{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOHN GLASS","gend":0,"add":"152 SWANSON ST","city":"DANVILLE","state":"VA","zip":"24540-9998","dob":"1965-05-18","age":"","mstatus":"","insh":"20064721*01","cliId":"","pno":4347105727,"cno":4347105727,"email":"","ename":"","eno":"","pphy":"SELLS, MARK NP","ppno":4348354876,"pcpadd":"949 PINEY FOREST RD","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":"24541-9998","pcpcounty":"","pcpid":"","pcpname":"GoDocs","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4348354875,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.84","K29.70","K31.84","Z20.822","M54.5","M23.90","M25.571","J44.9","M54.42","G89.29","M54.41","M25.572","R53.1","I69.398","M47.816","N50.812","N43.3","Z87.448","M24.811","G47.33","E66.9","U07.1","R50.9","M12.812","R22.41","M79.604","E11.9","Z79.84","NO DATA","I63.9","K21.9","J45.909","N52.9","H54.40","Z99.89","Z01.818","K64.9","R94.31","M19.011","M25.519","R52.","R60.9","Z47.89","M75.101","M12.811","I10.","E78.5","F17.210","M25.511","M25.512","G47.30","R39.81","N39.41","S46.011A","Z96.611","M54.2","G89.4","M79.2","M47.812","S01.01XA","G81.91","M54.9","V87.7XXS","M99.53","M54.16","N43.2","I86.1","K59.03","R51.9","M96.1","R31.0","M19.012","M24.812","S80.11XA","M17.0","Z79.01","M79.661","R73.03","Z47.1","Z96.612","V89.2XXA","R33.9","J43.9","M51.26","J02.0","G89.18","Z72.0","N39.498","R20.0","Z76.0","X50.0XXA","S19.9XXA","V87.7XXA","S93.492A","M25.562","W06.XXXA","R40.0","R53.82","G47.00","M75.102","G81.94","H53.122","G89.21","S05.91XA","R35.0","M50.30","J42.","K59.00","B35.1","H04.129","H57.12","J45.40","M54.89","E55.9","L60.2","Z91.81","H54.62","M19.212","W19.XXXA","M19.211","Z98.890","M79.631","R06.9","N28.1","Z87.891","R49.0","R29.91","G47.39","Z90.01","M19.019","M54.12","R26.89","H11.31","J30.89","J44.0","Z12.11","N40.1","M23.92","M23.91","M79.601","Z87.438","G25.2"],"date":["2021-02-13","2021-02-13","2021-02-13","2022-12-14","2021-09-10","2021-11-12","2022-02-25","2023-04-25","2023-04-25","2023-05-11","2021-02-17","2022-02-25","2022-01-19","2022-06-29","2023-05-01","2021-11-09","2021-09-29","2021-08-17","2021-11-22","2022-11-12","2022-02-04","2021-12-27","2021-12-27","2022-03-17","2022-05-30","2022-05-30","2023-04-08","2022-09-01","2023-05-01","2022-07-05","2022-09-01","2023-02-10","2023-05-11","2022-07-05","2022-05-30","2022-08-16","2022-08-16","2022-08-17","2022-09-01","2022-08-25","2022-08-27","2022-09-22","2022-12-14","2022-09-01","2022-09-01","2023-04-08","2023-02-10","2022-09-01","2023-05-11","2023-05-11","2022-12-14","2023-04-08","2023-01-23","2023-02-10","2023-05-01","2023-05-01","2023-05-01","2023-02-14","2023-02-14","2021-01-20","2022-07-05","2021-03-15","2021-05-14","2021-03-15","2021-07-01","2021-11-09","2021-09-03","2023-05-11","2021-12-15","2023-05-11","2022-09-27","2022-01-14","2021-11-05","2022-05-06","2022-05-06","2022-05-06","2022-05-06","2022-05-24","2022-12-07","2023-05-01","2021-01-21","2021-03-02","2021-11-12","2021-11-12","2021-12-15","2022-08-25","2023-05-11","2022-06-29","2023-04-12","2022-08-27","2023-02-10","2021-02-04","2021-02-04","2021-02-24","2021-02-24","2021-02-24","2022-02-04","2022-02-04","2022-02-04","2022-03-17","2022-02-23","2022-02-23","2023-05-11","2022-09-30","2023-02-23","2023-05-01","2021-11-12","2021-11-12","2021-11-12","2021-11-12","2021-11-12","2021-11-12","2022-01-19","2022-02-10","2022-02-10","2022-02-10","2022-02-10","2022-03-17","2022-05-06","2022-07-27","2022-08-27","2022-09-22","2022-09-22","2021-09-03","2021-11-02","2021-11-02","2021-12-15","2021-12-15","2021-12-15","2022-01-14","2022-01-19","2022-07-05","2022-09-28","2023-05-11","2023-05-11","2023-05-11","2021-09-29","2022-02-25","2022-02-25","2022-09-22","2022-09-27","2023-05-01"],"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":[["","55111012305","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","68382050010","OMEPRAZOLE","40 