{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KAREN  P MOORE","gend":1,"add":"PO BOX 903","city":"GRETNA","state":"VA","zip":"24557-9998","dob":"1964-06-28","age":"","mstatus":"","insh":"20052635*01","cliId":"","pno":4342210963,"cno":4342210963,"email":"","ename":"","eno":"","pphy":"FRAZIER, DONNA E NP","ppno":4342004175,"pcpadd":"16890 FOREST RD,","pcpcity":"FOREST","pcpstate":"VA","pcpzip":"24551-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4342004321,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B34.9","H66.91","H92.01","J02.9","J34.89","R51.9","J44.9","Z20.822","R91.8","J41.8","R06.02","Z72.0","R93.89","J47.9","L40.0","L29.8","Z79.899","L72.0","G89.4","L40.50","Z51.81","Z79.891","J06.9","R05.9","S33.5XXA","S80.12XA","S80.11XA","W01.0XXA","U07.1","R09.81","R07.0","F41.1","F42.2","F51.01","M79.7","NO DATA","M47.816","R19.7","L73.8","L30.4","N61.1","H40.1131","D48.5","L03.111","J43.2","F17.200","J42.","R06.09","J43.9","Z13.89","S21.002A","R10.84","R73.03","E78.2","L40.9","E55.9","E66.9","D23.5","G89.29","R11.2","R10.9","R91.1"],"date":["2021-03-30","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2022-07-13","2023-06-06","2023-04-21","2021-04-09","2023-06-06","2021-11-29","2022-11-11","2023-06-06","2023-06-06","2023-04-04","2022-07-06","2023-04-04","2023-04-04","2023-01-27","2023-01-27","2023-01-23","2023-01-27","2022-05-12","2023-02-19","2022-06-14","2022-06-14","2022-06-14","2022-06-14","2022-07-13","2023-02-19","2022-07-13","2022-11-11","2022-11-11","2022-11-11","2023-01-27","2023-02-19","2023-01-27","2023-04-21","2023-04-04","2022-07-06","2022-07-06","2022-10-21","2023-03-20","2022-10-06","2021-11-29","2023-06-06","2022-06-23","2023-06-06","2022-06-23","2022-11-11","2023-04-11","2023-04-21","2021-02-15","2021-02-15","2021-02-15","2021-02-15","2021-02-15","2023-03-20","2021-07-08","2023-02-19","2023-02-19","2023-06-06"],"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":[["","00173068220","VENTOLIN HFA","90 MCG","18","Select","Select",""],["","00115180401","HYDROXYZ PAM","CAP 50MG","180","Select","Select",""],["","00406052201","OXYCOD\/APAP","TAB 7.5-325","120","Select","Select",""],["","68645056259","IBUPROFEN","600 MG","90","Select","Select",""],["","00591352530","LIDOCAINE","5 %","30","Select","Select",""],["","31722053401","METHOCARBAM","TAB 750MG","120","Select","Select",""],["","16714013201","DOXEPIN HCL","CAP 10MG","30","Select","Select",""],["","43547028211","ESCITALOPRAM","TAB 20MG","90","Select","Select",""],["","69452014430","BENZONATATE","CAP 200MG","90","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","70069042101","LATANOPROST","0.005 %","2.5","Select","Select",""],["","60505016809","PRAVASTATIN","TAB 10MG","30","Select","Select",""],["","68382080701","TRAZODONE","TAB 150MG","90","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","60432060416","PROMETHAZINE","SYP DM","100","Select","Select",""],["","00093598627","EPINEPHRINE","0.3MG\/0.3","2","Select","Select",""],["","00069108530","PAXLOVID","TAB 300-100","30","Select","Select",""],["","11877001140","BINAXNOW COV","KIT HOME TES","2","Select","Select",""],["","51672129803","KETOCONAZOLE","CRE 0.02","60","Select","Select",""],["","21922001707","CLOBETASOL","OIN 0.0005","60","Select","Select",""],["","55513013760","OTEZLA","TAB 