{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANNETTE  A CAINE","gend":1,"add":"1653 NORTH MAIN ST","city":"DANVILLE","state":"VA","zip":"24540-9998","dob":"1964-05-12","age":"","mstatus":"","insh":"2068771*01","cliId":"","pno":4344294553,"cno":4344294553,"email":"","ename":"","eno":"","pphy":"ADAMS, DAVID MD","ppno":4348573600,"pcpadd":"414 PARK AVE,","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":"24541-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4348573601,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R07.9","I25.10","R06.00","I10.","E11.65","E78.5","E66.9","J45.909","M17.9","M51.36","M54.10","F33.0","F41.9","R07.1","F33.9","M17.0","M25.562","M25.561","G89.4","N17.9","M18.0","M25.661","M25.662","M94.261","M94.262","F40.01","F41.1","F43.12","F40.240","F40.11","F29.","F43.23","V58.89","S90.122A","J45.901","J06.9","R05.9","Z20.822","N39.0","E11.9","Z91.040","Z88.8","Z91.018","Z91.048","R10.32","M17.11","M17.12","F41.0","Z53.21","H04.123","Z96.1","H10.45","Z12.11","D37.4","Z86.010","Z80.0","R73.09","R06.02","R00.0","I51.7","Z79.4","Z88.0","Z88.4","F43.10","M79.673","M20.10","M77.30","E11.40","M79.671","M20.11","M77.31","M20.41","M79.672","M20.12","M77.32","M20.42","E78.2","E55.9","M19.041","R09.81","R82.998","R51.9","Z01.810","R00.2","J20.9","H52.221","R10.84","R73.9","N93.9","Z12.4","R01.1","K63.5","S63.641A","S05.01XA","H11.151","H43.821","H52.4","Z11.59","R09.89","G47.33","F31.5"],"date":["2021-12-28","2021-10-26","2021-03-02","2023-06-21","2021-06-16","2021-06-16","2023-01-13","2021-06-16","2021-06-16","2021-06-16","2021-06-16","2023-04-13","2023-04-13","2021-12-28","2023-06-21","2023-05-25","2022-03-02","2022-03-02","2023-06-21","2021-02-25","2021-05-04","2021-06-09","2021-06-09","2021-07-13","2021-07-13","2021-10-05","2021-10-05","2021-10-05","2021-10-05","2021-10-05","2021-10-05","2022-10-17","2022-09-15","2022-09-15","2023-03-01","2023-03-01","2023-03-01","2023-03-01","2022-12-01","2023-05-25","2022-12-01","2022-12-01","2022-12-01","2022-12-01","2022-12-01","2023-01-13","2023-01-13","2021-05-01","2021-05-01","2023-03-30","2023-04-17","2021-07-01","2021-12-14","2021-12-30","2021-12-14","2021-12-14","2022-04-12","2021-02-24","2022-12-01","2021-02-24","2023-05-25","2021-12-28","2021-12-28","2023-02-16","2022-05-02","2022-05-02","2022-05-02","2022-05-02","2022-05-02","2022-05-02","2022-05-02","2022-05-02","2022-05-02","2022-05-02","2022-05-02","2022-05-02","2023-05-25","2023-05-25","2022-06-10","2022-11-18","2022-11-18","2021-03-25","2021-07-26","2021-07-26","2022-02-18","2022-04-14","2022-12-01","2022-12-01","2021-01-06","2021-01-06","2021-10-26","2021-12-14","2022-07-20","2023-03-30","2023-03-30","2023-04-17","2023-04-17","2023-05-25","2023-06-14","2023-05-25","2023-02-16"],"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":[["","50228017905","GABAPENTIN","CAP 100MG","90","Select","Select",""],["","55111012105","ATORVASTATIN","TAB 10MG","90","Select","Select",""],["","00173068220","VENTOLIN HFA","AER ","18","Select","Select",""],["","00173071820","FLOVENT HFA","AER 44MCG","11","Select","Select",""],["","16729021101","DOXAZOSIN","TAB 1MG","30","Select","Select",""],["","70010006310","METFORMIN","TAB 500MG","60","Select","Select",""],["","23155000901","HYDROCHLOROT","TAB 50MG","30","Select","Select",""],["","68382005105","MELOXICAM","TAB 15MG","30","Select","Select",""],["","67877019910","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","31722052110","HYDRALAZINE","TAB 50MG","90","Select","Select",""],["","49348098023","SM ASPIRIN","TAB 81MG EC","30","Select","Select",""],["","16729017217","AMITRIPTYLIN","TAB 25MG","60","Select","Select",""],["","00002879759","HUMALOG MIX","INJ 75\/25KWP","18","Select","Select",""],["","31722070290","LOSARTAN POT","TAB 100MG","30","Select","Select",""],["","61442010310","DICLOFENAC","TAB 75MG DR","22","Select","Select",""],["","41167075142","CAPZASIN-HP","CRE 0.001","42","Select","Select",""],["","59267100001","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","62332014231","CELECOXIB","CAP 