{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CYNTHIA  N DAVIS","gend":1,"add":"PO BOX 413","city":"SCOTTSVILLE","state":"VA","zip":"24590-9998","dob":"1962-07-27","age":"","mstatus":"","insh":"20060921*01","cliId":"","pno":4343905503,"cno":4343905503,"email":"","ename":"","eno":"","pphy":"BISHOP, RAYMOND MD","ppno":4345915056,"pcpadd":"138 HERITAGE DR STE A","pcpcity":"PALMYRA","pcpstate":"VA","pcpzip":"22963-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4345915057,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J44.9","J96.11","R91.8","F17.210","J45.50","N39.3","J43.9","N81.84","J44.1","S42.254A","R06.02","Z72.0","J98.4","G47.33","J41.1","Z99.81","F17.200","R06.00","R05.3","F41.9","S42.201A","Z12.2","R07.9","I10.","E78.5","R40.0","G47.21","G47.34","Z20.822","R68.89","G47.61","R55.","M79.89","R07.81","R79.89","M25.511","M53.3","Z23.","R94.31","F31.9","J43.2","J30.9","J43.8"],"date":["2023-03-27","2023-03-07","2022-03-20","2023-01-23","2021-03-16","2023-03-30","2023-03-30","2023-03-30","2023-03-02","2022-09-08","2022-12-01","2023-02-01","2022-09-21","2021-03-08","2021-01-05","2021-01-19","2022-05-19","2022-05-19","2022-05-19","2022-08-04","2022-09-08","2023-01-23","2021-02-15","2021-02-15","2021-02-15","2021-03-08","2021-02-01","2021-03-08","2023-03-02","2023-03-02","2021-02-23","2021-03-22","2022-03-16","2022-03-16","2022-03-16","2022-09-06","2022-09-06","2021-05-05","2022-03-16","2022-04-05","2023-01-23","2021-01-19","2023-01-23"],"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":[["","27241009810","DULOXETINE","CAP 30MG","30","Select","Select",""],["","27808008602","HYD POL\/CPM","SUS 10-8\/5ML","100","Select","Select",""],["","00310460012","BEVESPI","AER 9-4.8MCG","11","Select","Select",""],["","00173072020","FLOVENT HFA","AER 220MCG","12","Select","Select",""],["","00093342501","LORAZEPAM","0.5 MG","30","Select","Select",""],["","43547034106","RISPERIDONE","1 MG","30","Select","Select",""],["","65862020399","LOSARTAN POT","TAB 100MG","30","Select","Select",""],["","29300011205","LAMOTRIGINE","100 MG","90","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","59746017210","PREDNISONE","5 MG","30","Select","Select",""],["","69315011710","FUROSEMIDE","40 MG","60","Select","Select",""],["","68001024604","ONDANSETRON","TAB 4MG ODT","30","Select","Select",""],["","00143980350","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","00310461612","BREZTRI AERO","AER SPHERE","11","Select","Select",""],["","69097031987","BUDESONIDE","SUS 0.5MG\/2","120","Select","Select",""],["","00536589688","NICOTINE TD","DIS 21MG\/24H","28","Select","Select",""],["","63402091130","BROVANA","NEB 15MCG","60","Select","Select",""],["","46122017708","GNP NICOTINE","LOZ 4MG MINT","72","Select","Select",""],["","65862064290","AZITHROMYCIN","500 MG","13","Select","Select",""],["","08373996600","INNOSPIRE ES","MIS NEBULIZE","1","Select","Select",""],["","67877019905","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","42806001101","SULINDAC","TAB 200MG","30","Select","Select",""],["","29300016910","TIZANIDINE","TAB 4MG","30","Select","Select",""],["","00597015561","STIOLTO","AER 2.5-2.5","4","Select","Select",""],["","70436005902","BUPROPION","TAB 150MG SR","60","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","59762444002","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00406012310","HYDROCO\/APAP","TAB 5-325MG","30","Select","Select",""],["","00054418325","DEXAMETHASON","TAB 2MG","18","Select","Select",""],["","33342002607","FAMCICLOVIR","TAB 500MG","21","Select","Select",""],["","00067512607","NICOTINE","DIS 21MG\/24H","28","Select","Select",""],["","68462039710","OMEPRAZOLE","40 MG","30","Select","Select",""],["","59310058020","PROAIR RESPI","AER ","1","Select","Select",""],["","68382070718","DOXYCYC MONO","CAP 100MG","20","Select","Select",""],["","00121077508","GG\/CODEINE","SOL 100-10\/5","300","Select","Select",""],["","16729011917","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","68382005001","MELOXICAM","TAB 7.5MG","10","Select","Select",""],["","27241009990","DULOXETINE HCL","60 MG","30","Select","Select",""],["","00121077504","GUAIFENESIN-CODEINE","10-100MG\/5","300","Select","Select",""],["","68001043697","CETIRIZINE HCL","10 MG","30","Select","Select",""],["","00310461612","BREZTRI AEROSPHERE","160-9-4.8","10.7","Select","Select",""],["","16729011917","MONTELUKAST SODIUM","10 MG","30","Select","Select",""],["","68382070718","DOXYCYCLINE MONOHYDRATE","100 MG","20","Select","Select",""],["","68001024604","ONDANSETRON ODT","4 MG","30","Select","Select",""],["","00597015561","STIOLTO RESPIMAT","2.5-2.5MCG","4","Select","Select",""],["","68180096301","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","65862020399","LOSARTAN POTASSIUM","100 MG","30","Select","Select",""],["","68001043490","NICOTINE PATCH","21 MG\/24HR","28","Select","Select",""],["","46122025560","NICOTINE LOZENGE","4 MG","80","Select","Select",""],["","76204020060","ALBUTEROL SULFATE","2.5 MG\/3ML","360","Select","Select",""],["","00009540001","NICOTROL","10 MG","168","Select","Select",""],["","16714040102","CEFUROXIME","500 MG","6","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":""}]}]}