{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOYCE FULLER","gend":1,"add":"172 PEARL LN","city":"RUSTBURG","state":"VA","zip":"24588-9998","dob":"1968-08-24","age":"","mstatus":"","insh":"20067979*01","cliId":"","pno":4343325240,"cno":4343325240,"email":"","ename":"","eno":"","pphy":"KILEL, JENNIFER NP","ppno":4349475967,"pcpadd":"320 FEDERAL ST,","pcpcity":"LYNCHBURG","pcpstate":"VA","pcpzip":"24504-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4349475971,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M79.3","E11.9","E66.01","F17.210","Z79.82","Z88.6","Z79.899","R60.0","U07.1","J96.20","R04.2","NO DATA","R10.9","N17.9","E11.649","R51.9","R03.0","R79.89","Z87.09","R60.9","M79.672","E79.0","I27.81","E66.2","Z09.","I10.","M10.9","R09.02","L03.116","Z79.4","H57.13","E10.9","H16.423","M25.475","S40.861A","W57.XXXA","R06.02","R06.2","J96.21","E11.21","Z68.44","E87.5","E55.9","E53.9","Z79.84","R11.2","M79.89","R10.2","R00.1","J96.11","Z72.0","I95.9","G93.41","R19.7","E16.2","R77.8","E11.49","N17.0","D63.1","E86.1","E11.40","Z99.81","Z68.43","E11.22","M54.16","N39.43","E87.70","I12.9","E11.65","H91.90","M54.9","B35.1","L84.","L60.3","E11.42","G47.33","H66.92","H72.92","R57.9","H90.3","H61.23","H60.501","I48.91"],"date":["2021-08-31","2023-09-19","2023-09-19","2023-08-02","2022-01-22","2021-08-21","2021-08-21","2023-01-06","2023-08-26","2022-01-24","2022-01-24","2023-09-19","2021-08-21","2023-09-19","2023-08-02","2022-06-01","2022-06-01","2022-06-01","2022-06-01","2023-01-06","2022-07-07","2022-06-30","2023-09-14","2023-09-19","2022-06-24","2023-08-02","2022-07-25","2022-01-22","2022-07-01","2023-07-18","2022-06-03","2022-06-03","2022-06-03","2022-06-26","2021-08-09","2021-08-09","2021-08-09","2021-08-09","2023-08-03","2022-01-22","2023-07-30","2023-09-14","2023-01-06","2022-01-22","2022-01-22","2022-06-01","2023-01-06","2023-01-06","2023-09-19","2023-09-19","2023-09-19","2023-09-18","2023-08-03","2023-08-03","2023-08-03","2023-08-03","2023-07-31","2023-09-14","2023-08-02","2023-08-02","2023-08-02","2023-08-02","2023-09-14","2023-09-14","2023-09-19","2023-09-19","2023-09-14","2023-09-14","2023-09-14","2023-09-14","2023-09-19","2023-08-15","2023-08-15","2023-08-15","2023-08-15","2023-08-29","2023-07-18","2023-07-18","2023-07-31","2023-08-08","2023-08-08","2023-08-11","2023-09-18"],"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":[["","00002850101","HUMULIN R","INJ U-500","20","Select","Select",""],["","68645058459","METFORMIN","TAB 1000MG","60","Select","Select",""],["","43547040111","FUROSEMIDE","20 MG","30","Select","Select",""],["","68645055654","LISINOP\/HCTZ","TAB 10-12.5","30","Select","Select",""],["","08290324911","INSULIN SYRG","MIS 0.5\/31G","100","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA","100","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","59676058015","JANSSEN VACC","INJ COVID-19","0","Select","Select",""],["","68180065208","DOXYCYC MONO","CAP 100MG","20","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","80777027399","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","00904423960","MAGNESIUM","TAB 500MG","30","Select","Select",""],["","42858000101","OXYCODONE","TAB 5MG","12","Select","Select",""],["","65862007701","CIPROFLOXACN","TAB 500MG","20","Select","Select",""],["","57237004001","PENICILLN VK","TAB 250MG","28","Select","Select",""],["","00054418125","DEXAMETHASON","TAB 1MG","60","Select","Select",""],["","00002143380","TRULICITY","INJ 