{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CYNTHIA M HAMMOCK","gend":1,"add":"2397 COTTON PATCH ROAD","city":"GRETNA","state":"VA","zip":"24557-9998","dob":"1967-05-13","age":"","mstatus":"","insh":"20028525*01","cliId":"","pno":4345099435,"cno":4345099435,"email":"","ename":"","eno":"","pphy":"VONELTEN, CHRISTOPHER B MD","ppno":4344009668,"pcpadd":"631 BERKMAR CIRCLE,","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":"22901-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4343814367,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","F33.1","F41.1","Z72.0","F20.89","J44.9","N39.490","N39.3","R26.9","R15.9","F12.10","F14.10","F20.9","M79.7","K13.0","B16.9","G93.41","E11.65","F17.200","J96.11","R06.02","NO DATA","R07.81","R55.","W19.XXXA","Z11.59","M79.89","R74.01","M25.541","M25.542","M25.571","M25.572","K76.9","I95.9","E87.1","Z91.19","N17.9","K86.89","G89.29","E13.10","Z79.4","Z09.","B00.9","A60.04","R60.0","R80.8","R80.9","Z20.822","R07.0","J06.9","F43.12","B34.9","L89.319","K59.00","R79.89","F17.210","R10.9","R42.","Z79.899","R41.82","T85.848A","M77.9","L03.113","L03.114","X58.XXXA","R17.","B19.10","R19.7","Z71.9","I10.","R22.2","L28.2","B37.2","B02.9","M79.661","M79.662","M79.604","R25.2","L53.8","M77.8","M25.531","R39.9","Z72.51","E10.9","E11.9","R81.","I15.2","E83.39","E11.69","E11.59","E78.5","F19.20","R21.","G47.33","Z79.52","E11.3293","H25.13","H52.13","M79.641","M79.642","Z99.81","Z28.21","F17.290","V58.89","K72.90","E11.21","K83.8","K59.09","Z91.14","M54.2","R91.1","F12.90","R07.89","R05.9","R30.0","Z12.11","G89.4","Z00.00","Z13.220","Z86.19","R53.83","V54.17","S12.690A","S12.600A","N39.0","S12.9XXS","E11.649","Z91.81","G93.40","R40.20","F14.90","J96.01","E86.0","R82.4","S12.691A","R09.02","E55.9","Z13.820","M48.52XA","Z79.85","Z79.84","R73.9","Z74.3"],"date":["2023-09-19","2023-08-31","2023-08-31","2023-07-03","2023-03-07","2023-09-19","2023-09-12","2023-09-12","2023-09-12","2023-09-12","2023-03-07","2023-06-29","2023-09-19","2023-09-12","2023-09-12","2022-07-05","2023-07-03","2023-09-15","2023-08-17","2023-08-03","2023-08-03","2023-08-31","2023-01-24","2023-01-24","2023-08-12","2021-08-05","2023-01-09","2022-05-12","2022-05-03","2022-05-03","2022-05-03","2022-05-03","2022-07-05","2022-07-05","2023-06-26","2022-07-05","2023-07-03","2022-07-05","2023-08-31","2023-01-14","2023-09-15","2023-01-14","2023-01-14","2023-01-14","2023-01-14","2023-01-14","2023-01-14","2023-09-15","2023-03-06","2023-03-06","2023-08-31","2021-08-05","2022-01-13","2022-05-26","2022-05-26","2023-01-01","2022-05-26","2022-06-17","2023-01-01","2023-09-16","2022-04-25","2022-04-25","2022-04-25","2022-04-25","2023-07-05","2022-06-18","2023-07-03","2022-06-30","2022-06-30","2023-01-24","2023-01-09","2023-03-20","2023-08-12","2023-03-20","2021-05-18","2021-05-18","2021-05-18","2021-05-18","2021-05-18","2021-11-24","2021-11-24","2022-06-02","2022-06-02","2022-06-02","2023-09-19","2022-06-02","2023-01-01","2023-01-02","2023-01-01","2023-01-02","2023-01-24","2023-06-27","2023-01-02","2023-01-01","2023-01-01","2021-01-29","2021-01-29","2021-01-29","2022-05-12","2022-05-12","2022-09-26","2022-09-26","2023-06-29","2022-04-29","2022-06-17","2022-06-17","2022-06-17","2022-06-17","2023-01-02","2023-08-12","2023-01-24","2023-07-20","2023-04-02","2023-04-02","2023-05-16","2023-05-16","2023-05-16","2023-05-30","2023-05-30","2023-05-30","2023-05-30","2023-07-11","2023-07-20","2023-07-05","2023-06-28","2023-07-06","2023-06-26","2023-06-26","2023-09-19","2023-06-26","2023-07-03","2023-09-19","2023-09-19","2023-09-19","2023-09-19","2023-09-16","2023-08-31","2023-08-31","2023-09-15","2023-09-15","2023-09-15","2023-09-15","2023-09-15"],"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":[["","12496120803","SUBOXONE","8 MG-2 MG","14","Select","Select",""],["","43068010602","FANAPT","6 