{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROBERTA  C REARDON","gend":1,"add":"93 BERKLEY AVE","city":"GROTTOES","state":"VA","zip":"24441-9998","dob":"1962-06-16","age":"","mstatus":"","insh":"20033798*01","cliId":"","pno":5402497480,"cno":5402497480,"email":"","ename":"","eno":"","pphy":"IUDICA, KATHLEEN S MD","ppno":5404339151,"pcpadd":"1831 RESERVOIR ST,","pcpcity":"HARRISONBURG","pcpstate":"VA","pcpzip":"22801-9998","pcpcounty":"","pcpid":"","pcpname":"Harrisonburg Family Practice Associates","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5404330547,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C50.411","N64.89","N62.","I89.0","Z78.0","Z80.3","Z68.42","Z17.0","Z85.3","Z95.828","K21.9","E66.01","Z45.2","E11.9","I10.","E78.00","B37.2","R06.02","E10.9","H40.053","J45.40","Z87.891","Z86.010","J44.9","Z79.811","Z20.828","R91.1","E11.8","Z79.4","E11.59","R30.0","Z13.31","Z23.","C50.911","E11.65","Z12.2","R91.8","I78.1","Z12.39","Z01.411","I49.3","Z12.11","K63.5","K64.8","F32.9","E89.89","Z12.31"],"date":["2023-06-20","2023-06-20","2022-01-06","2023-06-20","2023-06-20","2023-06-20","2023-06-20","2023-06-20","2023-03-07","2022-02-21","2022-05-24","2023-06-20","2023-05-08","2022-08-17","2023-03-08","2022-08-17","2021-05-04","2021-06-10","2021-05-10","2021-05-10","2021-10-25","2022-05-04","2021-07-21","2021-07-21","2022-08-08","2021-01-22","2022-05-04","2022-09-26","2023-03-08","2023-03-08","2023-03-08","2023-03-08","2023-03-08","2021-01-15","2022-03-09","2022-05-04","2022-05-04","2023-06-20","2022-09-20","2021-06-09","2021-06-10","2021-07-21","2021-07-21","2021-07-21","2021-08-16","2023-06-20","2023-06-20"],"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":[["","00006008061","JANUMET XR","50-1000 MG","60","Select","Select",""],["","00093505898","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","68382020906","ANASTROZOLE","1 MG","30","Select","Select",""],["","68645051054","HYDROCHLOROT","TAB 25MG","90","Select","Select",""],["","00186037020","SYMBICORT","160-4.5MCG","10.2","Select","Select",""],["","00186504031","NEXIUM","40 MG","30","Select","Select",""],["","69543012550","GLIMEPIRIDE","4 MG","180","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","75","Select","Select",""],["","59310057922","PROAIR HFA","AER ","26","Select","Select",""],["","43547033803","BENAZEPRIL","TAB 40MG","90","Select","Select",""],["","13668001101","CITALOPRAM","TAB 40MG","90","Select","Select",""],["","08627009111","DEXCOM G6","MIS RECEIVER","2","Select","Select",""],["","00169413212","OZEMPIC","INJ 2\/1.5ML","2","Select","Select",""],["","08290320550","BD PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","69097012403","TOPIRAMATE","100 MG","90","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","26","Select","Select",""],["","00093005805","TRAMADOL HCL","50 MG","90","Select","Select",""],["","00002143380","TRULICITY","INJ 0.75\/0.5","2","Select","Select",""],["","00169406013","VICTOZA","3-PAK 0.6 MG\/0.1","9","Select","Select",""],["","67877041301","METFORMIN","TAB 500MG ER","60","Select","Select",""],["","81131038679","RELION PEN","MIS 32GX4MM","100","Select","Select",""],["","68462018135","CLOTRIMAZOLE","1 %","30","Select","Select",""],["","00126001661","PREVIDENT","GEL 0.011","100","Select","Select",""],["","49035083705",""," ","14","Select","Select",""],["","59267102504","PFIZER VACC","INJ ADLT RTU","0","Select","Select",""],["","57599000200","FREESTYLE","MIS READER","1","Select","Select",""],["","57599080300","FREESTY LIBR","MIS 2 READER","1","Select","Select",""],["","00228202950","ALPRAZOLAM","TAB 0.5MG","2","Select","Select",""],["","49281072210","FLUBLOK QUAD","INJ 2022-23","0","Select","Select",""],["","00005200010","PREVNAR 20","INJ ","0","Select","Select",""],["","13668001101","CITALOPRAM HBR","40 MG","90","Select","Select",""],["","13668013701","ESCITALOPRAM OXALATE","20 