{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NANCY L BOWLING","gend":1,"add":"210 S PANTOPS DR APT 420","city":"CHARLOTTESVILLE","state":"VA","zip":"22911-9998","dob":"1949-09-14","age":"","mstatus":"","insh":"20024196*01","cliId":"","pno":4349774160,"cno":4349774160,"email":"","ename":"","eno":"","pphy":"THOMAS, MARIE NP","ppno":4349249333,"pcpadd":"1240 LEE ST,","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":"22903-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4349828420,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C34.12","R52.","D70.9","R50.81","J44.9","C18.7","I42.8","I50.30","Z87.891","Z87.898","Z01.810","Z86.79","Z45.2","C18.9","R53.83","Z53.21","I11.0","I50.22","J45.909","M62.81","R26.89","F10.10","Z79.899","Z79.51","Z79.52","Z95.810","Z60.2","R53.0","K52.1","T45.1X5A","Z51.11","R06.02","J96.21","J96.01","C34.90","J70.0","I50.9","J18.1","J98.4","R06.00","I42.9","J43.2","J44.1","E55.9","C34.92","D70.1","J44.0","C77.9","D69.59","J70.1","M54.30","R25.2","E83.42","Z08.","Z85.038","D12.5","D12.3","Z98.0","Z28.311","R53.1","Z99.81","I50.32","C19.","Z85.118","Z95.0","R91.8","K63.5","F41.9","I50.20","J30.1","C77.1","NO DATA","Z79.01","R91.1","C80.1","C77.2","D64.81","R26.2","I42.6","Z92.21","Z90.49","Z80.9","Z80.8","G47.00","Z66.","I10.","R78.81","J18.9","Z01.812","Z20.822","R19.7","K76.9","Z92.3","C78.00","Z23.","Z01.818","I48.0","T82.598A","T85.9XXA","R09.02","I07.9","E87.1","Z91.81","R60.9","M25.50","D84.9","B95.61","Z51.12","I34.0","I36.1","T82.7XXA","R51.9","D61.810","A41.9","A41.01","N39.0","G62.0","B96.89","G89.3","Z48.01","Z51.81","Z79.2","C78.1","V58.89","R10.13","D68.69","Z90.710","Z87.01","R06.89","R07.9","R11.0","Z11.59","I42.1"],"date":["2023-05-01","2023-03-20","2023-04-28","2023-03-27","2023-08-04","2023-05-01","2023-05-01","2021-02-22","2022-12-08","2021-02-22","2021-03-17","2021-03-17","2023-05-01","2023-03-21","2022-12-14","2021-05-16","2023-05-01","2023-08-04","2021-11-05","2021-07-15","2021-07-15","2021-09-23","2022-12-08","2023-08-04","2021-09-23","2023-02-06","2021-09-23","2021-11-05","2021-11-05","2021-11-05","2023-03-15","2023-04-27","2022-04-28","2023-04-29","2023-03-27","2022-10-19","2021-12-20","2021-01-12","2022-08-05","2023-08-04","2022-05-05","2023-04-12","2023-08-04","2021-04-23","2023-09-27","2021-11-03","2021-08-24","2021-08-24","2021-11-05","2023-08-21","2023-04-12","2023-02-22","2023-08-30","2022-04-13","2022-12-08","2022-04-13","2022-04-13","2022-04-13","2022-04-13","2022-04-30","2022-04-30","2022-06-17","2021-03-18","2022-12-08","2022-12-02","2022-11-16","2022-04-13","2022-06-09","2022-06-09","2022-08-05","2023-03-21","2023-03-22","2022-12-08","2022-12-08","2023-03-02","2021-11-05","2021-11-05","2021-11-05","2021-12-19","2022-04-28","2022-04-28","2021-12-19","2021-12-19","2022-04-28","2023-03-21","2022-12-02","2023-05-05","2021-01-27","2021-03-12","2022-05-18","2021-07-13","2021-10-26","2022-04-28","2022-10-19","2022-10-19","2022-12-02","2023-07-06","2021-05-26","2021-05-26","2022-08-05","2021-12-20","2023-03-21","2022-06-17","2021-07-13","2023-03-01","2023-03-29","2023-05-05","2023-09-27","2023-03-24","2023-03-24","2023-05-01","2023-03-27","2023-05-01","2023-03-27","2023-03-21","2023-03-21","2023-03-21","2023-03-21","2023-05-01","2023-05-01","2023-05-01","2023-05-01","2023-05-01","2023-05-01","2023-04-29","2022-04-28","2022-04-28","2022-04-28","2023-04-27","2023-04-27","2023-04-27","2023-04-27","2023-08-04"],"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":[["","65862053820","LEVOFLOXACIN","TAB 750MG","6","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00378967130","IPRATROPIUM\/","SOL ALBUTER","90","Select","Select",""],["","00378932132","WIXELA INHUB","250-50 MCG","60","Select","Select",""],["","59779030602","CVS PURELAX","POW ","238","Select","Select",""],["","00093013505","CARVEDILOL","6.25 MG","180","Select","Select",""],["","59779045806","CVS ALLERGY","TAB 10MG","90","Select","Select",""],["","69238148501","ERYTHROMYCIN","TAB 500MG BS","6","Select","Select",""],["","00093220305","METOCLOPRAM","TAB 10MG","3","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","90","Select","Select",""],["","00955100410","ENOXAPARIN","INJ 40\/0.4ML","11","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","3","Select","Select",""],["","00054001829","PREDNISONE","TAB 20MG","6","Select","Select",""],["","68180030360","CEFUROXIME","TAB 500MG","10","Select","Select",""],["","00093117701","NEOMYCIN","TAB 500MG","6","Select","Select",""],["","31604002674","VITAMIN D","3 50 