{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WHITNEY L KEY","gend":0,"add":"4945 HIXBURG ROAD","city":"PAMPLIN","state":"VA","zip":"23958-9998","dob":"1969-12-30","age":"","mstatus":"","insh":"20030582*01","cliId":"","pno":4349932202,"cno":4349932202,"email":"","ename":"","eno":"","pphy":"CORBETT, TIMOTHY W MD","ppno":4343929366,"pcpadd":"324 COMMERCE ROAD,","pcpcity":"FARMVILLE","pcpstate":"VA","pcpzip":"23901-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4343929348,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R07.9","R10.9","R10.13","K59.00","F17.200","K12.0","Z03.6","R25.1","R44.9","F11.90","R53.1","R19.7","S81.811A","X50.0XXA","I44.0","R07.89","R52.","I95.9","F11.20","NO DATA","F19.10","F41.9","Z76.0","I49.5","B19.20","R79.89","K21.9","R53.83","I10.","R53.81","R20.2","N40.1","N32.81","E29.1","Z12.5","Z72.0","R30.0","K64.8","Z86.19","N13.8","N32.0","M54.2","J44.9","Z73.3","B18.2","N41.9","G62.9","R00.1","I20.0","R42.","I45.89","R00.2","I11.9","F41.8","L03.211","R06.00","F32.9","M50.33","E66.9","Z68.30","N40.0","E80.29","F17.210","R51.9","H53.2","G43.109","E55.9","G47.10","M50.30","M54.12","W57.XXXA","Z79.82","K59.09","Z95.0","Z04.9","R06.02","G47.33","R20.0","Z86.2","Z20.828","I73.9","J01.90","F19.90","R94.30","R94.39","Z20.822","S80.01XA","Z48.02","Z86.69","I44.1","Z90.49","N41.0","I51.7","R94.31","B86.","K57.92","R80.9","R73.03","R07.1","M25.50","I49.1","R00.8","G60.9","Z00.00","Z79.899","Z51.81","S60.871A","S51.851A","W54.0XXA","Z87.891","G44.209"],"date":["2022-09-03","2022-01-02","2021-12-08","2021-12-08","2022-09-18","2022-06-21","2021-12-27","2022-01-02","2022-01-02","2022-01-02","2022-01-02","2022-01-02","2022-01-15","2022-01-15","2022-06-20","2022-09-18","2022-06-20","2022-06-20","2023-08-25","2023-05-23","2022-11-07","2022-11-07","2023-08-25","2023-09-08","2022-11-07","2022-11-07","2023-07-18","2022-11-07","2023-02-16","2023-01-12","2023-03-01","2021-12-03","2021-12-03","2021-09-03","2021-09-03","2021-12-03","2021-09-03","2021-10-13","2021-10-13","2021-11-08","2021-11-08","2022-06-06","2023-02-13","2022-06-06","2023-02-13","2021-11-08","2022-05-23","2023-09-08","2022-07-02","2022-09-18","2022-07-14","2022-09-18","2023-02-16","2023-08-25","2021-07-09","2021-11-23","2022-03-07","2022-04-07","2022-04-07","2022-04-07","2022-04-07","2022-04-07","2022-07-13","2022-06-06","2023-01-25","2021-04-09","2021-06-15","2021-11-10","2022-05-16","2022-05-16","2022-06-22","2022-07-13","2022-08-12","2023-09-08","2022-09-18","2022-09-03","2021-12-03","2021-11-23","2021-12-03","2021-11-29","2021-12-02","2022-01-07","2022-06-21","2022-06-27","2022-06-27","2022-09-03","2022-01-26","2022-01-26","2022-04-07","2022-06-21","2022-06-21","2022-03-07","2022-06-21","2022-06-21","2022-12-12","2021-12-07","2021-10-08","2021-10-08","2021-11-22","2021-12-03","2022-06-29","2022-06-20","2023-01-25","2023-01-12","2023-07-18","2023-07-18","2023-07-11","2023-07-18","2023-07-07","2023-07-07","2023-08-15"],"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","50","Select","Select",""],["","57237001890","DULOXETINE","CAP 30MG","60","Select","Select",""],["","23155050110","HYDROXYZ HCL","TAB 25MG","90","Select","Select",""],["","68180031902","BUPROPN HCL","TAB 150MG XL","60","Select","Select",""],["","00143972601","TESTOST CYP","INJ 200MG\/ML","10","Select","Select",""],["","47781035703","BUPREN\/NALOX","MIS 8-2MG","50","Select","Select",""],["","13811071710","CHLORZOXAZON","TAB 375MG","90","Select","Select",""],["","00023650110","UBRELVY","TAB 100MG","10","Select","Select",""],["","61874013030","VRAYLAR","CAP 3MG","30","Select","Select",""],["","80777027399","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","69452015120","VITAMIN D","CAP 50000UNT","4","Select","Select",""],["","00310461612","BREZTRI AERO","AER SPHERE","11","Select","Select",""],["","31722064530","TADALAFIL","TAB 10MG","30","Select","Select",""],["","51672131201","MUPIROCIN","OIN 0.02","15","Select","Select",""],["","68462029855","CLOTRIM\/BETA","CRE DIPROP","45","Select","Select",""],["","42806031250","DOXYCYCL HYC","TAB 100MG","20","Select","Select",""],["","68382013210","TAMSULOSIN","CAP 0.4MG","90","Select","Select",""],["","00469260230","MYRBETRIQ","TAB 50MG","90","Select","Select",""],["","00172572960","FAMOTIDINE","40 