{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CONNIE MORRIS GILLIPIE","gend":1,"add":"PO BOX 44","city":"SCOTTSVILLE","state":"VA","zip":"24590-9998","dob":"1966-06-28","age":"","mstatus":"","insh":"20032418*01","cliId":"","pno":4348822173,"cno":4348822173,"email":"","ename":"","eno":"","pphy":"STOKES JR, ROBERT LEE MD","ppno":4342207501,"pcpadd":"674 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":4342209401,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I48.0","R55.","E10.42","Z79.4","Z79.01","Z20.822","R07.9","I48.91","Z01.818","S05.01XA","NO DATA","Z00.00","E11.21","Z12.39","E11.8","E11.65","E11.40","Z01.419","Z12.4","Z12.31","E11.9","H35.3134","Z79.84","Z79.85","Z79.899","N30.01","B37.3","H35.52","Z12.11","Z11.59","I49.9","E10.40","R42.","R00.2"],"date":["2023-05-23","2022-08-22","2022-08-14","2022-08-14","2023-05-23","2022-08-14","2022-08-22","2022-10-20","2022-10-20","2023-02-13","2023-02-13","2023-03-21","2023-03-21","2023-03-21","2021-11-02","2021-11-02","2023-05-23","2022-12-01","2022-12-01","2022-12-01","2023-04-20","2023-04-20","2023-05-23","2023-05-23","2023-05-23","2021-01-29","2021-01-29","2022-05-03","2022-05-03","2022-05-03","2022-08-14","2022-08-04","2022-08-14","2022-08-14"],"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":[["","53885024510","ONETOUCH TES ULTRA","","100","Select","Select",""],["","00169266015","TRESIBA FLEX INJ","100UNIT","15","Select","Select",""],["","65162010250","GABAPENTIN CAP","300MG","90","Select","Select",""],["","00002879959","HUMALOG KWIK INJ","100\/ML","15","Select","Select",""],["","52268001201","SUPREP BOWEL SOL PREP KIT","","354","Select","Select",""],["","55111017915","TIZANIDINE TAB","2MG","90","Select","Select",""],["","53885001110","ONETOUCH DEL MIS PLUS","30G","100","Select","Select",""],["","52268020101","SUTAB","TAB","24","Select","Select",""],["","43386006019","GAVILYTE-C SOL","","4000","Select","Select",""],["","00002143480","TRULICITY INJ","1.5\/0.5","2","Select","Select",""],["","60505014102","GLIPIZIDE TAB","5MG","90","Select","Select",""],["","00003089421","ELIQUIS TAB","5MG","60","Select","Select",""],["","08290320122","BD PEN NEEDL MIS","32GX4MM","100","Select","Select",""],["","24979003803","METOPROL SUC TAB","50MG ER","30","Select","Select",""],["","24979002602","DILTIAZEM CAP","120MG ER","30","Select","Select",""],["","82607066026","FLOWFLEX KIT TEST","","2","Select","Select",""],["","69315011610","FUROSEMIDE TAB","20MG","30","Select","Select",""],["","67877058901","COLCHICINE TAB","0.6MG","5","Select","Select",""],["","65862055990","PANTOPRAZOLE TAB","20MG","30","Select","Select",""],["","00169266015","TRESIBA FLEXTOUCH U-","100 100\/ML (3)","15","Select","Select",""],["","65162010250","GABAPENTIN","300 MG","90","Select","Select",""],["","00003089421","ELIQUIS","5 MG","60","Select","Select",""],["","50742024890","DILTIAZEM","24HR ER (CD) 120 MG","30","Select","Select",""],["","00002879959","HUMALOG KWIKPEN U-","100 100\/ML","9","Select","Select",""],["","00002143480","TRULICITY","1.5 MG\/0.5","2","Select","Select",""],["","55111017915","TIZANIDINE HCL","2 MG","90","Select","Select",""],["","00169418113","OZEMPIC .","25 OR 0.5","3","Select","Select",""],["","62037059790","CARTIA XT","120 MG","90","Select","Select",""],["","08290320550","NANO","2ND GEN PEN NEEDLE 32GX 5\/32\"","100","Select","Select",""],["","60505014102","GLIPIZIDE","5 MG","90","Select","Select",""],["","61314062810","POLYMYXIN B SUL-TRIMETHOPRIM","10000-1\/ML","10","Select","Select",""],["","00574402435","ERYTHROMYCIN","5 MG\/GRAM","3.5","Select","Select",""],["","82607066026","FLOWFLEX COVID-","19 AG HOME TEST","1","Select","Select",""],["","00054429731","FUROSEMIDE","20 MG","60","Select","Select",""],["","73070040315","INSULIN DEGLUDEC PEN (U-","100) 100\/ML (3)","15","Select","Select",""],["","67877021905","CEPHALEXIN","500 MG","15","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":""}]}]}