{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SANDRA L SNYDER","gend":1,"add":"364 GEORGIA DR","city":"EVINGTON","state":"VA","zip":"24550-9998","dob":"1967-12-02","age":"","mstatus":"","insh":"20035371*01","cliId":"","pno":4348080559,"cno":4348080559,"email":"","ename":"","eno":"","pphy":"ALLEGA, GIULIANA MD","ppno":4343152850,"pcpadd":"935 SOUTH MAIN STREET,","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":4343152859,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S49.92XA","E11.9","W23.0XXA","Y92.89","J45.901","N17.9","I50.21","V62.84","F60.9","G47.33","C85.90","E66.01","J96.01","R13.10","K21.9","I11.0","I50.23","J45.909","Z91.19","Z85.72","T66.XXXA","J38.02","Z79.84","I44.7","Z20.822","R74.01","R74.8","Z86.73","R07.9","R77.8","R11.2","I50.22","E87.6","R06.02","F41.9","I10.","G47.00","Z95.810","NO DATA","I42.7","E87.1","D63.8","E11.42","F15.10","E83.42","N39.0","Z28.310","K76.1","Z91.14","I34.0","I07.1","F19.10","J45.21","I42.8","J38.00","D64.9","I95.2","T46.5X5A","I08.1","I21.4","E03.9","I24.8","F14.90","G43.909","E80.6","Z79.890","Z79.899","R05.9","M79.89","R21.","M43.6","J18.9","B37.0","J98.11","R06.00","R57.0","J38.01","Z51.5","I47.2","N17.8","F14.10","R94.5","Z71.89","E11.649","J44.9","B96.3","S93.409A","S93.609A","W10.8XXA","S16.1XXA","S39.012A","S80.00XA","S80.10XA","S46.912A","S70.02XA","V89.2XXA","I50.9","R07.89","I50.20","I50.1","R10.9","R39.9","R94.39","J90.","R60.0","R49.0","R52.","Z79.82","Z88.2","Z88.8","J44.1","J20.8","F12.10","L03.221","L73.9","B02.9","Z68.30","F41.0","R06.03","K04.7","R10.32","R09.02","R06.89","R00.0","I51.7","Z88.1","E86.0","N76.0","Y04.8XXA","I26.99","S70.11XA","M16.11","S79.911A","L03.119","D17.20","X58.XXXA","J06.9","J34.89","R09.81","R50.9","J02.9","R07.0","R55.","B97.89","I49.1","I95.9","R42.","R61.","M25.551","T63.481A"],"date":["2021-06-19","2023-08-08","2021-06-19","2021-06-19","2022-12-17","2022-11-22","2022-06-13","2022-06-13","2023-02-10","2022-06-13","2023-02-10","2022-06-13","2022-09-08","2022-06-13","2023-09-18","2023-07-23","2023-01-31","2023-07-06","2022-06-16","2022-06-16","2022-06-16","2022-06-16","2022-08-18","2022-11-22","2023-09-18","2022-08-24","2022-06-18","2022-06-16","2023-06-11","2023-01-31","2022-11-22","2023-07-23","2023-01-31","2023-07-06","2023-07-06","2023-02-10","2022-12-04","2023-07-24","2023-01-31","2022-09-08","2022-09-08","2022-08-18","2022-08-18","2022-12-12","2022-11-22","2022-08-18","2022-08-18","2022-08-18","2022-11-04","2023-02-10","2023-02-10","2023-07-23","2022-11-22","2022-11-22","2022-11-22","2022-11-22","2022-11-22","2022-11-22","2023-01-30","2022-12-17","2022-12-17","2023-01-30","2023-01-31","2023-07-06","2023-01-30","2023-01-30","2023-01-30","2023-09-18","2023-01-31","2021-05-24","2021-09-27","2022-06-10","2022-06-10","2022-06-10","2022-08-18","2022-09-12","2022-09-08","2022-09-09","2022-09-08","2022-09-08","2022-12-12","2022-09-12","2022-09-07","2022-12-12","2022-12-12","2022-12-12","2021-03-24","2021-03-24","2021-03-24","2022-04-05","2022-04-05","2022-04-05","2022-04-05","2022-04-05","2022-04-05","2022-04-05","2023-07-23","2023-07-23","2022-11-04","2022-09-08","2022-09-12","2022-02-22","2022-08-21","2022-08-24","2023-01-30","2022-03-20","2022-04-05","2022-08-30","2022-08-30","2022-08-30","2023-06-11","2022-12-12","2022-12-12","2021-07-17","2021-10-17","2021-10-17","2022-06-10","2022-06-10","2022-11-22","2022-02-22","2022-02-22","2022-06-10","2022-06-10","2023-07-23","2022-08-18","2022-08-18","2023-04-12","2023-06-11","2023-06-11","2023-07-06","2023-08-11","2023-08-08","2023-08-08","2023-08-08","2023-08-08","2023-08-08","2023-09-18","2023-09-18","2023-09-18","2023-09-18","2023-09-18","2023-09-18","2023-09-19","2023-09-18","2023-07-23","2023-07-23","2023-07-23","2023-07-23","2023-09-19","2023-09-19"],"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":[["","50742061510","METOPROL