MG","90","Select","Select",""],["","70377002911","ATORVASTATIN CALCIUM","40 MG","90","Select","Select",""],["","59310058020","PROAIR RESPICLICK","90 MCG","1","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","65862011801","BENAZEPRIL HCL","40 MG","30","Select","Select",""],["","49502025175","SEMGLEE (YFGN) PEN","100\/ML (3)","30","Select","Select",""],["","23155000810","HYDROCHLOROTHIAZIDE","25 MG","90","Select","Select",""],["","42806016005","HYDROXYZINE HCL","25 MG","60","Select","Select",""],["","67877041301","METFORMIN HCL ER","500 MG","60","Select","Select",""],["","00472033730","HYDROCORTISONE","2.5 %","60","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","100\/ML (3)","30","Select","Select",""],["","08290320550","NANO","2ND GEN PEN NEEDLE 32GX 5\/32\"","100","Select","Select",""],["","68180097903","LISINOPRIL","40 MG","90","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","90 MCG","18","Select","Select",""],["","00378797052","IPRATROPIUM BROMIDE","0.2 MG\/ML","60","Select","Select",""],["","16571041250","CIPROFLOXACIN HCL","500 MG","10","Select","Select",""],["","49502039475","INSULIN GLARGINE-YFGN","100\/ML (3)","60","Select","Select",""],["","57599080300","FREESTYLE LIBRE","2 READER ","1","Select","Select",""],["","00310737020","BUDESONIDE-FORMOTEROL FUMARATE","160-4.5MCG","10.2","Select","Select",""],["","00955172805","INSULIN GLARGINE SOLOSTAR","100\/ML (3)","90","Select","Select",""],["","00054327099","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","00186504031","NEXIUM CAP","40MG","30","Select","Select",""],["","69543012550","GLIMEPIRIDE TAB","4MG","180","Select","Select",""],["","16729003516","ANASTROZOLE TAB","1MG","30","Select","Select",""],["","00186037020","SYMBICORT AER","160-4.5","10","Select","Select",""],["","68645051054","HYDROCHLOROT TAB","25MG","90","Select","Select",""],["","59310057922","PROAIR HFA AER","","26","Select","Select",""],["","43547033803","BENAZEPRIL TAB","40MG","90","Select","Select",""],["","00088221905","LANTUS SOLOS INJ","100\/ML","90","Select","Select",""],["","13668001101","CITALOPRAM TAB","40MG","90","Select","Select",""],["","00006008061","JANUMET XR TAB","50-1000","60","Select","Select",""],["","00093505898","ATORVASTATIN TAB","40MG","90","Select","Select",""],["","65862017360","TOPIRAMATE TAB","100MG","90","Select","Select",""],["","08627009111","DEXCOM G","6 MIS RECEIVER","2","Select","Select",""],["","00169413212","OZEMPIC INJ","2\/1.5ML","2","Select","Select",""],["","08290320550","BD PEN NEEDL MIS","32GX4MM","100","Select","Select",""],["","57664037708","TRAMADOL HCL TAB","50MG","30","Select","Select",""],["","68180096301","ALBUTEROL AER HFA","","26","Select","Select",""],["","00169406013","VICTOZA INJ","18MG\/3ML","9","Select","Select",""],["","81131038679","RELION PEN MIS","32GX4MM","100","Select","Select",""],["","67877041301","METFORMIN TAB","500MG ER","60","Select","Select",""],["","00904782236","CLOTRIMAZOLE CRE","1%","15","Select","Select",""],["","00002143380","TRULICITY INJ","0.75\/0.5","2","Select","Select",""],["","59267102504","PFIZER VACC INJ ADLT RTU","","0","Select","Select",""],["","00126001661","PREVIDENT GEL","1.1%","100","Select","Select",""],["","57599080000","FREESTY LIBR KIT","2 SENSOR","1","Select","Select",""],["","57599080300","FREESTY LIBR MIS","2 READER","1","Select","Select",""],["","00228202950","ALPRAZOLAM TAB","0.5MG","2","Select","Select",""],["","57599000200","FREESTYLE MIS READER","","1","Select","Select",""],["","57599000101","FREESTYLE KIT SENSOR","","1","Select","Select",""],["","00005200010","PREVNAR","20 INJ","0","Select","Select",""],["","49281072210","FLUBLOK QUAD INJ","2022-23","0","Select","Select",""],["","72888001405","CYCLOBENZAPRINE HCL","10 MG","90","Select","Select",""],["","00173068220","VENTOLIN HFA","90 MCG","18","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":""}]}]}