBURG","state":"VA","zip":"22801-9998","dob":"1967-03-28","age":"","mstatus":"","insh":"20023525*01","cliId":"","pno":5407055985,"cno":5407055985,"email":"","ename":"","eno":"","pphy":"WILKINS, KATELYN NP","ppno":3477617200,"pcpadd":"41816 FENWAY CIRCLE,","pcpcity":"ASHBURN","pcpstate":"VA","pcpzip":"20148-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7033271166,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.84","R68.89","U07.1","Z00.00","F31.9","F20.0","I10.","K58.9","Z88.1","Z91.011","Z13.30","R07.9","N39.0","R51.9","Z88.8","I67.82","D32.0","Z86.16","Z11.59","V62.84","J06.9","R04.2","R05.1","Z20.822","J39.2","R06.7","E11.65","E78.5","Z71.2","F25.0","F70.","I26.99","R53.1","M62.81","E11.9","N17.9","R53.81","Z91.81","G47.00","Z79.01","E11.621","L97.412","Z86.711","L89.623","E86.0","R10.9","G89.29","Z82.49","R11.0","R40.4","Z71.89","R13.10","E83.42","E43.","L89.620","R62.7","D64.9","G40.909","NO DATA","N30.00","Z68.22","K58.1","R00.0","I95.9","R63.8","K59.00","F81.9","Z51.5","R63.4","R52.","R50.9","R41.82","M25.511","M75.01","M19.011","G31.9","F02.80","M54.5","F31.70","E78.2","I49.1","R07.89","R09.02","G44.89","R55.","W19.XXXA","N30.01","F22.","F69.","R46.2","Z79.899","G40.109","D69.6","F31.11","F79.","F25.9","F33.3","G31.84","R30.0","R32.","G83.9","E66.01","Z68.36","Z79.84","L03.116","L97.421","L97.422","I95.1","R31.9","A41.9","G93.41","L89.150","E87.0","G20.","G40.409","J98.11","L97.429","L03.032","M65.172","F03.90","F32.9","F23.","Z59.0","R41.0","R06.9","K59.09","F99.","Z79.2","Z99.3","F20.9","R06.02","R29.898","Z43.4","G40.209","F44.9","Z13.9","E53.8","F43.20","E13.9","F10.929","F41.9","Z03.818","G24.9","F06.31","M54.9","E66.9","M54.89","T74.11XA","M25.561","M25.562","M79.661","M79.662","R44.1","F20.3","K21.9","E87.1","E83.39","E83.41","B95.2","N30.91","R06.82","Z99.81","G93.40","Z93.1","H25.013","R11.2","G31.1","L89.153","Z43.1","K52.9","E56.9","R05.9","R09.89","R73.03","R29.6","Z83.3","R79.1","R90.82","R19.7","Z74.01","R56.9","M79.601","R73.9","R42.","Z91.14","Z98.51","S89.90XA","F39.","R44.0","L85.3","R10.13","M79.673","G45.9","R07.0","E16.1","E16.2","R10.30","Z00.8","L89.520","Z76.0","L08.9","Z74.3","F20.89"],"date":["2022-05-29","2022-03-18","2021-10-01","2021-09-26","2023-02-03","2023-02-10","2023-02-10","2022-10-14","2022-10-03","2022-10-03","2022-06-21","2022-09-24","2023-01-30","2021-10-03","2022-09-19","2021-10-19","2022-05-17","2022-06-23","2021-10-28","2022-10-25","2022-06-23","2022-06-23","2022-06-23","2023-01-31","2022-06-24","2022-06-24","2022-07-09","2023-02-06","2023-01-30","2022-07-22","2023-01-10","2023-02-08","2022-10-25","2023-02-10","2023-02-10","2023-02-03","2023-02-10","2023-01-31","2023-01-19","2023-01-01","2023-01-31","2022-09-21","2023-01-19","2022-10-19","2022-10-03","2022-10-03","2023-02-10","2022-10-03","2022-10-03","2022-10-03","2023-02-10","2023-02-10","2022-12-14","2023-02-10","2023-02-10","2023-02-10","2023-01-31","2023-01-02","2023-02-10","2022-12-30","2022-12-14","2022-12-14","2023-01-31","2023-01-23","2023-02-03","2022-12-28","2023-02-03","2023-02-10","2023-02-03","2023-02-03","2023-02-08","2023-01-31","2021-01-11","2021-04-15","2021-06-03","2023-01-02","2021-04-15","2021-04-15","2022-01-13","2022-01-13","2021-06-15","2022-06-20","2022-09-23","2021-10-02","2021-07-27","2021-09-28","2022-06-21","2022-01-13","2021-09-29","2021-09-29","2023-01-02","2023-02-10","2022-10-20","2022-03-18","2023-02-10","2021-10-28","2021-10-31","2023-01-23","2022-05-17","2022-05-17","2022-05-17","2022-10-14","2022-05-17","2022-10-14","2022-10-20","2022-09-13","2022-10-05","2023-02-03","2023-01-13","2023-02-03","2023-01-31","2023-01-31","2023-01-31","2023-01-31","2023-01-31","2023-01-31","2023-01-31","2023-01-31","2023-01-31","2023-02-03","2021-09-22","2022-09-11","2021-09-22","2021-09-24","2021-09-28","2022-05-30","2022-05-30","2022-10-14","2022-10-14","2023-01-10","2022-10-03","2022-10-25","2023-02-08","2023-02-08","2021-08-05","2021-07-27","2021-10-21","2021-10-28","2022-02-11","2022-02-16","2022-10-20","2022-06-28","2022-07-14","2022-10-20","2023-02-10","2022-10-20","2021-09-26","2021-09-28","2021-09-28","2021-09-28","2021-09-28","2021-09-28","2021-10-28","2022-09-11","2022-09-11","2023-01-30","2023-01-02","2023-01-02","2023-01-02","2023-01-02","2023-01-23","2023-01-31","2023-02-03","2023-02-10","2023-02-06","2023-02-08","2023-02-10","2023-02-10","2023-02-10","2021-06-15","2021-09-30","2022-06-23","2022-06-23","2022-07-02","2022-07-28","2022-07-28","2022-07-28","2022-07-28","2022-09-24","2023-01-02","2023-01-11","2021-04-15","2021-03-15","2021-04-07","2022-07-09","2022-04-25","2021-09-28","2022-02-16","2022-02-16","2022-03-18","2022-04-25","2022-09-11","2022-09-19","2021-09-14","2021-12-29","2021-12-29","2022-09-19","2022-06-30","2022-09-22","2022-11-01","2023-01-31","2022-09-23","2022-12-29"],"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":[["","00904699860","DOCUSATE