{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARY  C ELLIOTT","gend":1,"add":"507 CARDINAL CT","city":"SOUTH BOSTON","state":"VA","zip":"24592-9998","dob":"1973-03-13","age":"","mstatus":"","insh":"20054280*01","cliId":"","pno":4344460560,"cno":4344460560,"email":"","ename":"","eno":"","pphy":"KING, BRODERICK MD","ppno":4345751336,"pcpadd":"1627 SEYMOUR DR SUITE B","pcpcity":"SOUTH BOSTON","pcpstate":"VA","pcpzip":"24592-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4345751349,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L97.529","E11.49","E11.621","L03.116","L97.413","F17.200","Z86.718","Z68.42","Q76.0","E11.40","E66.01","E78.2","F17.210","F31.9","F41.9","I10.","J44.9","Z80.9","Z82.0","Z82.49","Z83.3","S98.112A","M86.9","Z47.81","E11.42","G47.33","E55.9","E78.00","R32.","Z89.412","Z79.4","Z91.81","F33.3","M79.672","Z91.018","M86.172","R60.0","L89.893","S90.222A","L84.","Z11.52","N39.3","E11.8","Z68.43","E11.610","M17.31","M85.80","H26.493","E11.65","S83.8X1A","M17.12","Z12.11","F41.1","K59.04","K21.9","Z01.89","I87.333","L03.114","L97.423","R53.83","F17.218","L97.522","L97.521","Z89.422","H66.91","L97.519","Z23.","E11.69","Z68.41","E66.9","Z20.822","M79.675","G89.29","L03.032","G47.30","H26.492","S63.502A","E11.628","Z03.818","L02.612","R23.8","E11.9","R06.09","R00.2","F31.30","G47.9","R51.9","R06.00","M25.532","T87.89","V58.89","L98.8","M47.816","M54.5","M62.830","E11.59","R74.8","L08.9","I49.9","L97.509","L02.412","R06.02","L97.421","NO DATA","D72.829","Z96.1","S80.01XA","S80.812A","H26.491","H66.93","J01.90"],"date":["2021-04-30","2022-10-07","2023-03-24","2021-03-29","2022-02-04","2021-05-01","2021-01-20","2023-03-24","2021-10-27","2022-11-20","2023-04-24","2023-03-07","2023-03-24","2022-11-20","2023-03-24","2023-03-24","2023-02-08","2021-03-23","2021-04-30","2022-11-20","2022-11-20","2023-03-24","2023-03-24","2021-07-05","2022-11-28","2023-02-08","2021-09-02","2021-09-02","2021-09-02","2021-10-27","2021-12-11","2021-07-05","2022-10-28","2021-12-11","2022-11-20","2022-10-07","2022-10-07","2022-10-07","2022-10-07","2022-10-07","2022-01-24","2023-04-24","2023-04-24","2022-11-28","2022-11-28","2022-09-12","2022-10-31","2022-05-11","2022-05-11","2022-05-17","2022-09-12","2023-03-24","2023-02-08","2023-02-08","2023-03-24","2023-03-16","2021-09-14","2021-03-25","2021-09-14","2021-03-25","2021-04-21","2021-04-03","2021-09-14","2022-01-22","2023-03-09","2021-03-29","2021-03-31","2021-04-30","2021-04-30","2022-11-20","2021-04-30","2021-11-20","2021-11-20","2021-11-20","2023-03-24","2022-06-01","2022-11-20","2021-03-23","2021-03-23","2021-11-20","2021-11-20","2023-03-24","2023-03-07","2022-09-06","2022-12-13","2022-12-13","2022-01-22","2022-05-24","2022-11-20","2021-10-27","2021-10-27","2021-10-27","2021-10-27","2021-02-18","2021-02-18","2021-04-30","2021-04-30","2021-05-01","2021-05-01","2021-12-06","2022-07-07","2021-04-21","2021-09-02","2023-03-24","2021-03-26","2021-05-10","2022-04-05","2022-04-05","2022-05-25","2023-03-27","2023-03-27"],"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":[["","57237001999","DULOXETINE","CAP 60MG","30","Select","Select",""],["","16729022517","SPIRONOLACT","TAB 25MG","60","Select","Select",""],["","98302000199","COMFORT EZ","MIS 31GX5MM","100","Select","Select",""],["","55111025960","ZIPRASIDONE","CAP 80MG","60","Select","Select",""],["","68382035305","BUPROPN HCL","TAB 150MG XL","90","Select","Select",""],["","70710114901","ISOSORB DIN","TAB 10MG","30","Select","Select",""],["","16729018317","HYDROCHLOROT","TAB 25MG","90","Select","Select",""],["","75834050005","METFORMIN","TAB 500MG ER","60","Select","Select",""],["","68462039710","OMEPRAZOLE","40 MG","90","Select","Select",""],["","00169406013","VICTOZA","3-PAK 0.6 MG\/0.1","9","Select","Select",""],["","42806031205","DOXYCYCL