{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TERESA B CORNETT","gend":1,"add":"1972 IZAAK WALTON RD APT 211","city":"MADISON HEIGHTS","state":"VA","zip":"24572-9998","dob":"1980-09-07","age":"","mstatus":"","insh":"20060367*01","cliId":"","pno":4342095430,"cno":4342095430,"email":"","ename":"","eno":"","pphy":"BOLUSA-SABUGO, AHGNES UNGOCO MD","ppno":4349291400,"pcpadd":"134 ELON RD,","pcpcity":"MADISON HEIGHTS","pcpstate":"VA","pcpzip":"24572-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4349290410,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R91.8","F31.9","K42.9","R10.9","R11.2","J01.80","J32.4","R05.9","F31.81","F90.0","N92.6","R06.00","NO DATA","E87.6","Z76.89","H61.23","R60.9","K21.9","Z68.43","E66.01","J30.9","G47.33","I10.","Z01.89","M51.36","E11.9","E66.9","L40.9","M47.816","G89.29","F11.21","J31.2","M53.3","M54.2","F41.9","G47.00","D72.829","L40.0","L44.8","Z20.822","S51.812A","R06.02","M54.9","J34.2","H60.8X3","Z30.40","R05.","L65.9","J32.8","J01.01","M19.90","M79.7","Z68.42","D22.5","L81.4","L02.511","D48.5","D22.71","D22.72","L91.8","R79.82","R73.03","D84.9","Z79.60","Z11.1","R22.2","M79.672","M77.52","Z12.4"],"date":["2021-01-12","2021-06-28","2021-12-08","2021-12-08","2021-12-08","2022-10-20","2023-03-22","2023-03-22","2023-07-19","2023-07-19","2022-05-13","2022-08-14","2023-01-10","2022-08-19","2022-08-15","2021-09-23","2021-10-19","2021-07-29","2021-10-19","2023-06-26","2023-01-09","2022-01-06","2021-10-19","2023-04-05","2023-01-10","2023-01-10","2023-01-10","2023-04-05","2023-01-10","2023-01-10","2023-01-10","2022-01-06","2022-07-26","2022-08-31","2023-07-19","2023-07-19","2021-05-10","2023-05-01","2021-04-16","2021-09-26","2022-03-19","2022-08-14","2022-10-11","2021-02-11","2021-02-11","2021-05-28","2021-08-29","2022-03-17","2023-01-09","2023-03-09","2022-10-11","2022-10-11","2022-10-11","2022-09-20","2022-09-20","2021-09-16","2021-09-16","2022-09-20","2022-09-20","2023-05-01","2022-11-22","2022-11-22","2023-04-05","2023-04-05","2023-04-05","2023-06-23","2023-08-29","2023-08-29","2023-08-09"],"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":[["","00074055402","HUMIRA PEN","INJ 40\/0.4ML","2","Select","Select",""],["","43547030503","ARIPIPRAZOLE","15 MG","30","Select","Select",""],["","50428041611","EARWAX REMOV","DRO KIT","15","Select","Select",""],["","69584009350","BUSPIRONE","TAB 15MG","60","Select","Select",""],["","00115180401","HYDROXYZ PAM","CAP 50MG","120","Select","Select",""],["","59779061275","ALLERGY RELF","TAB 10MG","30","Select","Select",""],["","64980056210","FUROSEMIDE","20 MG","30","Select","Select",""],["","49035086202","EQ EAR DROPS","SOL 6.5% OT","15","Select","Select",""],["","50111056101","TRAZODONE","TAB 100MG","60","Select","Select",""],["","69097012815","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","00093767902","ETONOGESTREL","MIS ETHY EST","1","Select","Select",""],["","13811070910","METHYLPHENID","TAB 54MG ER","30","Select","Select",""],["","59267100002","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","50458058701","CONCERTA","54 MG","30","Select","Select",""],["","65162068090","PROMETHAZINE","SOL DM","120","Select","Select",""],["","00093310905","AMOXICILLIN","500 MG","40","Select","Select",""],["","49281042250","FLUZONE QUAD","2022-2023 60MCG\/.5ML","0.5","Select","Select",""],["","59651000305","OMEPRAZOLE","40 MG","90","Select","Select",""],["","67877056110","METFORMIN","TAB 500MG","30","Select","Select",""],["","00093101042","MUPIROCIN","2 %","22","Select","Select",""],["","62559015116","OXYCODONE","SOL 