{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOHN M GODITT","gend":0,"add":"11199 DAKOTA LN","city":"HARRISONBURG","state":"VA","zip":"22802-9998","dob":"1967-03-28","age":"","mstatus":"","insh":"20066691*01","cliId":"","pno":5402364059,"cno":5402364059,"email":"","ename":"","eno":"","pphy":"GIBBS, CARLA A MD","ppno":5405647300,"pcpadd":"1661 S MAIN ST FL 1,","pcpcity":"HARRISONBURG","pcpstate":"VA","pcpzip":"22801-9998","pcpcounty":"","pcpid":"","pcpname":"SRMHMG - Sentara South Main Health Center","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7574317100,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S91.302A","L03.032","L97.522","E11.621","E11.21","B35.1","L60.3","M79.674","M79.675","L84.","E11.9","Z23.","I10.","G62.9","R33.9","E11.3393","D31.32","E11.69","L02.611","M00.9","L03.115","E11.40","L97.519","NO DATA","E11.649","E11.65","Z20.822","R74.8","R05.9","M10.9","F41.9","L03.90","A41.9","Z79.4","Z71.89","M86.9","J01.90","R22.41","T81.89XA","S91.301A","E10.621","K74.60","M19.90","E13.621","L97.509","F41.1","F32.9","E11.628","F17.290","E13.40","R60.0","R50.9","I36.1","I70.0","N17.9","R11.2","R55.","R42.","R07.89","L08.9","M43.06","M51.36","M54.16","M67.912","M43.16","T87.89","T87.44","A41.89","L03.031","G47.9","E78.00","Z79.2","Z79.84","Z79.1","K21.9","M47.26","Z89.439","R22.31","R11.0","R11.11","S92.332A","R22.42","M19.072","M20.12","M79.672","V54.16","V58.89","R39.13"],"date":["2022-05-16","2022-05-16","2022-05-25","2023-02-22","2022-12-13","2022-12-13","2022-12-13","2022-09-13","2022-09-13","2022-12-13","2023-04-18","2022-09-29","2023-09-07","2023-04-18","2023-09-25","2023-01-09","2023-01-09","2023-04-03","2023-02-17","2023-02-17","2023-04-15","2023-09-11","2023-02-17","2023-04-03","2023-02-17","2023-09-07","2023-02-17","2023-02-17","2023-02-17","2023-04-03","2023-04-03","2023-02-28","2023-02-28","2023-09-11","2023-02-17","2023-04-03","2022-12-30","2023-02-17","2023-04-01","2023-04-13","2022-05-19","2022-05-19","2022-05-19","2022-06-30","2022-06-30","2022-02-08","2022-02-08","2023-06-09","2023-03-04","2023-02-17","2023-02-17","2023-02-17","2023-02-19","2023-02-19","2023-04-18","2023-03-04","2023-04-14","2023-04-15","2023-04-14","2023-06-09","2023-06-23","2023-08-01","2023-06-23","2023-08-01","2023-08-01","2023-04-03","2023-04-03","2023-04-03","2023-04-03","2023-04-03","2023-04-03","2023-04-03","2023-04-03","2023-04-03","2023-09-07","2023-08-01","2023-08-01","2023-08-03","2023-03-04","2023-03-04","2023-08-31","2023-08-31","2023-08-31","2023-08-31","2023-09-11","2023-09-11","2023-09-11","2023-09-25"],"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":[["","59746017509","PREDNISONE","TAB 20MG","14","Select","Select",""],["","50228017805","GABAPENTIN","800 MG","120","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","15","Select","Select",""],["","50458014130","INVOKANA","300 MG","30","Select","Select",""],["","68645055754","LISINOP\/HCTZ","TAB 20-12.5","60","Select","Select",""],["","00093505898","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","27241009903","DULOXETINE","CAP 60MG","60","Select","Select",""],["","00169210125","NOVOLOG","INJ FLEX REL","30","Select","Select",""],["","73070010315","INSULIN ASPA","INJ FLEXPEN","30","Select","Select",""],["","68382005105","MELOXICAM","15 MG","90","Select","Select",""],["","56151146101","RELION TRUE","TES METRIX","100","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","100","Select","Select",""],["","56151146304","TRUE METRIX","TES GLUCOSE","100","Select","Select",""],["","53885004401","ONE TOUCH","KIT VERIO FL","1","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","100","Select","Select",""],["","00143928501","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","08290320749","BD PEN NEEDL","MIS 