{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RENEE  M BATTS-COX","gend":1,"add":"102 S COALTER ST APT 5","city":"STAUNTON","state":"VA","zip":"24401-9998","dob":"1963-11-07","age":"","mstatus":"","insh":"20023682*01","cliId":"","pno":5405886263,"cno":5405886263,"email":"","ename":"","eno":"","pphy":"REED, JOHN P MD","ppno":5409325687,"pcpadd":"53 S MEDICAL PARK DR","pcpcity":"FISHERSVILLE","pcpstate":"VA","pcpzip":"22939-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5409325688,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F25.0","NO DATA","M62.81","H40.1131","E11.9","H52.13","H40.153","Z98.890","Z11.59","F25.9","R12.","I10.","J45.909","M47.816","E66.9","K76.0","M47.9","F29.","R00.0","Z13.30","E66.01","Z79.899","K21.9","K52.9","M54.9","R74.01","Z20.822","Z91.128","Z88.0","Z78.1","R94.31","Z01.419","M54.17","M25.561","M25.562","R45.1","M13.861","M13.862","M47.817","J45.20","R73.03","D86.3","L85.3","L57.8","K63.3","M43.16","M47.896","J45.40","J30.2","Z68.39","K50.00","Z68.41","H25.13","D86.0","K51.80","E87.6","F23."],"date":["2023-04-21","2022-12-21","2022-11-23","2023-03-29","2023-03-29","2023-03-29","2023-02-22","2022-10-19","2021-06-21","2022-03-23","2021-11-30","2023-03-21","2023-04-24","2023-01-03","2023-02-13","2023-02-13","2022-12-21","2021-04-28","2021-06-14","2021-06-14","2023-03-21","2021-03-05","2022-04-22","2021-05-24","2021-08-02","2021-07-16","2021-07-16","2021-07-16","2021-07-16","2021-07-16","2021-07-16","2022-05-04","2022-08-02","2022-08-02","2022-08-02","2021-03-13","2022-03-02","2022-03-02","2022-11-22","2021-02-09","2021-02-09","2023-01-20","2021-05-27","2021-05-27","2021-09-28","2022-01-28","2022-01-28","2022-03-23","2022-03-23","2022-03-23","2022-04-22","2022-04-22","2022-09-27","2021-01-25","2021-01-25","2021-01-25","2021-02-11"],"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":[["","43598081115","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","29300039710","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","68462022301","LITHIUM CARB","TAB 300MG ER","30","Select","Select",""],["","70069005101","DORZOL\/TIMOL","SOL 22.3-6.8","10","Select","Select",""],["","00591224522","MESALAMINE","1.2 G","120","Select","Select",""],["","33342007007","OLANZAPINE","10 MG","30","Select","Select",""],["","50458056401","INVEGA SUST","INJ 234\/1.5","2","Select","Select",""],["","00065024610","BETOPTIC-S","SUS 0.25% OP","10","Select","Select",""],["","69097081312","GABAPENTIN","CAP 100MG","90","Select","Select",""],["","00456315467","AEROCHAMBER","MIS PLUS","1","Select","Select",""],["","65862044890","VALACYCLOVIR","500 MG","30","Select","Select",""],["","00603243721","BENZTROPINE","TAB 0.5MG","30","Select","Select",""],["","00085720601","DULERA","100-5 MCG","13","Select","Select",""],["","45802095301","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","59310057922","PROAIR HFA","AER ","17","Select","Select",""],["","65862056090","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","00067815204","VOLTAREN","GEL 0.01","150","Select","Select",""],["","00054004641","IPRATROPIUM","SPR 0.0006","15","Select","Select",""],["","42571014126","DORZOLAMIDE","SOL 2% OP","10","Select","Select",""],["","70954005920","PREDNISONE","TAB 10MG","55","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","65862056090","PANTOPRAZOLE SODIUM","40 MG","30","Select","Select",""],["","68462022301","LITHIUM CARBONATE ER","300 MG","30","Select","Select",""],["","42571014126","DORZOLAMIDE HCL","2 %","10","Select","Select",""],["","50458056401","INVEGA SUSTENNA","234MG\/1.5","1.5","Select","Select",""],["","68180033801","METFORMIN ER GASTRIC","500 MG","360","Select","Select",""],["","00378965132","TRAVOPROST","0.004 %","2.5","Select","Select",""],["","29300039710","AMLODIPINE BESYLATE","5 MG","90","Select","Select",""],["","69097052444","DICLOFENAC SODIUM","1 %","100","Select","Select",""],["","43598081115","CETIRIZINE HCL","10 MG","30","Select","Select",""],["","00603243721","BENZTROPINE MESYLATE","0.5 MG","30","Select","Select",""],["","46581021006","SALONPAS","10-6-3.1 %","30","Select","Select",""],["","00065024610","BETOPTIC S","0.25 %","10","Select","Select",""],["","00023320503","LUMIGAN","0.01 %","2.5","Select","Select",""],["","00456315467","AEROCHAMBER PLUS FLOW-VU","","1","Select","Select",""],["","00713063437","MOMETASONE FUROATE","0.1 %","45","Select","Select",""],["","68180096301","ALBUTEROL SULFATE HFA","90 MCG","8.5","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":""}]}]}