{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DANIEL RICKMAN","gend":0,"add":"1650 FIRST ST","city":"STAUNTON","state":"VA","zip":"24401-9998","dob":"1982-10-11","age":"","mstatus":"","insh":"2154489*01","cliId":"","pno":5402945157,"cno":5402945157,"email":"","ename":"","eno":"","pphy":"TRAN, GEORGE MD","ppno":5402457806,"pcpadd":"3881 CHURCHVILLE AVE,","pcpcity":"CHURCHVILLE","pcpstate":"VA","pcpzip":"24421-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5402139264,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R55.","S22.42XA","R06.02","K92.2","F10.10","K74.60","F39.","R07.9","F41.9","R18.8","R10.9","F10.20","I10.","D69.6","B18.2","Z09.","R07.89","K70.31","I85.11","Z20.822","K76.6","K31.89","K70.30","K21.9","K52.9","F17.200","Z88.1","Z79.899","Z86.010","Z87.11","R10.819","R11.0","Z99.89","E87.6","B19.20","F15.10","F17.210","R14.0","G89.29","R11.2","NO DATA","T50.991A","H10.212","Z87.19","Z87.442","R53.1","Z03.818","R10.13","I85.00","R10.84","E83.42","R16.0","F10.920","F10.129","R94.31","R00.0","K74.69","F15.21","E83.39","N30.91","K72.90","I85.10","R19.5","K70.11","E80.6","T78.49XA","S82.831A","S99.911A","Z98.890","Z87.891","Z88.3","R20.0","S82.401A","T85.631A","R10.0","D64.9","F32.9","Z88.8","R52.","R60.9","F10.239","J10.1","R20.2","D62.","Z86.19","Z91.5","E66.9","Z68.41","Z83.71","K92.0","Z79.1","I85.01","R42.","J40.","M94.0","D61.818","Z01.812","Z01.810","S82.61XA","V83.4XXA","K31.819","I25.2","F17.290","F90.9","Z71.6","R06.00","N20.0","N23.","K92.1","K29.80","F15.20","K72.00","E87.1","Z53.09","Z72.0","F90.2","S82.841A","V54.16","R10.10","Z13.9","E66.01","R09.02","R10.32","K65.2","D50.9","F90.1","I95.1","A41.9","R18.0","E87.70","Z86.16","R58.","T81.89XA","R10.11","R11.10","D70.9","R07.2","R77.0","K59.00","F15.90","R10.31","Z79.890","U07.1","S29.9XXA","R07.81","R60.0","S82.031A","Q21.8","J90.","J94.8","E43.","J96.01","D68.4","Z68.31","D53.9","Z90.49","R53.83","K70.9","J93.9","R07.1","I45.19","R03.0","D68.9","K76.81","F10.99","E44.1","Z68.30","I86.4","K76.9","J91.8","N20.1","Z99.81","Z71.89","J94.2","N17.9","J96.11","V62.84","R45.89","E87.5","F19.10","Z86.79"],"date":["2022-08-11","2021-01-09","2023-07-24","2022-06-13","2023-02-01","2023-07-25","2023-06-28","2023-05-08","2023-07-24","2023-07-25","2023-05-08","2023-07-11","2023-06-21","2023-06-30","2023-05-23","2022-06-28","2023-05-16","2023-07-24","2023-05-25","2023-02-14","2023-07-11","2023-05-23","2023-06-30","2023-05-16","2022-09-01","2022-09-03","2023-04-24","2023-06-16","2022-09-01","2022-09-01","2022-09-03","2023-06-12","2022-09-03","2023-03-13","2023-04-26","2022-12-07","2023-02-27","2023-04-19","2023-04-07","2023-04-19","2023-07-25","2022-11-29","2022-11-29","2023-05-08","2023-03-06","2023-03-14","2022-03-25","2023-06-16","2023-05-23","2023-04-07","2023-05-23","2022-05-17","2022-05-17","2023-02-07","2023-06-16","2022-08-07","2023-05-23","2022-10-24","2022-09-16","2022-10-12","2023-07-25","2023-07-11","2022-12-06","2023-03-22","2023-07-24","2021-01-18","2021-10-05","2022-03-14","2023-06-16","2023-06-12","2022-03-14","2022-03-14","2022-03-31","2022-08-09","2022-10-06","2023-05-23","2022-08-26","2023-04-24","2022-11-22","2022-11-22","2022-11-14","2022-11-16","2023-02-27","2021-01-15","2023-03-22","2021-01-14","2022-10-05","2022-06-09","2021-01-14","2023-06-01","2021-01-15","2022-07-26","2022-06-26","2021-06-03","2021-06-03","2022-06-09","2021-10-05","2021-10-05","2021-10-06","2021-10-06","2022-09-14","2022-12-07","2023-04-24","2023-05-16","2023-02-27","2023-07-12","2022-04-23","2022-04-23","2023-06-16","2022-06-09","2022-09-14","2022-10-24","2022-12-13","2021-05-17","2021-05-17","2021-07-10","2021-09-29","2021-10-21","2022-03-25","2022-06-09","2022-10-24","2022-08-06","2022-11-05","2022-10-24","2022-10-24","2022-10-24","2022-10-30","