{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WENDY S LACKEY","gend":1,"add":"109 MILLER S LN","city":"BUMPASS","state":"VA","zip":"23024-9998","dob":"1959-08-05","age":"","mstatus":"","insh":"20065427*01","cliId":"","pno":5402236058,"cno":5402236058,"email":"","ename":"","eno":"","pphy":"RICHMOND, MICHAEL DO","ppno":5409679401,"pcpadd":"SUITE 9 115 JEFFERSON HWY,","pcpcity":"LOUISA","pcpstate":"VA","pcpzip":"23093-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5409679405,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L82.1","R55.","Z95.818","R42.","M79.605","G43.109","M79.604","I63.9","C50.911","R22.1","Z17.0","C50.912","U07.1","E87.6","NO DATA","J96.01","K21.9","I10.","F39.","M35.1","M35.9","Z79.899","M89.49","M79.7","Z71.85","R06.02","I48.91","R06.09","I73.00","M18.11","Z79.1","H25.13","R59.1","Z23.","Z85.3","R07.9","R11.0","Z71.89","Z71.3","Z08.","Z86.000","H66.90","R09.1","M54.6","M54.5","J96.11","J01.00","F32.2","R68.89","Z11.59","M15.9"],"date":["2021-01-22","2022-11-04","2022-10-03","2021-07-26","2022-07-12","2022-07-12","2022-07-12","2022-10-03","2021-10-19","2021-10-19","2021-10-19","2021-10-19","2023-07-23","2022-01-29","2022-02-01","2022-01-28","2022-01-28","2022-02-01","2022-01-28","2022-01-28","2023-09-22","2022-03-16","2022-03-16","2022-03-16","2022-03-16","2022-10-25","2021-07-23","2022-10-25","2021-09-15","2021-02-19","2021-09-15","2021-04-09","2021-09-24","2021-09-24","2021-10-28","2022-02-21","2021-10-05","2022-02-23","2022-02-23","2021-07-20","2021-07-20","2021-10-05","2022-02-18","2021-02-10","2021-02-10","2022-02-01","2022-02-23","2022-02-23","2022-02-23","2022-06-21","2023-09-22"],"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":[["","00378668977","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","43598081115","CETIRIZINE","TAB 10MG","90","Select","Select",""],["","65862047090","LOSARTAN\/HCT","TAB 100-25","90","Select","Select",""],["","31722072690","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","68462015305","TOPIRAMATE","50 MG","180","Select","Select",""],["","31722088490","ROSUVASTATIN","TAB 20MG","90","Select","Select",""],["","68382005105","MELOXICAM","15 MG","30","Select","Select",""],["","70954005930","PREDNISONE","PAK 10MG","21","Select","Select",""],["","00093005805","TRAMADOL HCL","50 MG","21","Select","Select",""],["","29300042301","AMITRIPTYLIN","TAB 100MG","30","Select","Select",""],["","55111012701","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","68462010630","ONDANSETRON","TAB 8MG","15","Select","Select",""],["","00172572970","FAMOTIDINE","40 MG","90","Select","Select",""],["","00254101196","SUCRALFATE","1 G\/10 ML","1800","Select","Select",""],["","68382009601","HYDROXYCHLOR","TAB 200MG","135","Select","Select",""],["","55111017915","TIZANIDINE","TAB 2MG","30","Select","Select",""],["","51672128202","TRIAMCINOLON","CRE 0.001","30","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","30","Select","Select",""],["","65162010150","GABAPENTIN","CAP 100MG","90","Select","Select",""],["","68382091634","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00116200116","CHLORHEX GLU","SOL 0.0012","473","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","16","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","27808006502","PROMETH\/COD","SOL 6.25-10","140","Select","Select",""],["","65862020199","LOSARTAN POT","TAB 25MG","30","Select","Select",""],["","58657050916","GUAIFENESIN","LIQ 100\/5ML","473","Select","Select",""],["","42806071501","BENZONATATE","CAP 200MG","42","Select","Select",""],["","47781091601","DEXAMETHASON","TAB 6MG","10","Select","Select",""],["","00113365074","MUCUS ER MAX","TAB 1200MG","30","Select","Select",""],["","63824002336","MUCINEX","TAB 1200MG","30","Select","Select",""],["","00406012405","HYDROCO\/APAP","TAB 7.5-325","4","Select","Select",""],["","68180013501","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","00143980305","DOXYCYCL HYC","CAP 100MG","10","Select","Select",""],["","64380073706","VITAMIN D","2 1250 MCG","4","Select","Select",""],["","23155013525","DOXYCYC MONO","TAB 100MG","20","Select","Select",""],["","00067815202","VOLTAREN","GEL 