SUC","TAB 25MG ER","30","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","30","Select","Select",""],["","00555087202","MEDROXYPR AC","TAB 2.5MG","30","Select","Select",""],["","59779045839","CVS ALLERGY","TAB 10MG","30","Select","Select",""],["","69315012710","FOLIC ACID","1 MG","30","Select","Select",""],["","00173071920","FLOVENT HFA","AER 110MCG","12","Select","Select",""],["","00555088602","ESTRADIOL","TAB 1MG","30","Select","Select",""],["","23155000810","HYDROCHLOROT","TAB 25MG","90","Select","Select",""],["","59651021430","AZELASTINE","SPR 0.001","30","Select","Select",""],["","16571040250","CETIRIZINE","TAB 10MG","10","Select","Select",""],["","29300022019","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","70377002811","ATORVASTATIN","TAB 20MG","90","Select","Select",""],["","67877056110","METFORMIN","TAB 500MG","180","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA","200","Select","Select",""],["","27241009903","DULOXETINE","CAP 60MG","60","Select","Select",""],["","57664050083","MIRTAZAPINE","TAB 30MG","30","Select","Select",""],["","67877026218","RIZATRIPTAN","TAB 10MG","12","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","74312001380","VITAMIN B-12","TAB 1000MCG","30","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00173068220","VENTOLIN HFA","AER ","54","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","30","Select","Select",""],["","40985021104","B-12","TAB 1000 CR","90","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","53489011905","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","57237016199","OMEPRAZOLE","CAP 20MG","7","Select","Select",""],["","00603188016","LIDOCAINE","PAD 0.05","5","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","68382079201","ACYCLOVIR","TAB 800MG","35","Select","Select",""],["","43547040011","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","68180012202","CEPHALEXIN","500 MG","20","Select","Select",""],["","00121086802","NYSTATIN","SUS 100000","140","Select","Select",""],["","00172392570","DIAZEPAM","TAB 2MG","10","Select","Select",""],["","00597015230","JARDIANCE","TAB 10MG","30","Select","Select",""],["","00378064110","PREDNISONE","TAB 10MG","13","Select","Select",""],["","33342002208","LEVOFLOXACIN","TAB 500MG","10","Select","Select",""],["","50428031542","TUSSIN DM","LIQ 10-100\/5","237","Select","Select",""],["","43547040211","FUROSEMIDE","40 MG","30","Select","Select",""],["","76385011050","CARVEDILOL","3.125 MG","60","Select","Select",""],["","62332002791","LOSARTAN POT","TAB 25MG","30","Select","Select",""],["","69842081926","CVSTUSSIN DM","LIQ 20-400MG","236","Select","Select",""],["","49483048112","ASPIRIN LOW","TAB 81MG EC","30","Select","Select",""],["","00603020922","MAG OXIDE","TAB 400MG","28","Select","Select",""],["","53746054201","POT CHLORIDE","CAP 10MEQ ER","60","Select","Select",""],["","65162006205","SUCRALFATE","SUS 