{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHARON C SWIFT","gend":1,"add":"2109 WESTERLY DR","city":"LYNCHBURG","state":"VA","zip":"24501-9998","dob":"1978-04-08","age":"","mstatus":"","insh":"20053633*01","cliId":"","pno":4342094027,"cno":4342094027,"email":"","ename":"","eno":"","pphy":"STIRGWOLT, JENNIFER K DO","ppno":4342003366,"pcpadd":"800 5TH STREET,","pcpcity":"LYNCHBURG","pcpstate":"VA","pcpzip":"24504-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4348472521,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.65","F31.31","F43.10","F41.1","F63.3","J41.0","F17.210","G47.33","Z71.3","E11.43","J02.9","R09.81","J44.1","J32.9","Z72.0","G47.00","Z20.822","S52.351A","S52.501A","G89.18","E11.8","J44.9","R06.02","R05.9","R68.89","V58.89","L51.9","M25.512","S43.002A","R07.9","E11.9","I10.","E78.5","F31.62","F17.200","H66.91","R19.7","B34.9","S52.301A","S06.0X0A","J04.0","F31.4","E55.9","E78.2","Z79.4","Z71.82","Z99.81","Z91.19","K21.9","S69.91XA","S93.491A","M25.571","R41.841","R11.2","E10.42","J45.20","R15.9","R15.2","Z20.828","NO DATA","J96.11","G43.009","F41.0","V89.2XXD","R00.2","F31.9","F41.8","R05.1","J30.2","J34.2","R63.4","Z00.00","M89.8X9","G47.30","S92.101A","S62.309A","R51.9","M54.2","R07.81","V87.7XXA","S62.316A","S90.01XA","L03.90","J18.9","R53.83","E66.9","J96.10","R52.","F41.9","H65.01","J01.40","J40.","J20.9","H92.01","G50.0","H92.03","J06.9","M77.8","M25.531","H10.31","M18.11","G56.01","M19.131","S60.211A","W22.8XXA","J30.1","J30.81","J30.89","J34.89","J35.2","H65.92","E11.40","Z79.51","Z13.31"],"date":["2021-05-19","2023-07-18","2023-07-18","2023-07-18","2023-07-18","2022-06-06","2023-08-12","2022-10-02","2022-06-27","2022-09-13","2022-07-02","2023-08-04","2022-07-02","2022-07-02","2022-07-02","2023-07-18","2023-09-11","2022-08-23","2022-08-23","2022-08-23","2023-08-29","2023-08-12","2022-12-15","2023-03-28","2023-01-31","2022-10-27","2021-04-15","2021-04-28","2021-04-28","2021-08-28","2022-12-15","2023-08-12","2022-07-26","2021-12-15","2022-04-04","2022-10-22","2022-04-19","2022-01-06","2022-08-23","2022-09-15","2021-04-05","2022-05-03","2023-02-15","2023-02-15","2023-08-12","2021-05-14","2021-08-28","2021-08-28","2023-03-28","2022-09-13","2022-09-13","2022-09-13","2022-10-13","2023-01-31","2021-03-01","2021-04-12","2021-10-20","2021-10-20","2022-01-20","2023-08-12","2022-09-13","2023-08-29","2022-09-13","2022-09-13","2022-12-15","2022-12-15","2022-12-15","2022-12-20","2023-08-04","2023-08-04","2023-02-15","2022-01-04","2022-04-04","2022-04-04","2022-08-17","2022-08-17","2023-03-28","2022-08-17","2022-08-17","2022-08-17","2022-08-18","2022-08-18","2021-07-20","2022-01-20","2022-04-19","2022-07-26","2022-08-17","2023-09-11","2022-08-17","2022-10-10","2022-12-20","2023-01-18","2023-03-28","2023-03-28","2023-04-12","2023-03-27","2023-03-27","2023-05-22","2023-05-22","2023-02-07","2023-06-23","2023-06-23","2023-06-05","2023-06-16","2023-06-16","2023-09-19","2023-09-19","2023-09-19","2023-08-04","2023-08-04","2023-08-12","2023-08-12","2023-08-12","2023-08-29"],"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":[["","00169369619","NOVOLOG MIX","INJ FLEXPEN","60","Select","Select",""],["","57664050183","MIRTAZAPINE","TAB 45MG","30","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","400","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","400","Select","Select",""],["","51991074790","DULOXETINE","CAP 30MG","30","Select","Select",""],["","68180098103","LISINOPRIL","20 MG","90","Select","Select",""],["","00193731221","CONTOUR","TES NEXT","200","Select","Select",""],["","43598029890","PREGABALIN","300 MG","60","Select","Select",""],["","63402030430","LATUDA","40 MG","30","Select","Select",""],["","70377003012","ATORVASTATIN","TAB 80MG","90","Select","Select",""],["","69452015120","VITAMIN D","2 1250 MCG","4","Select","Select",""],["","45802000403","HYDROCORT","CRE 0.025","28","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","31","Select","Select",""],["","64380094906","PREDNISONE","50 