30MG","60","Select","Select",""],["","49281042250","FLUZONE QUAD","INJ 2022-23","0","Select","Select",""],["","13668048450","MINOCYCLINE","CAP 100MG","14","Select","Select",""],["","49884094499","VARENICLINE","0.5 (11)-1","53","Select","Select",""],["","67877025145","TRIAMCINOLON","CRE 0.001","454","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","90 MCG","18","Select","Select",""],["","00406052201","OXYCODONE-ACETAMINOPHEN","7.5-325 MG","120","Select","Select",""],["","00115180301","HYDROXYZINE PAMOATE","25 MG","60","Select","Select",""],["","49884015676","VARENICLINE TARTRATE","1 MG","60","Select","Select",""],["","43547028111","ESCITALOPRAM OXALATE","10 MG","90","Select","Select",""],["","13668048750","MINOCYCLINE HCL","100 MG","14","Select","Select",""],["","47335023583","METHOTREXATE","2.5 MG","16","Select","Select",""],["","69315012710","FOLIC ACID","1 MG","30","Select","Select",""],["","31722053401","METHOCARBAMOL","750 MG","120","Select","Select",""],["","68382080701","TRAZODONE HCL","150 MG","90","Select","Select",""],["","69315091001","DIPHENOXYLATE-ATROPINE","2.5-.025MG","12","Select","Select",""],["","65862018730","ONDANSETRON HCL","4 MG","12","Select","Select",""],["","11877001140","BINAXNOW COVID-","19 AG SELF TEST ","8","Select","Select",""],["","00093101042","MUPIROCIN","2 %","22","Select","Select",""],["","49281040020","ADACEL TDAP","2-2.5-5\/.5","0.5","Select","Select",""],["","00173068220","VENTOLIN HFA AER","","18","Select","Select",""],["","00115180301","HYDROXYZ PAM CAP","25MG","60","Select","Select",""],["","68645056259","IBUPROFEN TAB","600MG","90","Select","Select",""],["","31722053401","METHOCARBAM TAB","750MG","120","Select","Select",""],["","00406052201","OXYCOD\/APAP TAB","7.5-325","120","Select","Select",""],["","00591352530","LIDOCAINE PAD","5%","30","Select","Select",""],["","16714013201","DOXEPIN HCL CAP","10MG","30","Select","Select",""],["","43547028211","ESCITALOPRAM TAB","20MG","90","Select","Select",""],["","69452014430","BENZONATATE CAP","200MG","90","Select","Select",""],["","68382080701","TRAZODONE TAB","150MG","90","Select","Select",""],["","60505016809","PRAVASTATIN TAB","10MG","30","Select","Select",""],["","70069042101","LATANOPROST SOL","0.005%","2","Select","Select",""],["","00186037020","SYMBICORT AER","160-4.5","10","Select","Select",""],["","00310737020","BUDES\/FORMOT AER","160-4.5","10","Select","Select",""],["","00093598627","EPINEPHRINE INJ","0.3MG","2","Select","Select",""],["","60432060416","PROMETHAZINE SYP DM","","100","Select","Select",""],["","58160082311","SHINGRIX INJ","50\/0.5ML","1","Select","Select",""],["","11877001140","BINAXNOW COV KIT HOME TES","","2","Select","Select",""],["","21922001707","CLOBETASOL OIN","0.05%","60","Select","Select",""],["","51672129803","KETOCONAZOLE CRE","2%","60","Select","Select",""],["","00069110120","PAXLOVID TAB","150-100","20","Select","Select",""],["","55513013760","OTEZLA TAB","30MG","60","Select","Select",""],["","49281042250","FLUZONE QUAD INJ","2022-23","0","Select","Select",""],["","49884094499","VARENICLINE TAB","0.5& 1MG","53","Select","Select",""],["","13668048450","MINOCYCLINE CAP","100MG","14","Select","Select",""],["","67877025145","TRIAMCINOLON CRE","0.1%","454","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":""}]}]}