{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TAMMY OWENS","gend":1,"add":"1775 SILAS DODD LN","city":"DRY FORK","state":"VA","zip":"24549-9998","dob":"1961-12-02","age":"","mstatus":"","insh":"20033005*01","cliId":"","pno":4344298799,"cno":4344298799,"email":"","ename":"","eno":"","pphy":"WADE-FOSTER, MARILYN NP","ppno":4342287923,"pcpadd":"1291 SOUTH BOSTON RD","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":"24540-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4344216416,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.5","M79.651","M79.661","M79.604","M25.561","G89.4","M79.662","M79.605","R20.2","R25.2","K59.00","R10.9","NO DATA","M25.551","F33.1","J44.1","J06.9","E11.649","Z20.822","J44.9","Z79.891","F31.32","F33.2","F41.1","Z79.899","H40.1132","M45.5","H25.12","R35.0","N39.0","R11.0","H25.811","H25.812","H35.371","R06.02","E11.9","H40.1131","R26.89","M62.81","Z91.81","J44.0","J18.9","J96.01","E11.65","R91.8","R74.8","E87.2","E78.5","F31.9","F41.9","J39.8","I25.10","G25.81","J30.2","K21.9","R10.84","Z01.419","Z71.9","Z28.21","Z87.81","R12.","R30.0","Z79.4","R05.9","R06.00","J80.","R00.0","R06.2","H25.13","H52.4","H25.11"],"date":["2021-09-13","2022-07-11","2022-07-11","2022-07-11","2022-07-11","2022-07-11","2021-05-11","2021-09-13","2022-04-12","2021-09-13","2022-04-07","2021-12-06","2022-07-11","2022-07-11","2022-05-31","2022-07-04","2022-06-04","2022-06-04","2022-07-02","2022-07-02","2022-07-11","2022-03-30","2022-03-30","2022-03-30","2022-03-30","2022-06-28","2022-03-09","2022-05-04","2022-05-04","2022-07-03","2021-08-16","2022-03-23","2022-03-23","2022-03-23","2022-07-02","2022-07-02","2021-07-06","2021-12-01","2021-12-01","2021-12-01","2022-07-03","2022-07-03","2022-07-03","2022-07-03","2022-07-03","2022-07-03","2022-07-03","2022-07-03","2022-07-03","2022-07-03","2022-07-03","2022-07-03","2022-07-03","2022-07-03","2022-07-03","2021-04-25","2022-01-11","2022-01-11","2022-01-11","2022-01-11","2022-04-07","2022-05-04","2022-06-04","2022-06-04","2022-07-02","2022-07-02","2022-07-02","2022-07-02","2022-02-17","2022-02-17","2022-04-20"],"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":[["","67877024801","QUETIAPINE","TAB 400MG","60","Select","Select",""],["","55111012305","ATORVASTATIN","TAB 40MG","60","Select","Select",""],["","00002822259","INSULIN LISP","INJ 100\/ML","45","Select","Select",""],["","00378718505","METFORMIN","TAB 500MG","90","Select","Select",""],["","00378005301","CIMETIDINE","TAB 200MG","60","Select","Select",""],["","00406052201","OXYCOD\/APAP","TAB 7.5-325","90","Select","Select",""],["","68382050010","OMEPRAZOLE","CAP 40MG","90","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","26","Select","Select",""],["","00002880559","HUMULIN N","INJ U-100KWP","18","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","29300012510","MELOXICAM","TAB 15MG","30","Select","Select",""],["","31722072690","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","65162010250","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","59310057922","PROAIR HFA","AER ","26","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","200","Select","Select",""],["","70069023101","BRIMONIDINE","SOL 0.2% OP","15","Select","Select",""],["","08290320109","BD PEN NEEDL","MIS 31GX8MM","100","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA","300","Select","Select",""],["","11917001489","INSULIN SYRG","MIS 0.5\/29G","500","Select","Select",""],["","55111017915","TIZANIDINE","TAB 2MG","40","Select","Select",""],["","00173088710","TRELEGY","AER ELLIPTA","180","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","15","Select","Select",""],["","59267100001","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","00173086910","ANORO ELLIPT","AER 62.5-25","60","Select","Select",""],["","24208048510","DORZOLAMIDE","SOL 2% OP","10","Select","Select",""],["","00078090438","SIMBRINZA","SUS 1-0.2%","8","Select","Select",""],["","13668044101","CELECOXIB","CAP 100MG","60","Select","Select",""],["","31604002754","TURMERIC","CAP 500MG","90","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","00115180301","HYDROXYZ PAM","CAP 25MG","90","Select","Select",""],["","11917014767","VITAMIN D3","CAP 5000UNIT","90","Select","Select",""],["","68462025301","ROPINIROLE","TAB 0.25MG","30","Select","Select",""],["","00591079501","DICYCLOMINE","TAB 20MG","40","Select","Select",""],["","65862064230","AZITHROMYCIN","TAB 500MG","2","Select","Select",""],["","00591544210","PREDNISONE","TAB 10MG","14","Select","Select",""],["","00121087316","LACTULOSE","SOL 10GM\/15","900","Select","Select",""],["","00002879959","HUMALOG KWIK","INJ 100\/ML","15","Select","Select",""],["","00536110888","NICOTINE TD","DIS 21MG\/24H","28","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","61314063705","PREDNISOLONE","SUS 1% OP","5","Select","Select",""],["","67618010760","SLOW-MAG","TAB ","180","Select","Select",""],["","60505100301","KETOROLAC","SOL 0.005","5","Select","Select",""],["","00002880359","HUMULIN","INJ 70\/30KWP","15","Select","Select",""],["","42806031250","DOXYCYCL HYC","TAB 100MG","20","Select","Select",""],["","00781713593","MOXIFLOXACIN","SOL HCL 0.5%","3","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","30","Select","Select",""],["","76204060060","IPRATROPIUM\/","SOL ALBUTER","180","Select","Select",""],["","00472103016","HYDROMET","SYP 5-1.5\/5","120","Select","Select",""],["","45802065087","LORATADINE","TAB 10MG","14","Select","Select",""],["","65862017760","CEFDINIR","CAP 300MG","10","Select","Select",""],["","00185012201","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","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":""}]}]}