1GM\/10ML","1200","Select","Select",""],["","00310621030","FARXIGA","10 MG","15","Select","Select",""],["","00527495332","LEVOTHYROXIN","CAP 50MCG","30","Select","Select",""],["","66993007996","FLUTICAS HFA","AER 110MCG","12","Select","Select",""],["","65862050220","AMOX\/K CLAV","TAB 500-125","10","Select","Select",""],["","68180086106","AZITHROMYCIN","250 MG","4","Select","Select",""],["","65862098799","POTASSIUM CHLORIDE","10 MEQ","60","Select","Select",""],["","68180051303","LISINOPRIL","5 MG","30","Select","Select",""],["","00603020922","MAGNESIUM OXIDE","400 MG","60","Select","Select",""],["","68180072003","AMLODIPINE TAB","5MG","30","Select","Select",""],["","00093317431","ALBUTEROL AER HFA","","8","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","23155000810","HYDROCHLOROT TAB","25MG","90","Select","Select",""],["","68180012202","CEPHALEXIN CAP","500MG","12","Select","Select",""],["","70710113908","FLUCONAZOLE TAB","150MG","1","Select","Select",""],["","00172392570","DIAZEPAM TAB","2MG","5","Select","Select",""],["","00378064110","PREDNISONE TAB","10MG","13","Select","Select",""],["","00121086802","NYSTATIN SUS","100000","140","Select","Select",""],["","00173071920","FLOVENT HFA AER","110MCG","12","Select","Select",""],["","69842081926","CVSTUSSIN DM LIQ","20-400MG","236","Select","Select",""],["","33342002208","LEVOFLOXACIN TAB","500MG","10","Select","Select",""],["","59779035934","TUSSIN DM LIQ","10-100\/5","237","Select","Select",""],["","59651021430","AZELASTINE SPR","0.1%","30","Select","Select",""],["","00597015230","JARDIANCE TAB","10MG","30","Select","Select",""],["","49483048112","ASPIRIN LOW TAB","81MG EC","30","Select","Select",""],["","16571040250","CETIRIZINE TAB","10MG","10","Select","Select",""],["","43547040211","FUROSEMIDE TAB","40MG","30","Select","Select",""],["","76385011050","CARVEDILOL TAB","3.125MG","60","Select","Select",""],["","74312001380","VITAMIN B-","12 TAB 1000MCG","30","Select","Select",""],["","66993007996","FLUTICAS HFA AER","110MCG","12","Select","Select",""],["","62332002791","LOSARTAN POT TAB","25MG","30","Select","Select",""],["","27241009903","DULOXETINE CAP","60MG","60","Select","Select",""],["","57237016199","OMEPRAZOLE CAP","20MG","7","Select","Select",""],["","00603188016","LIDOCAINE PAD","5%","5","Select","Select",""],["","00603020922","MAG OXIDE TAB","400MG","28","Select","Select",""],["","50742061510","METOPROL SUC TAB","25MG ER","30","Select","Select",""],["","69315012710","FOLIC ACID TAB","1000MCG","30","Select","Select",""],["","00378180310","LEVOTHYROXIN TAB","50MCG","30","Select","Select",""],["","65162006205","SUCRALFATE SUS","1GM\/10ML","1200","Select","Select",""],["","53746054201","POT CHLORIDE CAP","10MEQ ER","60","Select","Select",""],["","68180016006","AZITHROMYCIN TAB","250MG","2","Select","Select",""],["","00310621030","FARXIGA TAB","10MG","30","Select","Select",""],["","00527495332","LEVOTHYROXIN CAP","50MCG","30","Select","Select",""],["","65862050220","AMOX\/K CLAV TAB","500-125","10","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","00093031401","KETOROLAC TROMETHAMINE","10 MG","10","Select","Select",""],["","53885024510","ONETOUCH ULTRA TEST STRIP","","300","Select","Select",""],["","64380071207","BENZONATATE","100 MG","30","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":""}]}]}