{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WILLIAM A SULLIVAN","gend":0,"add":"353 10TH ST NW APT C","city":"CHARLOTTESVILLE","state":"VA","zip":"22903-9998","dob":"1960-07-01","age":"","mstatus":"","insh":"20035800*01","cliId":"","pno":4349088097,"cno":4349088097,"email":"","ename":"","eno":"","pphy":"BOGGS, ZACHARY HARRIS MD","ppno":4349241931,"pcpadd":"1222 JEFFERSON PARK AVE,","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":"22903-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4342444451,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z87.09","E11.69","Z79.4","E11.9","C34.2","Z92.3","A41.51","N30.00","N40.1","R33.8","Z46.6","L98.8","E11.65","E11.40","J44.9","I69.351","E43.","M62.81","R26.89","E78.5","H40.9","F17.210","Z79.82","R64.","Z68.1","Z16.11","R62.7","E11.42","H91.90","N39.490","Z79.84","R53.1","L60.2","D50.9","E78.2","R52.","R33.9","Z51.5","Z02.89","M77.41","R20.2","Z00.00","C34.11","Z23.","I10.","R91.1","A41.9","N39.0","R32.","N28.89","Z20.822","L85.3","L98.9","NO DATA","Z79.891","R63.4","Z87.442","N13.30","N20.1","N20.0","N13.5","N13.2","R73.09","R60.0","E16.2","W17.89XA","Z41.9","N13.8","N32.89","I69.30","H90.5","Z91.89","Z87.898","S61.214A","S50.811A","E11.649","S59.911A","T83.098A","R29.6"],"date":["2021-04-19","2022-07-26","2023-09-13","2023-06-26","2023-07-19","2023-01-10","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2023-08-21","2021-04-19","2023-09-13","2021-04-19","2023-08-21","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2023-09-07","2021-04-19","2021-04-04","2021-04-04","2021-04-04","2021-04-06","2021-04-04","2021-04-04","2021-04-04","2021-04-04","2023-02-27","2023-02-15","2023-08-25","2022-07-26","2023-08-25","2023-08-28","2023-02-27","2023-02-15","2023-02-15","2022-07-26","2023-04-03","2022-12-13","2022-12-13","2023-09-07","2022-12-13","2021-04-04","2021-04-04","2021-04-04","2023-08-21","2021-04-04","2021-08-13","2021-09-30","2023-02-27","2023-06-26","2023-08-25","2023-08-09","2023-08-21","2023-08-09","2023-08-09","2023-08-15","2023-08-28","2023-09-07","2023-09-20","2023-09-07","2023-09-07","2023-08-15","2023-08-21","2023-08-21","2023-08-21","2023-08-21","2023-08-25","2023-09-06","2023-09-07","2023-09-07","2023-09-07","2023-09-07","2023-08-28","2023-09-13"],"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":[["","00093005805","TRAMADOL HCL","50 MG","60","Select","Select",""],["","00006011231","JANUVIA","50 MG","30","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","90","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","100","Select","Select",""],["","57237001401","TAMSULOSIN","CAP 0.4MG","90","Select","Select",""],["","00002773701","INSULIN LISP","INJ 100\/ML","10","Select","Select",""],["","70377002711","ATORVASTATIN","TAB 10MG","30","Select","Select",""],["","69097094312","GABAPENTIN","300 MG","90","Select","Select",""],["","67877056310","METFORMIN","TAB 1000MG","180","Select","Select",""],["","00002771559","BASAGLAR","INJ 100UNIT","15","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","24","Select","Select",""],["","56151210201","PEN NEEDLES","MIS 31GX6MM","100","Select","Select",""],["","65862014990","FINASTERIDE","TAB 5MG","90","Select","Select",""],["","00536100901","FERROUS SULF","TAB 325MG","90","Select","Select",""],["","50428029449","CVS IRON","TAB 325MG","90","Select","Select",""],["","08290328438","INSULIN SYRG","MIS 0.3\/31G","100","Select","Select",""],["","59267100002","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","00002751001","HUMALOG","INJ 100\/ML","10","Select","Select",""],["","00169185189","NOVOFINE","MIS 32GX6MM","100","Select","Select",""],["","08290320749","BD PEN NEEDL","MIS 32GX6MM","100","Select","Select",""],["","68180098103","LISINOPRIL","20 MG","90","Select","Select",""],["","67877056310","METFORMIN HCL","1000 MG","180","Select","Select",""],["","00002773701","INSULIN LISPRO","100\/ML","10","Select","Select",""],["","69097014260","ALBUTEROL SULFATE HFA","90 MCG","6.7","Select","Select",""],["","53885027210","ONETOUCH VERIO TEST STRIP","","100","Select","Select",""],["","70377002711","ATORVASTATIN CALCIUM","10 MG","90","Select","Select",""],["","00597007541","SPIRIVA HANDIHALER","18 MCG","90","Select","Select",""],["","00002771559","BASAGLAR KWIKPEN U-","100 100\/ML (3)","15","Select","Select",""],["","57237016199","OMEPRAZOLE","20 MG","90","Select","Select",""],["","08290320109","ULTRA-FINE SHORT PEN NEEDLE","31 GX5\/16\"","300","Select","Select",""],["","69097094312","GABAPENTIN CAP","300MG","90","Select","Select",""],["","00002751001","HUMALOG INJ","100\/ML","10","Select","Select",""],["","67877056310","METFORMIN TAB","1000MG","60","Select","Select",""],["","00002771559","BASAGLAR INJ","100UNIT","15","Select","Select",""],["","53885027210","ONETOUCH TES VERIO","","100","Select","Select",""],["","00006011231","JANUVIA TAB","50MG","30","Select","Select",""],["","00093005805","TRAMADOL HCL TAB","50MG","14","Select","Select",""],["","70377002711","ATORVASTATIN TAB","10MG","90","Select","Select",""],["","08290328438","INSULIN SYRG MIS","0.3\/31G","100","Select","Select",""],["","00597007541","SPIRIVA CAP HANDIHLR","","90","Select","Select",""],["","08290320749","BD PEN NEEDL MIS","32GX6MM","100","Select","Select",""],["","68180098103","LISINOPRIL TAB","20MG","90","Select","Select",""],["","08290328438","INSULIN SYRINGE","31 GX5\/16\"","300","Select","Select",""],["","00781261305","AMOXICILLIN","500 MG","9","Select","Select",""],["","59779030602","PURELAX","17 G\/DOSE","238","Select","Select",""],["","57237001401","TAMSULOSIN HCL","0.4 MG","90","Select","Select",""],["","00536100901","FERROUS SULFATE","325(65) MG","30","Select","Select",""],["","75826011510","PHENAZOPYRIDINE HCL","200 MG","10","Select","Select",""],["","57664049983","MIRTAZAPINE","15 MG","90","Select","Select",""],["","49502025175","SEMGLEE (YFGN) PEN","100\/ML (3)","15","Select","Select",""],["","50090617800","INSULIN GLARGINE SOLOSTAR","100\/ML (3)","15","Select","Select",""],["","43386009019","GAVILYTE-G","236-22.74G","4000","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":""}]}]}