5MG\/5ML","210","Select","Select",""],["","68382097001","CHLORTHALID","TAB 25MG","30","Select","Select",""],["","53489011905","DOXYCYCL HYC","CAP 100MG","14","Select","Select",""],["","49483070210","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","27241011904","FENOFIBRATE","134 MG","90","Select","Select",""],["","49483060350","IBUPROFEN","600 MG","20","Select","Select",""],["","43598065530","BUPROPN HCL","TAB 150MG XL","30","Select","Select",""],["","00472016615","NYSTATIN","OIN 100000","15","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","12","Select","Select",""],["","62332054745","CLOBETASOL","CRE 0.0005","45","Select","Select",""],["","45802005505","TRIAMCINOLON","OIN 0.001","454","Select","Select",""],["","45802065078","LORATADINE","10 MG","30","Select","Select",""],["","11527075043","SOD FLUORIDE","PST 0.011","100","Select","Select",""],["","50228014610","HYDROCHLOROT","CAP 12.5MG","30","Select","Select",""],["","65862092585","INCASSIA","0.35 MG","84","Select","Select",""],["","00487020103","IPRATROPIUM\/","SOL ALBUTER","360","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","50111078751","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","59883001604","FLUORIDEX","PST 0.011","100","Select","Select",""],["","69097015807","MELOXICAM","7.5 MG","28","Select","Select",""],["","42806040021","METHYLPRED","TAB 4MG","21","Select","Select",""],["","49035007021","EQ MUCUS ER","TAB 600MG","60","Select","Select",""],["","70436015301","POT CHLORIDE","TAB 20MEQ ER","4","Select","Select",""],["","29300041519","CYCLOBENZAPR","TAB 10MG","60","Select","Select",""],["","00603533815","PREDNISONE","10 MG","21","Select","Select",""],["","68382003616","VENLAFAXINE","CAP 150MG ER","30","Select","Select",""],["","49035028338","EQ 12 HR MUC","TAB 600MG","60","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","00169406013","VICTOZA","3-PAK 0.6 MG\/0.1","9","Select","Select",""],["","00904698640","MUCUS RELIEF ER","600 MG","60","Select","Select",""],["","49483070210","FLUOXETINE HCL","20 MG","30","Select","Select",""],["","68382003616","VENLAFAXINE HCL ER","150 MG","90","Select","Select",""],["","11527073044","SODIUM FLUORIDE","1.1 %","100","Select","Select",""],["","16571040250","CETIRIZINE HCL","10 MG","21","Select","Select",""],["","00168026950","CLOBETASOL PROPIONATE","0.05 %","50","Select","Select",""],["","13811070910","METHYLPHENIDATE ER","54 MG","30","Select","Select",""],["","59746000103","METHYLPREDNISOLONE","4 MG","21","Select","Select",""],["","00074055402","HUMIRA(CF) PEN","40MG\/0.4ML","2","Select","Select",""],["","00115180401","HYDROXYZINE PAMOATE","50 MG","120","Select","Select",""],["","68180072103","AMLODIPINE BESYLATE","10 MG","30","Select","Select",""],["","69584009350","BUSPIRONE HCL","15 MG","60","Select","Select",""],["","49035007021","MUCUS ER","600 MG","60","Select","Select",""],["","45802005505","TRIAMCINOLONE ACETONIDE","0.1 %","454","Select","Select",""],["","67877056110","METFORMIN HCL","500 MG","30","Select","Select",""],["","16571020106","DICLOFENAC SODIUM","75 MG","60","Select","Select",""],["","50111056101","TRAZODONE HCL","100 MG","60","Select","Select",""],["","68382097001","CHLORTHALIDONE","25 MG","90","Select","Select",""],["","23155013525","DOXYCYCLINE MONOHYDRATE","100 MG","20","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","90 MCG","18","Select","Select",""],["","29300041519","CYCLOBENZAPRINE HCL","10 MG","60","Select","Select",""],["","49035049858",""," ","60","Select","Select",""],["","43547030503","ARIPIPRAZOLE TAB","15MG","30","Select","Select",""],["","69584009350","BUSPIRONE