32GX6MM","90","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","68645056259","IBUPROFEN","TAB 600MG","21","Select","Select",""],["","69238110002","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","57599000101","FREESTYLE","KIT SENSOR","2","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","49502039475","INSULIN GLAR","INJ 100U\/ML","15","Select","Select",""],["","57599080300","FREESTY LIBR","MIS 2 READER","1","Select","Select",""],["","49502025175","SEMGLEE","INJ 100U\/ML","30","Select","Select",""],["","00093505898","ATORVASTATIN CALCIUM","40 MG","30","Select","Select",""],["","53885027210","ONETOUCH VERIO TEST STRIP","","100","Select","Select",""],["","42858000101","OXYCODONE HCL","5 MG","12","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","100\/ML (3)","15","Select","Select",""],["","68382013201","TAMSULOSIN HCL","0.4 MG","30","Select","Select",""],["","00169210125","NOVOLOG FLEXPEN","100\/ML (3)","12","Select","Select",""],["","31722072320","LEVOFLOXACIN","750 MG","14","Select","Select",""],["","72578005518","DOXYCYCLINE HYCLATE","100 MG","20","Select","Select",""],["","56151146004","TRUE METRIX GLUCOSE TEST STRIP","","100","Select","Select",""],["","43547035311","LISINOPRIL","10 MG","30","Select","Select",""],["","08290320749","ULTRA-FINE MICRO PEN NEEDLE","32 GX 1\/4\"","100","Select","Select",""],["","29300039705","AMLODIPINE BESYLATE","5 MG","30","Select","Select",""],["","27241009903","DULOXETINE HCL","60 MG","60","Select","Select",""],["","49502025175","SEMGLEE (YFGN) PEN","100\/ML (3)","30","Select","Select",""],["","73070010315","INSULIN ASPA INJ FLEXPEN","","30","Select","Select",""],["","00169633910","NOVOLOG INJ FLEXPEN","","15","Select","Select",""],["","27241009903","DULOXETINE CAP","60MG","60","Select","Select",""],["","68645055754","LISINOP\/HCTZ TAB","20-12.5","60","Select","Select",""],["","00093505898","ATORVASTATIN TAB","40MG","30","Select","Select",""],["","00088221905","LANTUS SOLOS INJ","100\/ML","15","Select","Select",""],["","50458014130","INVOKANA TAB","300MG","30","Select","Select",""],["","68382005105","MELOXICAM TAB","15MG","30","Select","Select",""],["","50228017805","GABAPENTIN TAB","800MG","120","Select","Select",""],["","56151146304","TRUE METRIX TES GLUCOSE","","100","Select","Select",""],["","53885027210","ONETOUCH TES VERIO","","100","Select","Select",""],["","56151146101","RELION TRUE TES METRIX","","100","Select","Select",""],["","53885004401","ONE TOUCH KIT VERIO FL","","1","Select","Select",""],["","53885019401","ONETOUCH KIT VERIO FL","","1","Select","Select",""],["","53885000810","ONETOUCH DEL MIS PLUS","33G","100","Select","Select",""],["","08290320749","BD PEN NEEDL MIS","32GX6MM","90","Select","Select",""],["","67877021905","CEPHALEXIN CAP","500MG","40","Select","Select",""],["","31722099601","HYDROCO\/APAP TAB","5-325MG","12","Select","Select",""],["","68645056259","IBUPROFEN TAB","600MG","21","Select","Select",""],["","69238110002","DOXYCYCL HYC CAP","100MG","20","Select","Select",""],["","00781261305","AMOXICILLIN CAP","500MG","21","Select","Select",""],["","49502039475","INSULIN GLAR INJ","100U\/ML","15","Select","Select",""],["","00169210125","NOVOLOG INJ FLEX REL","","15","Select","Select",""],["","57599080300","FREESTY LIBR MIS","2 READER","1","Select","Select",""],["","57599000101","FREESTYLE KIT SENSOR","","2","Select","Select",""],["","00143928501","AMOXICILLIN TAB","875MG","20","Select","Select",""],["","49502025175","SEMGLEE INJ","100U\/ML","30","Select","Select",""],["","57599081800","FREESTYLE LIBRE","3 SENSOR","2","Select","Select",""],["","00093216568","NALOXONE HCL","4 MG","2","Select","Select",""],["","70700015010","OMEPRAZOLE","20 MG","90","Select","Select",""],["","68645055854","LISINOPRIL-HYDROCHLOROTHIAZIDE","20 MG-25MG","90","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":""}]}]}