MG","90","Select","Select",""],["","59651036205","IBUPROFEN","800 MG","21","Select","Select",""],["","65862042001","SMZ\/TMP DS","TAB 800-160","14","Select","Select",""],["","65862056099","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","64980032005","TRIAMCINOLON","PST DEN 0.1%","5","Select","Select",""],["","51991096257","POLYETH GLYC","POW 3350 NF","510","Select","Select",""],["","00591079501","DICYCLOMINE","TAB 20MG","30","Select","Select",""],["","65862050301","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","65862067705","ALPRAZOLAM","TAB 0.5MG","20","Select","Select",""],["","00093314705","CEPHALEXIN","500 MG","21","Select","Select",""],["","65862053750","LEVOFLOXACIN","500 MG","7","Select","Select",""],["","65162010150","GABAPENTIN","CAP 100MG","30","Select","Select",""],["","00185002201","ORPHENADRINE","TAB 100MG ER","60","Select","Select",""],["","57664050318","TIZANIDINE","TAB 4MG","21","Select","Select",""],["","72618300002","NURTEC","TAB 75MG ODT","8","Select","Select",""],["","69097042107","CELECOXIB","CAP 200MG","30","Select","Select",""],["","00603533815","PREDNISONE","PAK 10MG","21","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","20","Select","Select",""],["","00456120130","LINZESS","CAP 145MCG","30","Select","Select",""],["","57237002801","AMOXICILLIN","500 MG","21","Select","Select",""],["","00536589588","NICOTINE TD","DIS 14MG\/24H","28","Select","Select",""],["","21922002107","PERMETHRIN","CRE 0.05","60","Select","Select",""],["","70000041503","CLEARLAX","POW ","510","Select","Select",""],["","00378876793","BUPRENORPHINE-NALOXONE","8 MG-2 MG","60","Select","Select",""],["","65862050320","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","20","Select","Select",""],["","27241009809","DULOXETINE HCL","30 MG","60","Select","Select",""],["","65862056090","PANTOPRAZOLE SODIUM","40 MG","90","Select","Select",""],["","00378876793","BUPREN\/NALOX MIS","8-2MG","60","Select","Select",""],["","69452015120","VITAMIN D CAP","50000UNT","4","Select","Select",""],["","12496120803","SUBOXONE MIS","8-2MG","60","Select","Select",""],["","65862067705","ALPRAZOLAM TAB","0.5MG","20","Select","Select",""],["","65862050301","AMOX\/K CLAV TAB","875-125","20","Select","Select",""],["","00093314705","CEPHALEXIN CAP","500MG","28","Select","Select",""],["","65862053820","LEVOFLOXACIN TAB","750MG","7","Select","Select",""],["","68180029506","DULOXETINE CAP","30MG","60","Select","Select",""],["","68180031902","BUPROPN HCL TAB","150MG XL","60","Select","Select",""],["","72618300002","NURTEC TAB","75MG ODT","1","Select","Select",""],["","00143980350","DOXYCYCL HYC CAP","100MG","14","Select","Select",""],["","00603533815","PREDNISONE PAK","10MG","21","Select","Select",""],["","00172572960","FAMOTIDINE TAB","40MG","30","Select","Select",""],["","65162010150","GABAPENTIN CAP","100MG","30","Select","Select",""],["","69097042107","CELECOXIB CAP","200MG","30","Select","Select",""],["","00185002201","ORPHENADRINE TAB","100MG ER","60","Select","Select",""],["","70000041503","CLEARLAX POW","","510","Select","Select",""],["","00536589588","NICOTINE TD DIS","14MG\/24H","28","Select","Select",""],["","65862056099","PANTOPRAZOLE TAB","40MG","30","Select","Select",""],["","00456120130","LINZESS CAP","145MCG","30","Select","Select",""],["","57664050318","TIZANIDINE TAB","4MG","21","Select","Select",""],["","51991096257","POLYETH GLYC POW","3350 NF","510","Select","Select",""],["","00093031401","KETOROLAC TAB","10MG","20","Select","Select",""],["","65862001501","AMOXICILLIN TAB","875MG","20","Select","Select",""],["","21922002107","PERMETHRIN CRE","5%","60","Select","Select",""],["","42806031250","DOXYCYCL HYC TAB","100MG","20","Select","Select",""],["","00093342001","CYCLOBENZAPRINE HCL","5 MG","270","Select","Select",""],["","69097015915","MELOXICAM","15 MG","30","Select","Select",""],["","00093081101","NORTRIPTYLINE HCL","25 MG","30","Select","Select",""],["","00591079501","DICYCLOMINE HCL","20 MG","20","Select","Select",""],["","65862018730","ONDANSETRON HCL","4 MG","14","Select","Select",""],["","43547036111","LOSARTAN POTASSIUM","50 MG","90","Select","Select",""],["","45802086802","POLYETHYLENE GLYCOL","3350 17 G\/DOSE","238","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":""}]}]}