MG","10","Select","Select",""],["","00054004544","IPRATROPIUM","SPR 0.0003","30","Select","Select",""],["","29300042010","AMITRIPTYLIN","TAB 25MG","30","Select","Select",""],["","68462015305","TOPIRAMATE","50 MG","96","Select","Select",""],["","68462016405","CARVEDILOL","12.5 MG","60","Select","Select",""],["","50383070016","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00173072020","FLOVENT HFA","AER 220MCG","12","Select","Select",""],["","00378718505","METFORMIN","TAB 500MG","30","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00904672559","SENNA","TAB 8.6MG","30","Select","Select",""],["","11917004918","ACETAMIN","TAB 500MG","120","Select","Select",""],["","68462018135","CLOTRIMAZOLE","CRE 0.01","30","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","300","Select","Select",""],["","45802086866","POLYETH GLYC","POW 3350 NF","238","Select","Select",""],["","00904719260","FEXOFENADINE","TAB 60MG","60","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","74312052807","D3","CAP 50MCG","90","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","57896040101","STOOL SOFTNR","CAP 100MG","60","Select","Select",""],["","00363058714","ASPIRIN 81","TAB 81MG EC","30","Select","Select",""],["","00135057602","FLONASE ALGY","SPR 50MCG","10","Select","Select",""],["","00904675180","ASPIRIN LOW","TAB 81MG EC","30","Select","Select",""],["","00093216568","NALOXONE HCL","SPR ","2","Select","Select",""],["","31722071030","SILDENAFIL","TAB 50MG","10","Select","Select",""],["","65162062750","TRAMADOL HCL","50 MG","12","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","30","Select","Select",""],["","00591352530","LIDOCAINE","5 %","90","Select","Select",""],["","45963055650","GABAPENTIN","300 MG","90","Select","Select",""],["","00469260130","MYRBETRIQ","25 MG","30","Select","Select",""],["","00168001516","HYDROCORT","CRE 0.01","454","Select","Select",""],["","61314063006","NEO\/POLY\/DEX","SUS 0.1% OP","5","Select","Select",""],["","00574402435","ERYTHROMYCIN","OIN 5MG\/GM","4","Select","Select",""],["","65862052790","VENLAFAXINE","CAP 37.5 ER","30","Select","Select",""],["","00363017508","PAIN RELIEVE","TAB 500MG","120","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","15","Select","Select",""],["","70954006020","PREDNISONE","TAB 20MG","10","Select","Select",""],["","00363041414","ASPIRIN","TAB 81MG EC","90","Select","Select",""],["","43598044674","NICOTINE PATCH","7MG\/24HR","28","Select","Select",""],["","00363017508","PAIN RELIEVER","500 MG","120","Select","Select",""],["","65862052790","VENLAFAXINE HCL ER","37.5 MG","30","Select","Select",""],["","43598083205","ATORVASTATIN CALCIUM","40 MG","1","Select","Select",""],["","67877056105","METFORMIN HCL","500 MG","180","Select","Select",""],["","00904678370","ASPIRIN EC","81 MG","16","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","00904719260","FEXOFENADINE HCL","60 MG","90","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","00378113401","KETOROLAC TROMETHAMINE","10 MG","20","Select","Select",""],["","29300039810","AMLODIPINE BESYLATE","10 MG","90","Select","Select",""],["","45802086802","POLYETHYLENE GLYCOL","3350 17 G\/DOSE","238","Select","Select",""],["","42806071401","BENZONATATE","100 MG","20","Select","Select",""],["","70010019905","GUAIFENESIN ER","600 MG","60","Select","Select",""],["","43598081115","CETIRIZINE HCL","10 MG","90","Select","Select",""],["","00378165993","SILDENAFIL CITRATE","50 MG","10","Select","Select",""],["","00116200116","CHLORHEXIDINE GLUCONATE","0.12 %","473","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":""}]}]}