MG","30","Select","Select",""],["","71093011205","GABAPENTIN","800 MG","84","Select","Select",""],["","29300024601","BUSPIRONE","TAB 15MG","60","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","69452015120","VITAMIN D","2 1250 MCG","4","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","15","Select","Select",""],["","68382009805","PAROXETINE","TAB 20MG","90","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","15","Select","Select",""],["","00378876793","BUPREN\/NALOX","MIS 8-2MG","56","Select","Select",""],["","70436001002","BUPROPN HCL","TAB 150MG XL","30","Select","Select",""],["","00904652261","SENNA-LAX","TAB 8.6MG","30","Select","Select",""],["","53885027150","ONETOUCH","TES VERIO","250","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","90","Select","Select",""],["","68462029855","CLOTRIM\/BETA","CRE DIPROP","45","Select","Select",""],["","68462011944","FLUCONAZOLE","150 MG","1","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","30","Select","Select",""],["","51224002218","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","69547035302","NARCAN","4 MG","2","Select","Select",""],["","91237000170","EASY COMFORT","MIS 31GX5\/16","100","Select","Select",""],["","65862001401","AMOXICILLIN","500 MG","10","Select","Select",""],["","57237000830","MIRTAZAPINE","15 MG","30","Select","Select",""],["","51991031190","DESVENLAFAX","TAB 50MG ER","30","Select","Select",""],["","57896010410","ACETAMINOPHE","TAB 325MG","120","Select","Select",""],["","00168001131","BACITR ZINC","OIN 500\/GM","28","Select","Select",""],["","59651039401","BACLOFEN","10 MG","60","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","120","Select","Select",""],["","70954006030","PREDNISONE","TAB 20MG","5","Select","Select",""],["","13668059502","NYSTATIN","100000\/G","30","Select","Select",""],["","68382092106","ENTECAVIR","TAB 1MG","30","Select","Select",""],["","50804016638","MAG CITRATE","SOL LEMON","296","Select","Select",""],["","64764024060","AMITIZA","CAP 24MCG","60","Select","Select",""],["","00591079401","DICYCLOMINE","CAP 10MG","30","Select","Select",""],["","50228043401","NAPROXEN","TAB 250MG","60","Select","Select",""],["","53885001110","ONETOUCH DEL","MIS PLUS 30G","100","Select","Select",""],["","00115703301","FLUDROCORT","TAB 0.1MG","30","Select","Select",""],["","00093314701","CEPHALEXIN","500 MG","28","Select","Select",""],["","00185012201","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","31722070530","VALACYCLOVIR","TAB 1GM","20","Select","Select",""],["","00406012310","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","29300013901","DIVALPROEX","TAB 250MG DR","60","Select","Select",""],["","10006073038","MAGNESIUM OXIDE","400 MG","30","Select","Select",""],["","45802088094","NYSTATIN-TRIAMCINOLONE","100000-0.1","30","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","90 MCG","18","Select","Select",""],["","53885004401","ONETOUCH VERIO FLEX METER","","1","Select","Select",""],["","29300013901","DIVALPROEX SODIUM","250 MG","60","Select","Select",""],["","68382009905","PAROXETINE HCL","30 MG","60","Select","Select",""],["","43598058230","BUPRENORPHINE-NALOXONE","8 MG-2 MG","6","Select","Select",""],["","69315011710","FUROSEMIDE","40 MG","30","Select","Select",""],["","91237000170","EASY COMFORT PEN NEEDLE","31 GX5\/16\"","100","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","100\/ML (3)","15","Select","Select",""],["","27808003503","HYDROCODONE-ACETAMINOPHEN","5 MG-325MG","12","Select","Select",""],["","68462015713","ONDANSETRON ODT","4 MG","30","Select","Select",""],["","29300024601","BUSPIRONE HCL","15 MG","60","Select","Select",""],["","65162079108","LIDOCAINE","5 %","30","Select","Select",""],["","51672128202","TRIAMCINOLONE ACETONIDE","0.1 %","30","Select","Select",""],["","53885027150","ONETOUCH VERIO TEST