{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CATHY GAINES","gend":1,"add":"1231 WHITE OAK FORK CHURCH ROAD","city":"VIRGILINA","state":"VA","zip":"24598-9998","dob":"1969-04-06","age":"","mstatus":"","insh":"20084251*01","cliId":"","pno":4344708019,"cno":4344708019,"email":"","ename":"","eno":"","pphy":"OTERO-TRUITT, TESSIE MD","ppno":4345755864,"pcpadd":"2210 WILBORN AVENUE,","pcpcity":"SOUTH BOSTON","pcpstate":"VA","pcpzip":"24592-9998","pcpcounty":"","pcpid":"","pcpname":"Halifax Endocrinology & Osteoporosis Center, PC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4345758929,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["NO DATA","J01.10","Z20.822","R07.81","F41.8","N39.0","R30.0","E11.42","Z79.4","I10.","E78.5","E66.9","Z13.30","M54.42","J06.9","M54.32","M72.2","M79.671","M79.672","E10.49","E11.69","E66.01","Z68.38","N30.00","F31.81","E78.2","M54.40","G89.29","M62.838","M54.16","M54.9","K64.4","K62.89","M25.559","H04.123","E11.3293","H52.4"],"date":["2023-08-31","2023-03-18","2023-03-18","2023-03-18","2023-04-20","2023-04-20","2023-04-20","2023-06-27","2023-06-27","2023-06-27","2023-06-27","2023-06-27","2023-02-10","2022-09-01","2023-03-18","2023-08-31","2022-08-10","2022-08-10","2022-08-10","2022-08-10","2022-11-29","2022-11-29","2022-11-29","2022-09-23","2023-03-02","2022-11-29","2022-11-29","2023-08-31","2023-03-09","2023-08-31","2023-08-31","2023-07-05","2023-07-05","2023-08-31","2023-08-22","2023-08-22","2023-08-22"],"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":[["","00169185275","NOVOFINE AUT","MIS 30GX8MM","200","Select","Select",""],["","59746033890","LOSARTAN\/HCT","TAB 100-12.5","90","Select","Select",""],["","08290320109","BD PEN NEEDL","MIS 31GX8MM","100","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","15","Select","Select",""],["","00002879959","HUMALOG KWIK","INJ 100\/ML","15","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00002822259","INSULIN LISP","INJ 100\/ML","15","Select","Select",""],["","00093505998","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","13668021830","ARIPIPRAZOLE","10 MG","90","Select","Select",""],["","16714057702","ALLOPURINOL","300 MG","30","Select","Select",""],["","68645051654","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","65162019011","NAPROXEN","TAB 500MG","60","Select","Select",""],["","57599080000","FREESTY LIBR","KIT 2 SENSOR","2","Select","Select",""],["","68382005005","MELOXICAM","TAB 7.5MG","30","Select","Select",""],["","70710128605","BACLOFEN","20 MG","14","Select","Select",""],["","00603533815","PREDNISONE","PAK 10MG","21","Select","Select",""],["","65162027250","SMZ\/TMP DS","TAB 800-160","10","Select","Select",""],["","00002318280","TRULICITY","4.5 MG\/0.5","2","Select","Select",""],["","16729044416","BUPROPN HCL","TAB 300MG XL","30","Select","Select",""],["","16729017217","AMITRIPTYLIN","TAB 25MG","90","Select","Select",""],["","29300041519","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","49502039475","INSULIN GLAR","INJ 100U\/ML","15","Select","Select",""],["","57237002801","AMOXICILLIN","500 MG","14","Select","Select",""],["","00169431430","RYBELSUS","14 MG","30","Select","Select",""],["","00169185275","NOVOFINE AUTOCOVER","30GX1\/3\"","200","Select","Select",""],["","55111014512","FLUCONAZOLE","150 MG","1","Select","Select",""],["","57599080000","FREESTYLE LIBRE","2 SENSOR","2","Select","Select",""],["","65162083366","DICLOFENAC SODIUM","1 %","100","Select","Select",""],["","65162027250","SULFAMETHOXAZOLE-TRIMETHOPRIM","800-160 MG","14","Select","Select",""],["","16729044416","BUPROPION XL","300 MG","30","Select","Select",""],["","49502039475","INSULIN GLARGINE-YFGN","100\/ML (3)","15","Select","Select",""],["","59746033890","LOSARTAN-HYDROCHLOROTHIAZIDE","100-12.5MG","90","Select","Select",""],["","00093505998","ATORVASTATIN CALCIUM","20 MG","30","Select","Select",""],["","29300042010","AMITRIPTYLINE HCL","25 MG","90","Select","Select",""],["","65162068110","PHENAZOPYRIDINE HCL","100 MG","12","Select","Select",""],["","68645051654","AMLODIPINE BESYLATE","10 MG","90","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","100\/ML (3)","15","Select","Select",""],["","42806071401","BENZONATATE","100 MG","30","Select","Select",""],["","00002822259","INSULIN LISPRO KWIKPEN U-","100 100\/ML","9","Select","Select",""],["","00093505998","ATORVASTATIN TAB","20MG","30","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","00002879959","HUMALOG KWIK INJ","100\/ML","15","Select","Select",""],["","00088221905","LANTUS SOLOS INJ","100\/ML","15","Select","Select",""],["","57599080000","FREESTY LIBR KIT","2 SENSOR","2","Select","Select",""],["","13668021730","ARIPIPRAZOLE TAB","5MG","30","Select","Select",""],["","68382005005","MELOXICAM TAB","7.5MG","30","Select","Select",""],["","16714004211","ALLOPURINOL TAB","300MG","30","Select","Select",""],["","08290320109","BD PEN NEEDL MIS","31GX8MM","100","Select","Select",""],["","59746033890","LOSARTAN\/HCT TAB","100-12.5","90","Select","Select",""],["","00169185275","NOVOFINE AUT MIS","30GX8MM","200","Select","Select",""],["","00832105415","BACLOFEN TAB","10MG","30","Select","Select",""],["","68645051654","AMLODIPINE TAB","10MG","30","Select","Select",""],["","00002822259","INSULIN LISP INJ","100\/ML","9","Select","Select",""],["","00002318280","TRULICITY INJ","4.5\/0.5","2","Select","Select",""],["","69097087612","BUPROPN HCL TAB","300MG XL","30","Select","Select",""],["","16729017217","AMITRIPTYLIN TAB","25MG","90","Select","Select",""],["","65162027250","SMZ\/TMP DS TAB","800-160","10","Select","Select",""],["","65162019011","NAPROXEN TAB","500MG","60","Select","Select",""],["","49502039475","INSULIN GLAR INJ","100U\/ML","15","Select","Select",""],["","00603533815","PREDNISONE PAK","10MG","21","Select","Select",""],["","29300041519","CYCLOBENZAPR TAB","10MG","30","Select","Select",""],["","00781261305","AMOXICILLIN CAP","500MG","30","Select","Select",""],["","00143924920","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","20","Select","Select",""],["","00713050324","ANUCORT-HC","25 MG","14","Select","Select",""],["","00093031401","KETOROLAC TROMETHAMINE","10 MG","10","Select","Select",""],["","00078091112","XIIDRA","5 %","60","Select","Select",""],["","51672127501","CLOTRIMAZOLE","1 %","15","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":""}]}]}