SOD","CAP 100MG","60","Select","Select",""],["","00363023820","STOOL SOFTNR","CAP 100MG","60","Select","Select",""],["","00363410040","STOOL SOFTEN","CAP 100MG","60","Select","Select",""],["","70954005920","PREDNISONE","TAB 10MG","5","Select","Select",""],["","70700010916","CLOBETASOL","CRE 0.0005","30","Select","Select",""],["","11917004980","PETROLEUM","GEL ","106","Select","Select",""],["","68180098103","LISINOPRIL","20 MG","30","Select","Select",""],["","16714020030","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","13811071910","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","67877021901","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","45802086866","POLYETH GLYC","POW 3350 NF","28","Select","Select",""],["","57664051083","MIRTAZAPINE","7.5 MG","10","Select","Select",""],["","60505257808","ATORVASTATIN","TAB 10MG","30","Select","Select",""],["","00003089421","ELIQUIS","5 MG","28","Select","Select",""],["","00003376474","ELIQUIS ST P","TAB 5MG","74","Select","Select",""],["","68382011314","RISPERIDONE","TAB 0.5MG","60","Select","Select",""],["","50458058451","XARELTO STAR","TAB 15\/20MG","51","Select","Select",""],["","63323060594","ENOXAPARIN","INJ 100MG\/ML","14","Select","Select",""],["","68645058459","METFORMIN","TAB 1000MG","60","Select","Select",""],["","67877024210","QUETIAPINE","TAB 25MG","7","Select","Select",""],["","68382010610","DIVALPROEX","CAP 125MG","2","Select","Select",""],["","50484001030","SANTYL","250 UNIT\/G","30","Select","Select",""],["","65162027250","SMZ\/TMP DS","TAB 800-160","14","Select","Select",""],["","51660002927","OMEPRAZOLE","TAB 20MG DR","30","Select","Select",""],["","43598021055","SSD","CRE 0.01","100","Select","Select",""],["","53885004601","ONETOUCH","KIT ULTRA 2","1","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","100","Select","Select",""],["","00093506201","HYDROXYZ HCL","TAB 50MG","90","Select","Select",""],["","11917009215","FERROUS SULF","TAB 325MG","30","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","30","Select","Select",""],["","69238110002","DOXYCYCL HYC","CAP 100MG","28","Select","Select",""],["","60505311108","OLANZAPINE","5 MG","30","Select","Select",""],["","29300013805","DIVALPROEX SODIUM","125 MG","120","Select","Select",""],["","10702001801","OXYCODONE HCL","5 MG","1","Select","Select",""],["","70010006510","METFORMIN HCL","1000 MG","60","Select","Select",""],["","69315011610","FUROSEMIDE","20 MG","30","Select","Select",""],["","65628007005","FIRST-OMEPRAZOLE","2 MG\/ML","150","Select","Select",""],["","67877041920","LINEZOLID","600 MG","9","Select","Select",""],["","57237010099","METOPROLOL TARTRATE","25 MG","30","Select","Select",""],["","00406800330","MORPHINE SULFATE","100 MG\/5ML","30","Select","Select",""],["","00054353244","LORAZEPAM INTENSOL","2 MG\/ML","30","Select","Select",""],["","55111028050","LEVOFLOXACIN","500 MG","1","Select","Select",""],["","65862059805","TAMSULOSIN HCL","0.4 MG","30","Select","Select",""],["","55150016205","LIDOCAINE HCL","10 MG\/ML","5","Select","Select",""],["","00781320895","CEFTRIAXONE","1 G","1","Select","Select",""],["","00338004904","SODIUM CHLORIDE","0.9 %","2000","Select","Select",""],["","60505257808","ATORVASTATIN CALCIUM","10 MG","30","Select","Select",""],["","00641604425","LORAZEPAM","2 MG\/ML","1","Select","Select",""],["","23155050210","HYDROXYZINE HCL","50 MG","30","Select","Select",""],["","00121067585","VALPROIC ACID","250 MG\/5ML","473","Select","Select",""],["","08290381423","INSYTE AUTOGUARD","22GX1\"","1","Select","Select",""],["","08290306546","NORMAL SALINE FLUSH","0.9 %","10","Select","Select",""],["","53746074501","PROMETHAZINE HCL","12.5 MG","28","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":""}]}]}