STRIP","","50","Select","Select",""],["","43598013901","KETOROLAC TROMETHAMINE","10 MG","20","Select","Select",""],["","69452029020","ACYCLOVIR","400 MG","15","Select","Select",""],["","00168025846","CLOTRIMAZOLE-BETAMETHASONE","1 %-0.05 %","45","Select","Select",""],["","70954025220","FLUDROCORTISONE ACETATE","0.1 MG","30","Select","Select",""],["","53885001110","ONETOUCH DELICA PLUS LANCET","30 GAUGE","100","Select","Select",""],["","00169633910","NOVOLOG FLEXPEN","100\/ML (3)","15","Select","Select",""],["","67877056301","METFORMIN HCL","1000 MG","180","Select","Select",""],["","45802011222","MUPIROCIN","2 %","22","Select","Select",""],["","61442010210","DICLOFENAC SODIUM","50 MG","20","Select","Select",""],["","59746000103","METHYLPREDNISOLONE","4 MG","21","Select","Select",""],["","16571078350","CYCLOBENZAPRINE HCL","10 MG","30","Select","Select",""],["","29300024601","BUSPIRONE TAB","15MG","60","Select","Select",""],["","50228017805","GABAPENTIN TAB","800MG","90","Select","Select",""],["","57896010410","ACETAMINOPHE TAB","325MG","120","Select","Select",""],["","00168001131","BACITR ZINC OIN","500\/GM","28","Select","Select",""],["","53885027150","ONETOUCH TES VERIO","","250","Select","Select",""],["","13107003134","MIRTAZAPINE TAB","15MG","30","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","12496120403","SUBOXONE MIS","4-1MG","28","Select","Select",""],["","43068010602","FANAPT TAB","6MG","30","Select","Select",""],["","68382009905","PAROXETINE TAB","30MG","60","Select","Select",""],["","57237007710","ONDANSETRON TAB","4MG ODT","30","Select","Select",""],["","55111018015","TIZANIDINE TAB","4MG","90","Select","Select",""],["","00088221905","LANTUS SOLOS INJ","100\/ML","15","Select","Select",""],["","00169633910","NOVOLOG INJ FLEXPEN","","15","Select","Select",""],["","45802005911","NYSTATIN CRE","100000","30","Select","Select",""],["","70954006030","PREDNISONE TAB","20MG","5","Select","Select",""],["","00093031401","KETOROLAC TAB","10MG","20","Select","Select",""],["","50228043401","NAPROXEN TAB","250MG","60","Select","Select",""],["","53885001110","ONETOUCH DEL MIS PLUS","30G","100","Select","Select",""],["","67877021901","CEPHALEXIN CAP","500MG","30","Select","Select",""],["","59651039499","BACLOFEN TAB","10MG","60","Select","Select",""],["","00378876793","BUPREN\/NALOX MIS","8-2MG","56","Select","Select",""],["","91237000170","EASY COMFORT MIS","31GX5\/16","100","Select","Select",""],["","68382092106","ENTECAVIR TAB","1MG","30","Select","Select",""],["","50804016638","MAG CITRATE SOL LEMON","","296","Select","Select",""],["","00185012201","NITROFURANTN CAP","100MG","10","Select","Select",""],["","00115703301","FLUDROCORT TAB","0.1MG","30","Select","Select",""],["","00591079401","DICYCLOMINE CAP","10MG","30","Select","Select",""],["","64764024060","AMITIZA CAP","24MCG","60","Select","Select",""],["","00406012310","HYDROCO\/APAP TAB","5-325MG","12","Select","Select",""],["","31722070530","VALACYCLOVIR TAB","1GM","20","Select","Select",""],["","29300013901","DIVALPROEX TAB","250MG DR","60","Select","Select",""],["","68180096301","ALBUTEROL AER HFA","","8","Select","Select",""],["","23155050101","HYDROXYZINE HCL","25 MG","4","Select","Select",""],["","14539067401","HYDROXYZINE PAMOATE","25 MG","90","Select","Select",""],["","00002773701","INSULIN LISPRO","100\/ML","10","Select","Select",""],["","49502039380","INSULIN GLARGINE-YFGN","100\/ML","10","Select","Select",""],["","29300012501","MELOXICAM","15 MG","15","Select","Select",""],["","69584061110","METHOCARBAMOL","500 MG","30","Select","Select",""],["","00002143380","TRULICITY","0.75MG\/0.5","2","Select","Select",""],["","31722071310","PANTOPRAZOLE SODIUM","40 MG","30","Select","Select",""],["","65862051230","PIOGLITAZONE HCL","15 MG","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":""}]}]}