MG","5","Select","Select",""],["","00186037020","SYMBICORT","160-4.5MCG","10.2","Select","Select",""],["","08290320749","BD PEN NEEDL","MIS 32GX6MM","100","Select","Select",""],["","00071101868","LYRICA","CAP 300MG","180","Select","Select",""],["","00169643810","LEVEMIR","INJ FLEXTOUC","30","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","15","Select","Select",""],["","49483070210","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","70377000812","ROSUVASTATIN","TAB 20MG","90","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","30","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","80777027398","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","65862059401","DIVALPROEX","TAB 250MG ER","70","Select","Select",""],["","62756052269","SUMATRIPTAN","TAB 100MG","9","Select","Select",""],["","65162052110","PROMETHAZINE","TAB 25MG","20","Select","Select",""],["","57237016199","OMEPRAZOLE","CAP 20MG","90","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","7","Select","Select",""],["","68180086111","AZITHROMYCIN","250 MG","6","Select","Select",""],["","00054418625","DEXAMETHASON","TAB 6MG","7","Select","Select",""],["","71930002643","BROM\/PSE\/DM","SYP ","210","Select","Select",""],["","70954002010","PRAZOSIN HCL","2 MG","30","Select","Select",""],["","50111056101","TRAZODONE","TAB 100MG","30","Select","Select",""],["","00169406012","VICTOZA","2-PAK 0.6 MG\/0.1","3","Select","Select",""],["","70377004812","PRAVASTATIN","TAB 80MG","30","Select","Select",""],["","00002143480","TRULICITY","1.5 MG\/0.5","2","Select","Select",""],["","80681015600","COENZYME Q10","CAP 200MG","30","Select","Select",""],["","10702002901","PHENTERMINE","CAP 37.5MG","30","Select","Select",""],["","69097012403","TOPIRAMATE","100 MG","30","Select","Select",""],["","16571040250","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","13668004801","LAMOTRIGINE","150 MG","60","Select","Select",""],["","53489011905","DOXYCYCL HYC","CAP 100MG","14","Select","Select",""],["","43547034206","RISPERIDONE","TAB 2MG","30","Select","Select",""],["","50924097110","SOFTCLIX","MIS LANCETS","400","Select","Select",""],["","65702071210","ACCU-CHEK","TES GUIDE","400","Select","Select",""],["","64380071207","BENZONATATE","100 MG","21","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","20","Select","Select",""],["","65702073110","ACCU-CHECK","KIT GUIDE ME","100","Select","Select",""],["","65862039110","ONDANSETRON","TAB 8MG ODT","10","Select","Select",""],["","53885004401","ONE TOUCH","KIT VERIO FL","1","Select","Select",""],["","33342002208","LEVOFLOXACIN","500 MG","7","Select","Select",""],["","45802048678","DOCUSATE SOD","CAP 100MG","60","Select","Select",""],["","49281042250","FLUZONE QUAD","INJ 2022-23","0","Select","Select",""],["","65862057490","MONTELUKAST SODIUM","10 MG","90","Select","Select",""],["","50111056101","TRAZODONE HCL","100 MG","60","Select","Select",""],["","00169643210","LEVEMIR FLEXPEN","100\/ML (3)","30","Select","Select",""],["","47335070349","ALBUTEROL SULFATE","2.5 MG\/3ML","375","Select","Select",""],["","08290320749","ULTRA-FINE MICRO PEN NEEDLE","32 GX 1\/4\"","100","Select","Select",""],["","00169633910","NOVOLOG FLEXPEN","100\/ML (3)","30","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","90 MCG","18","Select","Select",""],["","53746074501","PROMETHAZINE HCL","12.5 MG","20","Select","Select",""],["","65862019405","FLUOXETINE HCL","40 MG","30","Select","Select",""],["","16571040250","CETIRIZINE HCL","10 MG","30","Select","Select",""],["","24208031510","POLYMYXIN B SUL-TRIMETHOPRIM","10000-1\/ML","10","Select","Select",""],["","00310737020","BUDESONIDE-FORMOTEROL FUMARATE","160-4.5MCG","10.2","Select","Select",""],["","51991081701","PROPRANOLOL HCL ER","60 MG","30","Select","Select",""],["","70436015542","PROMETHAZINE-DM","6.25-15\/5","120","Select","Select",""],["","00143122701","DICYCLOMINE HCL","20 MG","10","Select","Select",""],["","70377004812","PRAVASTATIN SODIUM","80 