TAB","15MG","60","Select","Select",""],["","00093767902","ETONOGESTREL MIS ETHY EST","","1","Select","Select",""],["","50111056101","TRAZODONE TAB","100MG","60","Select","Select",""],["","59651000305","OMEPRAZOLE CAP","40MG","90","Select","Select",""],["","49483070210","FLUOXETINE CAP","20MG","30","Select","Select",""],["","00115180401","HYDROXYZ PAM CAP","50MG","120","Select","Select",""],["","59651003247","IBUPROFEN SUS","100\/5ML","400","Select","Select",""],["","69097012815","AMLODIPINE TAB","10MG","30","Select","Select",""],["","13811070910","METHYLPHENID TAB","54MG ER","30","Select","Select",""],["","00074055402","HUMIRA PEN INJ","40\/0.4ML","2","Select","Select",""],["","68382097001","CHLORTHALID TAB","25MG","30","Select","Select",""],["","43547040111","FUROSEMIDE TAB","20MG","30","Select","Select",""],["","27241011904","FENOFIBRATE CAP","134MG","30","Select","Select",""],["","67877056110","METFORMIN TAB","500MG","30","Select","Select",""],["","50228014610","HYDROCHLOROT CAP","12.5MG","30","Select","Select",""],["","45802005505","TRIAMCINOLON OIN","0.1%","454","Select","Select",""],["","00093101042","MUPIROCIN OIN","2%","22","Select","Select",""],["","11527073044","SOD FLUORIDE PST","1.1%","100","Select","Select",""],["","00472016615","NYSTATIN OIN","100000","15","Select","Select",""],["","68462053253","CLOBETASOL SOL","0.05%","50","Select","Select",""],["","68180012202","CEPHALEXIN CAP","500MG","12","Select","Select",""],["","62332054745","CLOBETASOL CRE","0.05%","45","Select","Select",""],["","67877025145","TRIAMCINOLON CRE","0.1%","454","Select","Select",""],["","45802065078","LORATADINE TAB","10MG","30","Select","Select",""],["","65862092585","INCASSIA TAB","0.35MG","84","Select","Select",""],["","42806040021","METHYLPRED TAB","4MG","21","Select","Select",""],["","59883001604","FLUORIDEX PST","1.1%","100","Select","Select",""],["","00487020103","IPRATROPIUM\/ SOL ALBUTER","","360","Select","Select",""],["","70436015301","POT CHLORIDE TAB","20MEQ ER","4","Select","Select",""],["","50111078751","AZITHROMYCIN TAB","250MG","6","Select","Select",""],["","49035007021","EQ MUCUS ER TAB","600MG","60","Select","Select",""],["","69097015807","MELOXICAM TAB","7.5MG","28","Select","Select",""],["","50458058701","CONCERTA TAB","54MG","30","Select","Select",""],["","49035028338","EQ","12 HR MUC TAB 600MG","60","Select","Select",""],["","66993001968","ALBUTEROL AER HFA","","18","Select","Select",""],["","29300041519","CYCLOBENZAPR TAB","10MG","60","Select","Select",""],["","00378064110","PREDNISONE TAB","10MG","10","Select","Select",""],["","49483060350","IBUPROFEN TAB","600MG","20","Select","Select",""],["","65862001501","AMOXICILLIN TAB","875MG","14","Select","Select",""],["","16571020106","DICLOFENAC TAB","75MG DR","60","Select","Select",""],["","68382003516","VENLAFAXINE CAP","75MG ER","30","Select","Select",""],["","00169406012","VICTOZA INJ","18MG\/3ML","6","Select","Select",""],["","53489011905","DOXYCYCLINE HYCLATE","100 MG","20","Select","Select",""],["","47335075649","IPRATROPIUM-ALBUTEROL","0.5-3MG\/3","180","Select","Select",""],["","50111033401","METRONIDAZOLE","500 MG","14","Select","Select",""],["","31722070530","VALACYCLOVIR","1000 MG","20","Select","Select",""],["","62332014231","CELECOXIB","200 MG","30","Select","Select",""],["","59316020514","BIOFREEZE","4 %","74","Select","Select",""],["","68462010530","ONDANSETRON HCL","4 MG","30","Select","Select",""],["","65862057490","MONTELUKAST SODIUM","10 MG","90","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE","50 MCG","16","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":""}]}]}