200MG","30","Select","Select",""],["","00002823305","INSULIN LISP","INJ PROTAMIN","15","Select","Select",""],["","68180098103","LISINOPRIL","20 MG","30","Select","Select",""],["","64380080807","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","59651030901","FLUOXETINE","TAB 20MG","30","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","40","Select","Select",""],["","00228424106","CLONIDINE","TAB 0.1MG ER","60","Select","Select",""],["","50228046601","NABUMETONE","TAB 750MG","60","Select","Select",""],["","49884072703","DOXYCYC MONO","CAP 100MG","20","Select","Select",""],["","67877024210","QUETIAPINE","TAB 25MG","60","Select","Select",""],["","00002771559","BASAGLAR","INJ 100UNIT","15","Select","Select",""],["","70801000301","ZILRETTA","INJ 32MG","2","Select","Select",""],["","00093321992","KETOCONAZOLE","CRE 0.02","60","Select","Select",""],["","29300034905","ALLOPURINOL","TAB 100MG","30","Select","Select",""],["","11917014057","MELATONIN","TAB 5MG","30","Select","Select",""],["","68462010905","TOPIRAMATE","TAB 100MG","30","Select","Select",""],["","61314063006","NEO\/POLY\/DEX","SUS 0.1% OP","5","Select","Select",""],["","24208091055","ERYTHROMYCIN","OIN 5MG\/GM","4","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","14","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","70010019905","GUAIFENESIN","TAB 600MG ER","28","Select","Select",""],["","00067815203","VOLTAREN ARTHRITIS PAIN","1 %","500","Select","Select",""],["","76204060060","IPRATROPIUM-ALBUTEROL","0.5-3MG\/3","900","Select","Select",""],["","64980051505","OFLOXACIN","0.3 %","5","Select","Select",""],["","00002823305","INSULIN LISPRO PROTAMINE MIX","75-25\/ML","15","Select","Select",""],["","76204020030","ALBUTEROL SULFATE","2.5 MG\/3ML","270","Select","Select",""],["","29943000215","BLINK TEARS","0.25 %","15","Select","Select",""],["","70010019905","GUAIFENESIN ER","600 MG","20","Select","Select",""],["","83490031062","VIOS AEROSOL DELIVERY SYSTEM","","1","Select","Select",""],["","83490022137","PARI LC PLUS NEBULIZER","","1","Select","Select",""],["","69097052444","DICLOFENAC SODIUM","1 %","500","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","90 MCG","18","Select","Select",""],["","43598083005","ATORVASTATIN CALCIUM","10 MG","90","Select","Select",""],["","68180098103","LISINOPRIL TAB","20MG","30","Select","Select",""],["","29300013601","CLONIDINE TAB","0.2MG","30","Select","Select",""],["","55111012105","ATORVASTATIN TAB","10MG","90","Select","Select",""],["","00002879759","HUMALOG MIX INJ","75\/25KWP","18","Select","Select",""],["","49884072703","DOXYCYC MONO CAP","100MG","20","Select","Select",""],["","50228046601","NABUMETONE TAB","750MG","60","Select","Select",""],["","00002823305","INSULIN LISP INJ PROTAMIN","","15","Select","Select",""],["","70801000301","ZILRETTA INJ","32MG","2","Select","Select",""],["","16729021101","DOXAZOSIN TAB","1MG","30","Select","Select",""],["","00002771559","BASAGLAR INJ","100UNIT","15","Select","Select",""],["","70010006310","METFORMIN TAB","500MG","60","Select","Select",""],["","67877024201","QUETIAPINE TAB","25MG","60","Select","Select",""],["","29300034905","ALLOPURINOL TAB","100MG","30","Select","Select",""],["","00093321930","KETOCONAZOLE CRE","2%","60","Select","Select",""],["","11917014057","MELATONIN TAB","5MG","30","Select","Select",""],["","68382014005","TOPIRAMATE TAB","100MG","30","Select","Select",""],["","70010019905","GUAIFENESIN TAB","600MG ER","28","Select","Select",""],["","54629061500","MELATONIN SUB","5MG","30","Select","Select",""],["","68462037430","TOPIRAMATE CAP ER","100MG","30","Select","Select",""],["","61314063006","NEO\/POLY\/DEX SUS","0.1% OP","5","Select","Select",""],["","65862042005","SMZ\/TMP DS TAB","800-160","14","Select","Select",""],["","00574402435","ERYTHROMYCIN OIN","5MG\/GM","4","Select","Select",""],["","57237007710","ONDANSETRON TAB","4MG ODT","12","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":""}]}]}