HYC","TAB 100MG","28","Select","Select",""],["","70000021306","ALLERGY RELF","TAB 10MG","30","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","30","Select","Select",""],["","68382080705","TRAZODONE","TAB 150MG","90","Select","Select",""],["","67877012440","SILVER SULFA","CRE 0.01","30","Select","Select",""],["","50228017805","GABAPENTIN","800 MG","90","Select","Select",""],["","42806055212","OMEGA-3-ACID","CAP 1GM","120","Select","Select",""],["","55111065001","METAXALONE","TAB 800MG","15","Select","Select",""],["","23155050110","HYDROXYZ HCL","TAB 25MG","150","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","15","Select","Select",""],["","00172409680","BACLOFEN","TAB 10MG","30","Select","Select",""],["","49502019675","SEMGLEE","INJ 100U\/ML","30","Select","Select",""],["","67877032005","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","00093720210","PRAVASTATIN","TAB 40MG","90","Select","Select",""],["","08222095831","PEN NEEDLES","MIS 31GX8MM","100","Select","Select",""],["","67877041920","LINEZOLID","TAB 600MG","14","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","10","Select","Select",""],["","73070010315","INSULIN ASPA","INJ FLEXPEN","15","Select","Select",""],["","53489014605","SMZ\/TMP DS","TAB 800-160","14","Select","Select",""],["","53885024450","ONETOUCH","TES ULTRA","50","Select","Select",""],["","57237023305","SMZ-TMP DS","TAB 800-160","20","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","28","Select","Select",""],["","57664037718","TRAMADOL HCL","TAB 50MG","10","Select","Select",""],["","16729028617","ROSUVASTATIN","TAB 20MG","90","Select","Select",""],["","00173086910","ANORO ELLIPT","AER 62.5-25","60","Select","Select",""],["","65862076890","FENOFIBRATE","TAB 48MG","30","Select","Select",""],["","00173068220","VENTOLIN HFA","AER ","18","Select","Select",""],["","80681013100","VITAMIN D3","CAP 5000UNIT","30","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","12","Select","Select",""],["","69097015815","MELOXICAM","7.5 MG","30","Select","Select",""],["","21922000909","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","43386048026","ORPHENADRINE","TAB 100MG ER","18","Select","Select",""],["","63304061650","DOXYCYC MONO","CAP 100MG","20","Select","Select",""],["","45802065087","LORATADINE","10 MG","30","Select","Select",""],["","57237002901","AMOXICILLIN","875 MG","14","Select","Select",""],["","67877021905","CEPHALEXIN","500 MG","40","Select","Select",""],["","16729044316","BUPROPION XL","150 MG","90","Select","Select",""],["","00169633910","NOVOLOG FLEXPEN","100\/ML (3)","15","Select","Select",""],["","74312019377","VITAMIN D","3 125 MCG","30","Select","Select",""],["","42806055212","OMEGA-","3 ACID ETHYL ESTERS 1 G","120","Select","Select",""],["","16729018317","HYDROCHLOROTHIAZIDE","25 MG","90","Select","Select",""],["","70710114901","ISOSORBIDE DINITRATE","10 MG","30","Select","Select",""],["","69584085290","SPIRONOLACTONE","25 MG","60","Select","Select",""],["","31722016860","DULOXETINE HCL","20 MG","30","Select","Select",""],["","23155050110","HYDROXYZINE HCL","25 MG","150","Select","Select",""],["","55111025960","ZIPRASIDONE HCL","80 MG","60","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","100\/ML (3)","30","Select","Select",""],["","75834050005","METFORMIN HCL ER","500 MG","180","Select","Select",""],["","68382080705","TRAZODONE HCL","150 MG","90","Select","Select",""],["","98302000199","COMFORT EZ PEN NEEDLE","31 GX3\/16\"","100","Select","Select",""],["","42571016201","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","20","Select","Select",""],["","16729028617","ROSUVASTATIN CALCIUM","20 MG","90","Select","Select",""],["","73070010315","INSULIN ASPART FLEXPEN","100\/ML (3)","15","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":""}]}]}