{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DAVID CORRIGAN","gend":0,"add":"104 LAUREL CIR APT B","city":"CHARLOTTESVILLE","state":"VA","zip":"22903-9998","dob":"1959-12-20","age":"","mstatus":"","insh":"20067013*01","cliId":"","pno":4347601392,"cno":4347601392,"email":"","ename":"","eno":"","pphy":"MEMARI, MILAD MD","ppno":4349241931,"pcpadd":"1222 JEFFERSON PARK AVE,","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":"22903-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4342444451,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F10.20","F10.10","Z12.2","F39.","R10.13","Z72.0","I10.","Z23.","S42.402A","W10.1XXA","Y93.01","Y92.480","Z13.1","Z13.220","R94.5","H53.8","R04.0","H90.3","H91.90","R61.","R07.9","E87.1","I16.1","R79.89","E61.1","R60.0","K22.8","K44.9","R51.9","G89.29","R63.8","E55.9","Z01.00","E78.5","N40.1","H90.5","R35.0","I16.0","R05.9","E87.2","E22.2","J44.9","D50.9","F41.9","Z20.822","M50.30","F17.210","J06.9","I95.9","E63.9","Z79.899","R63.4","K22.70","K63.5","K52.9","Z87.19","R10.9","I25.2","K29.50","R39.9","Z12.5","N50.811","R23.4","S42.495A","V54.11","F10.230","R93.89","K92.1","Z87.891","M25.561","Z78.9","R19.5","R41.0","W10.8XXA"],"date":["2021-10-21","2022-07-08","2023-02-17","2023-05-19","2021-04-05","2023-05-19","2023-05-19","2023-05-19","2021-07-12","2021-07-12","2021-07-12","2021-07-12","2021-10-21","2023-05-19","2021-10-21","2021-10-21","2021-10-21","2022-03-22","2022-03-22","2022-05-24","2022-05-24","2022-07-08","2022-05-24","2022-07-08","2023-05-19","2022-07-08","2021-04-15","2021-04-15","2022-02-22","2022-02-22","2022-05-06","2023-05-19","2022-05-06","2022-05-06","2022-05-06","2022-05-06","2022-05-06","2022-05-22","2022-05-22","2022-05-22","2022-05-22","2022-05-22","2022-05-22","2022-05-22","2022-05-22","2022-05-22","2023-02-17","2022-05-22","2022-05-22","2022-05-22","2022-05-22","2021-03-16","2021-03-16","2021-03-16","2021-09-30","2021-09-30","2021-09-30","2022-05-22","2023-05-19","2022-01-10","2022-01-10","2022-01-10","2022-01-10","2021-07-27","2021-08-20","2022-05-23","2021-03-16","2021-03-16","2022-02-11","2023-09-07","2023-09-07","2023-09-07","2023-09-07","2023-09-07"],"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":[["","68180051303","LISINOPRIL","TAB 5MG","90","Select","Select",""],["","00378668910","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","10006073021","VITAMIN B1","TAB 100MG","90","Select","Select",""],["","51224020650","NALTREXONE","TAB 50MG","30","Select","Select",""],["","69097083312","SERTRALINE","TAB 25MG","180","Select","Select",""],["","51645090599","VITAMIN B-1","TAB 100MG","30","Select","Select",""],["","71930001752","ONDANSETRON","TAB 4MG","20","Select","Select",""],["","57237001405","TAMSULOSIN","CAP 0.4MG","60","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","20","Select","Select",""],["","66758095985","PROVENTIL","AER HFA","20","Select","Select",""],["","53191036201","D3-50","CAP 50000UNT","16","Select","Select",""],["","68382012205","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","51991074710","DULOXETINE","CAP 30MG","30","Select","Select",""],["","37205028887","SENTRY","TAB ","90","Select","Select",""],["","00093735598","FINASTERIDE","TAB 5MG","90","Select","Select",""],["","68382039801","POT CHLORIDE","TAB 20MEQ ER","60","Select","Select",""],["","00223176002","SOD CHLORIDE","TAB 1GM","180","Select","Select",""],["","69315012710","FOLIC ACID","1 MG","90","Select","Select",""],["","00904759180","FEROSUL","TAB 325MG","15","Select","Select",""],["","54629007501","MULTI-VIT\/","TAB MINERALS","90","Select","Select",""],["","00536466110","THEREMS-M","TAB ","30","Select","Select",""],["","31722070110","LOSARTAN POT","TAB 50MG","90","Select","Select",""],["","00378395205","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","75834002001","VITAMIN D3","CAP 50000UNT","4","Select","Select",""],["","00069108530","PAXLOVID","TAB 300-100","30","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","49281042250","FLUZONE QUAD","INJ 2022-23","0","Select","Select",""],["","51991074710","DULOXETINE HCL","30 MG","30","Select","Select",""],["","65862020299","LOSARTAN POTASSIUM","50 MG","90","Select","Select",""],["","75834002001","VITAMIN D","3 1250 MCG","4","Select","Select",""],["","68180096301","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","70436015301","POTASSIUM CHLORIDE","20 MEQ","60","Select","Select",""],["","00378668910","PANTOPRAZOLE SODIUM","40 MG","90","Select","Select",""],["","43598044874","NICOTINE PATCH","21 MG\/24HR","28","Select","Select",""],["","57237001405","TAMSULOSIN CAP","0.4MG","60","Select","Select",""],["","51224020650","NALTREXONE TAB","50MG","30","Select","Select",""],["","65862056099","PANTOPRAZOLE TAB","40MG","90","Select","Select",""],["","69097083312","SERTRALINE TAB","25MG","180","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","00536466110","THEREMS-M TAB","","30","Select","Select",""],["","00223176002","SOD CHLORIDE TAB","1GM","180","Select","Select",""],["","51991074710","DULOXETINE CAP","30MG","30","Select","Select",""],["","37205028787","SENTRY TAB SENIOR","","90","Select","Select",""],["","10006073021","VITAMIN B","1 TAB 100MG","90","Select","Select",""],["","00378395205","ATORVASTATIN TAB","40MG","30","Select","Select",""],["","68382039801","POT CHLORIDE TAB","20MEQ ER","180","Select","Select",""],["","53191036201","D","3-50 CAP 50000UNT","4","Select","Select",""],["","00093735598","FINASTERIDE TAB","5MG","90","Select","Select",""],["","68382012205","AMLODIPINE TAB","5MG","30","Select","Select",""],["","68180096301","ALBUTEROL AER HFA","","8","Select","Select",""],["","66758095985","PROVENTIL AER HFA","","7","Select","Select",""],["","00904759180","FEROSUL TAB","325MG","15","Select","Select",""],["","58657015110","FOLIC ACID TAB","1MG","90","Select","Select",""],["","54629007501","MULTI-VIT\/ TAB MINERALS","","30","Select","Select",""],["","37205028887","SENTRY TAB","","90","Select","Select",""],["","65862020299","LOSARTAN POT TAB","50MG","30","Select","Select",""],["","00069108530","PAXLOVID TAB","300-100","30","Select","Select",""],["","58160082311","SHINGRIX INJ","50\/0.5ML","1","Select","Select",""],["","49281042250","FLUZONE QUAD INJ","2022-23","0","Select","Select",""],["","10006073021","VITAMIN B-","1 100 MG","90","Select","Select",""],["","51224020650","NALTREXONE HCL","50 MG","90","Select","Select",""],["","00223176002","SODIUM CHLORIDE","1000 MG","180","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":""}]}]}