MCG","225","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","12","Select","Select",""],["","59746011506","PROCHLORPER","TAB 10MG","30","Select","Select",""],["","69842093108","ACETAMINOPHN","TAB 500MG","30","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","7","Select","Select",""],["","61314031801","ZARXIO","INJ 300\/0.5","2","Select","Select",""],["","55513019201","NEULASTA","KIT 6MG\/0.6M","1","Select","Select",""],["","00054418425","DEXAMETHASON","TAB 4MG","24","Select","Select",""],["","68462010630","ONDANSETRON","TAB 8MG","30","Select","Select",""],["","50428027684","MELATONIN","TAB 5MG","90","Select","Select",""],["","00093031101","LOPERAMIDE","CAP 2MG","30","Select","Select",""],["","59762106101","DIPHEN\/ATROP","TAB 2.5MG","30","Select","Select",""],["","70436000203","POT CHLORIDE","TAB 10MEQ ER","5","Select","Select",""],["","69315011610","FUROSEMIDE","TAB 20MG","180","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","12","Select","Select",""],["","00904656460","BENZONATATE","100 MG","20","Select","Select",""],["","62332000191","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","10572010001","PEG-3350","SOL ELECTROL","4000","Select","Select",""],["","00054032756","FLUTIC\/SALME","AER 250\/50","60","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","00173069600","ADVAIR DISKU","AER 250\/50","60","Select","Select",""],["","42806015905","HYDROXYZ HCL","TAB 10MG","90","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","30","Select","Select",""],["","68180016106","AZITHROMYCIN","TAB 500MG","1","Select","Select",""],["","66758095985","PROVENTIL","AER HFA","7","Select","Select",""],["","00003089421","ELIQUIS","5 MG","60","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","40093010231","VIT D3 HP","CAP 2000UNIT","90","Select","Select",""],["","00603020922","MAGNESIUM OXIDE","400 MG","14","Select","Select",""],["","69097017364","IPRATROPIUM-ALBUTEROL","0.5-3MG\/3","180","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","90 MCG","18","Select","Select",""],["","00173069600","ADVAIR DISKUS","250-50 MCG","60","Select","Select",""],["","45963055650","GABAPENTIN","300 MG","90","Select","Select",""],["","71930001852","ONDANSETRON HCL","8 MG","30","Select","Select",""],["","10702001001","HYDROXYZINE HCL","10 MG","90","Select","Select",""],["","42858000101","OXYCODONE HCL","5 MG","30","Select","Select",""],["","00054418425","DEXAMETHASONE","4 MG","20","Select","Select",""],["","59746011506","PROCHLORPERAZINE MALEATE","10 MG","30","Select","Select",""],["","00536124710","SENEXON-S","8.6MG-50MG","60","Select","Select",""],["","00597007541","SPIRIVA HANDIHALER","18 MCG","90","Select","Select",""],["","65862057490","MONTELUKAST SODIUM","10 MG","90","Select","Select",""],["","66993008796","FLUTICASONE-SALMETEROL HFA","115-21MCG","12","Select","Select",""],["","00173071620","ADVAIR HFA","115-21MCG","12","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","69315011610","FUROSEMIDE TAB","20MG","180","Select","Select",""],["","69097014260","ALBUTEROL AER HFA","","7","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","50111056001","TRAZODONE TAB","50MG","30","Select","Select",""],["","00054327099","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","00904656460","BENZONATATE CAP","100MG","30","Select","Select",""],["","66993058597","FLUTIC\/SALME AER","250\/50","60","Select","Select",""],["","00054001829","PREDNISONE TAB","20MG","2","Select","Select",""],["","10572010001","PEG-","3350 SOL ELECTROL","4000","Select","Select",""],["","00173069600","ADVAIR DISKU AER","250\/50","60","Select","Select",""],["","68462010630","ONDANSETRON TAB","8MG","28","Select","Select",""],["","42806015905","HYDROXYZ HCL TAB","10MG","90","Select","Select",""],["","47335075649","IPRATROPIUM\/ SOL ALBUTER","","90","Select","Select",""],["","66758095985","PROVENTIL AER HFA","","7","Select","Select",""],["","00597007541","SPIRIVA CAP HANDIHLR","","90","Select","Select",""],["","68180016106","AZITHROMYCIN TAB","500MG","1","Select","Select",""],["","76385011250","CARVEDILOL TAB","12.5MG","180","Select","Select",""],["","65862057490","MONTELUKAST TAB","10MG","30","Select","Select",""],["","00378932132","WIXELA INHUB AER","250\/50","60","Select","Select",""],["","00003089421","ELIQUIS TAB","5MG","60","Select","Select",""],["","40093010231","VIT D","3 HP CAP 2000UNIT","90","Select","Select",""],["","69452015120","VITAMIN D CAP","50000UNT","30","Select","Select",""],["","00173068220","VENTOLIN HFA","90 MCG","18","Select","Select",""],["","68180096412","TIOTROPIUM BROMIDE","18 MCG","90","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":""}]}]}