0.75\/0.5","2","Select","Select",""],["","70010000201","COLCHICINE","0.6 MG","90","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","15","Select","Select",""],["","50111078751","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","49035049860","EQ MUCUS ER","TAB 600MG","20","Select","Select",""],["","49035028338","EQ 12 HR MUC","TAB 600MG","20","Select","Select",""],["","53885024510","ONETOUCH ULTRA TEST STRIP","","100","Select","Select",""],["","68180096301","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","08290324911","VEO INSULIN SYRINGE","31GX15\/64\"","100","Select","Select",""],["","72578005518","DOXYCYCLINE HYCLATE","100 MG","20","Select","Select",""],["","68645058459","METFORMIN HCL","1000 MG","180","Select","Select",""],["","00574402435","ERYTHROMYCIN","5 MG\/GRAM","3.5","Select","Select",""],["","49035007021","MUCUS ER","600 MG","20","Select","Select",""],["","00093101042","MUPIROCIN","2 %","22","Select","Select",""],["","68645055654","LISINOPRIL-HYDROCHLOROTHIAZIDE","10-12.5 MG","30","Select","Select",""],["","00002850101","HUMULIN R U-","500 500\/ML","20","Select","Select",""],["","59746012206","MECLIZINE HCL","12.5 MG","90","Select","Select",""],["","68382005005","MELOXICAM","7.5 MG","30","Select","Select",""],["","00065042930","SYSTANE","0.3 %-0.4%","30","Select","Select",""],["","00002850101","HUMULIN R INJ U-","500","20","Select","Select",""],["","00054418125","DEXAMETHASON TAB","1MG","60","Select","Select",""],["","68645055654","LISINOP\/HCTZ TAB","10-12.5","30","Select","Select",""],["","43547040111","FUROSEMIDE TAB","20MG","30","Select","Select",""],["","08290324911","INSULIN SYRG MIS","0.5\/31G","60","Select","Select",""],["","53885024510","ONETOUCH TES ULTRA","","100","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","68645058459","METFORMIN TAB","1000MG","180","Select","Select",""],["","68180096301","ALBUTEROL AER HFA","","8","Select","Select",""],["","00002143380","TRULICITY INJ","0.75\/0.5","2","Select","Select",""],["","00904423960","MAGNESIUM TAB","500MG","30","Select","Select",""],["","57237004001","PENICILLN VK TAB","250MG","28","Select","Select",""],["","65862007701","CIPROFLOXACN TAB","500MG","20","Select","Select",""],["","42858000101","OXYCODONE TAB","5MG","12","Select","Select",""],["","70010000201","COLCHICINE TAB","0.6MG","30","Select","Select",""],["","59746017509","PREDNISONE TAB","20MG","15","Select","Select",""],["","67877021905","CEPHALEXIN CAP","500MG","28","Select","Select",""],["","68180065208","DOXYCYC MONO CAP","100MG","20","Select","Select",""],["","50111078751","AZITHROMYCIN TAB","250MG","6","Select","Select",""],["","49035028338","EQ","12 HR MUC TAB 600MG","20","Select","Select",""],["","49035049860","EQ MUCUS ER TAB","600MG","20","Select","Select",""],["","00143924920","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","20","Select","Select",""],["","99073070827","FREESTYLE LITE TEST STRIP","","100","Select","Select",""],["","68180016613","VANCOMYCIN HCL","125 MG","24","Select","Select",""],["","43598032675","CIPROFLOXACIN-DEXAMETHASONE","0.3 %-0.1%","7.5","Select","Select",""],["","59746000106","METHYLPREDNISOLONE","4 MG","3","Select","Select",""],["","29300035501","TRAMADOL HCL","50 MG","42","Select","Select",""],["","68645061090","LISINOPRIL","10 MG","30","Select","Select",""],["","00591352530","LIDOCAINE","5 %","10","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":""}]}]}