0.01","50","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","00186037020","SYMBICORT","160-4.5MCG","30.6","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","00121086800","NYSTATIN","SUS 100000","160","Select","Select",""],["","00378428885","ELETRIPTAN","TAB 40MG","10","Select","Select",""],["","00527155201","BUT\/ASA\/CAFF","CAP ","18","Select","Select",""],["","00002143611","EMGALITY","INJ 120MG\/ML","2","Select","Select",""],["","31722072610","MONTELUKAST SODIUM","10 MG","90","Select","Select",""],["","65862020199","LOSARTAN POTASSIUM","25 MG","90","Select","Select",""],["","29300042301","AMITRIPTYLINE HCL","100 MG","30","Select","Select",""],["","23155005901","VERAPAMIL HCL","40 MG","60","Select","Select",""],["","68382009601","HYDROXYCHLOROQUINE SULFATE","200 MG","135","Select","Select",""],["","13668013605","ESCITALOPRAM OXALATE","10 MG","30","Select","Select",""],["","65862056099","PANTOPRAZOLE SODIUM","40 MG","90","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","00310737020","BUDESONIDE-FORMOTEROL FUMARATE","160-4.5MCG","30.6","Select","Select",""],["","31722088490","ROSUVASTATIN CALCIUM","20 MG","90","Select","Select",""],["","51672130005","AMMONIUM LACTATE","12 %","225","Select","Select",""],["","53746051401","SPIRONOLACTONE","50 MG","30","Select","Select",""],["","68462029201","VERAPAMIL ER","120 MG","30","Select","Select",""],["","43598081115","CETIRIZINE TAB","10MG","30","Select","Select",""],["","29300042301","AMITRIPTYLIN TAB","100MG","30","Select","Select",""],["","31722072690","MONTELUKAST TAB","10MG","90","Select","Select",""],["","65862047090","LOSARTAN\/HCT TAB","100-25","30","Select","Select",""],["","55111017915","TIZANIDINE TAB","2MG","30","Select","Select",""],["","68382009601","HYDROXYCHLOR TAB","200MG","45","Select","Select",""],["","65162006205","SUCRALFATE SUS","1GM\/10ML","600","Select","Select",""],["","42291076590","PANTOPRAZOLE TAB","40MG DR","90","Select","Select",""],["","68382091634","METHYLPRED TAB","4MG","21","Select","Select",""],["","31722088490","ROSUVASTATIN TAB","20MG","90","Select","Select",""],["","27808006502","PROMETH\/COD SOL","6.25-10","140","Select","Select",""],["","42806071501","BENZONATATE CAP","200MG","42","Select","Select",""],["","65862020199","LOSARTAN POT TAB","25MG","30","Select","Select",""],["","58657050916","GUAIFENESIN LIQ","100\/5ML","473","Select","Select",""],["","47781091601","DEXAMETHASON TAB","6MG","10","Select","Select",""],["","68462010905","TOPIRAMATE TAB","100MG","270","Select","Select",""],["","00172572960","FAMOTIDINE TAB","40MG","90","Select","Select",""],["","65162010150","GABAPENTIN CAP","100MG","90","Select","Select",""],["","00591544221","PREDNISONE PAK","10MG","21","Select","Select",""],["","63824002336","MUCINEX TAB","1200MG","30","Select","Select",""],["","00406012405","HYDROCO\/APAP TAB","7.5-325","4","Select","Select",""],["","00143980305","DOXYCYCL HYC CAP","100MG","10","Select","Select",""],["","68382005105","MELOXICAM TAB","15MG","90","Select","Select",""],["","43547028110","ESCITALOPRAM TAB","10MG","30","Select","Select",""],["","00113365074","MUCUS ER MAX TAB","1200MG","30","Select","Select",""],["","69452015120","VITAMIN D CAP","50000UNT","3","Select","Select",""],["","00310737020","BUDES\/FORMOT AER","160-4.5","10","Select","Select",""],["","23155013525","DOXYCYC MONO TAB","100MG","20","Select","Select",""],["","66689000816","NYSTATIN SUS","100000","160","Select","Select",""],["","00067815202","VOLTAREN GEL","1%","50","Select","Select",""],["","00186037020","SYMBICORT AER","160-4.5","10","Select","Select",""],["","00002143611","EMGALITY INJ","120MG\/ML","2","Select","Select",""],["","00378428885","ELETRIPTAN TAB","40MG","10","Select","Select",""],["","66993001968","ALBUTEROL AER HFA","","18","Select","Select",""],["","00527155201","BUT\/ASA\/CAFF CAP","","18","Select","Select",""],["","57237023305","SULFAMETHOXAZOLE-TRIMETHOPRIM","800-160 MG","14","Select","Select",""],["","63304069201","CLINDAMYCIN HCL","150 MG","42","Select","Select",""],["","60505470303","SOLIFENACIN SUCCINATE","10 MG","90","Select","Select",""],["","59746000103","METHYLPREDNISOLONE","4 MG","21","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":""}]}]}