MG","90","Select","Select",""],["","53885027210","ONETOUCH VERIO TEST STRIP","","100","Select","Select",""],["","00169643810","LEVEMIR FLEXTOUCH","100\/ML (3)","30","Select","Select",""],["","68180067306","LURASIDONE HCL","80 MG","30","Select","Select",""],["","00093216568","NALOXONE HCL","4 MG","2","Select","Select",""],["","16571020106","DICLOFENAC SODIUM","75 MG","60","Select","Select",""],["","69097014260","ALBUTEROL AER HFA","","7","Select","Select",""],["","57237016199","OMEPRAZOLE CAP","20MG","90","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","00186037020","SYMBICORT AER","160-4.5","10","Select","Select",""],["","62756052269","SUMATRIPTAN TAB","100MG","9","Select","Select",""],["","49483070210","FLUOXETINE CAP","20MG","30","Select","Select",""],["","65162052110","PROMETHAZINE TAB","25MG","20","Select","Select",""],["","00169643810","LEVEMIR INJ FLEXTOUC","","30","Select","Select",""],["","70377000812","ROSUVASTATIN TAB","20MG","90","Select","Select",""],["","69452015120","VITAMIN D CAP","50000UNT","4","Select","Select",""],["","00169633910","NOVOLOG INJ FLEXPEN","","15","Select","Select",""],["","65862059501","DIVALPROEX TAB","500MG ER","90","Select","Select",""],["","57664050183","MIRTAZAPINE TAB","45MG","30","Select","Select",""],["","43598029890","PREGABALIN CAP","300MG","180","Select","Select",""],["","68180016011","AZITHROMYCIN TAB","250MG","6","Select","Select",""],["","00054418625","DEXAMETHASON TAB","6MG","7","Select","Select",""],["","71930002643","BROM\/PSE\/DM SYP","","210","Select","Select",""],["","68180098103","LISINOPRIL TAB","20MG","90","Select","Select",""],["","70954002010","PRAZOSIN HCL CAP","2MG","30","Select","Select",""],["","50111056101","TRAZODONE TAB","100MG","60","Select","Select",""],["","00002143380","TRULICITY INJ","0.75\/0.5","2","Select","Select",""],["","00169406013","VICTOZA INJ","18MG\/3ML","9","Select","Select",""],["","70377004812","PRAVASTATIN TAB","80MG","90","Select","Select",""],["","10702002901","PHENTERMINE CAP","37.5MG","30","Select","Select",""],["","80681015600","COENZYME Q","10 CAP 200MG","30","Select","Select",""],["","50924097110","SOFTCLIX MIS LANCETS","","400","Select","Select",""],["","10702002501","PHENTERMINE TAB","37.5MG","30","Select","Select",""],["","53885027210","ONETOUCH TES VERIO","","400","Select","Select",""],["","53746010901","HYDROCO\/APAP TAB","5-325MG","28","Select","Select",""],["","53489011905","DOXYCYCL HYC CAP","100MG","14","Select","Select",""],["","69097012303","TOPIRAMATE TAB","50MG","90","Select","Select",""],["","64380071307","BENZONATATE CAP","200MG","30","Select","Select",""],["","65702073110","ACCU-CHECK KIT GUIDE ME","","100","Select","Select",""],["","43547034206","RISPERIDONE TAB","2MG","30","Select","Select",""],["","16571040250","CETIRIZINE TAB","10MG","30","Select","Select",""],["","08290320749","BD PEN NEEDL MIS","32GX6MM","100","Select","Select",""],["","00054327099","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","13668004960","LAMOTRIGINE TAB","200MG","30","Select","Select",""],["","53885024510","ONETOUCH TES ULTRA","","400","Select","Select",""],["","00378064205","PREDNISONE TAB","20MG","19","Select","Select",""],["","70436015542","PROMETHAZINE SOL DM","","140","Select","Select",""],["","65702071210","ACCU-CHEK TES GUIDE","","400","Select","Select",""],["","45802048678","DOCUSATE SOD CAP","100MG","60","Select","Select",""],["","63402030630","LATUDA TAB","60MG","30","Select","Select",""],["","33342002208","LEVOFLOXACIN TAB","500MG","7","Select","Select",""],["","53885004401","ONE TOUCH KIT VERIO FL","","1","Select","Select",""],["","65862039110","ONDANSETRON TAB","8MG ODT","10","Select","Select",""],["","00378827091","ALBUTEROL NEB","0.083%","360","Select","Select",""],["","49281042250","FLUZONE QUAD INJ","2022-23","0","Select","Select",""],["","53885024510","ONETOUCH ULTRA TEST STRIP","","100","Select","Select",""],["","54629409760","NAC","600 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":""}]}]}