2022-11-16","2022-11-30","2022-12-13","2023-02-11","2022-03-25","2022-08-09","2023-07-24","2022-11-30","2022-11-16","2022-01-01","2022-09-23","2022-10-16","2022-10-19","2022-11-05","2022-12-07","2023-02-07","2021-01-25","2021-01-25","2021-01-25","2021-10-06","2023-04-26","2023-07-25","2023-07-25","2023-05-01","2023-05-01","2023-05-23","2023-04-24","2023-04-24","2023-04-24","2023-03-13","2023-03-13","2023-05-16","2023-05-16","2023-04-27","2023-05-16","2023-05-26","2023-05-01","2023-05-23","2023-05-23","2023-05-23","2023-05-23","2023-07-25","2023-07-25","2023-06-12","2023-06-21","2023-07-23","2023-07-23","2023-07-25","2023-06-30","2023-06-30","2023-06-28","2023-07-22","2023-07-25","2023-06-16"],"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":[["","16729018201","HYDROCHLOROT","TAB 12.5MG","7","Select","Select",""],["","50428661736","CVS ALLERGY","CAP 25MG","12","Select","Select",""],["","68180030260","CEFUROXIME","TAB 250MG","6","Select","Select",""],["","62135030901","CIPROFLOXACN","TAB 500MG","30","Select","Select",""],["","00172572880","FAMOTIDINE","20 MG","180","Select","Select",""],["","00591555510","PROPRANOLOL","TAB 20MG","270","Select","Select",""],["","59779001951","ALLERGY REL","CAP 25MG","12","Select","Select",""],["","59651000305","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","16729020201","BUSPIRONE","TAB 10MG","60","Select","Select",""],["","00228212750","CLONIDINE","TAB 0.1MG","30","Select","Select",""],["","69315012710","FOLIC ACID","1 MG","30","Select","Select",""],["","10006070011","VITAMIN B1","TAB 100MG","30","Select","Select",""],["","76385011050","CARVEDILOL","TAB 3.125MG","60","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","43547028010","ESCITALOPRAM","TAB 5MG","7","Select","Select",""],["","68462027030","ATOMOXETINE","CAP 80MG","30","Select","Select",""],["","13668033005","TRAZODONE","TAB 50MG","28","Select","Select",""],["","57237000830","MIRTAZAPINE","TAB 15MG","14","Select","Select",""],["","43547030303","ARIPIPRAZOLE","TAB 5MG","7","Select","Select",""],["","11845005651","B-1","TAB 100MG","21","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","20","Select","Select",""],["","00093005805","TRAMADOL HCL","TAB 50MG","20","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","40","Select","Select",""],["","00378668910","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","43547040111","FUROSEMIDE","20 MG","180","Select","Select",""],["","00555003302","CHLORDIAZEP","CAP 10MG","6","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","69315090501","LORAZEPAM","1 MG","30","Select","Select",""],["","65862009620","CEFPODOXIME","TAB 200MG","20","Select","Select",""],["","00121087316","LACTULOSE","10 G\/15 ML","3600","Select","Select",""],["","23155050110","HYDROXYZ HCL","TAB 25MG","30","Select","Select",""],["","50111064803","FLUOXETINE","CAP 20MG","90","Select","Select",""],["","00143312601","DICYCLOMINE","CAP 10MG","30","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","4","Select","Select",""],["","53746051405","SPIRONOLACT","TAB 50MG","90","Select","Select",""],["","80681007600","MULTIVITAMIN","TAB ","30","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","30","Select","Select",""],["","45963043864","ENULOSE","10 G\/15 ML","240","Select","Select",""],["","68462043518","ACAMPRO CAL","TAB 333MG","180","Select","Select",""],["","69238126601","OSELTAMIVIR","CAP 75MG","8","Select","Select",""],["","68462043518","ACAMPROSATE CALCIUM","333 MG","180","Select","Select",""],["","00245531911","KLOR-CON M","20 20 MEQ","7","Select","Select",""],["","00069108530","PAXLOVID (EUA)","300-100 MG","30","Select","Select",""],["","10702001801","OXYCODONE HCL","5 MG","20","Select","Select",""],["","42806016005","HYDROXYZINE HCL","25 MG","30","Select","Select",""],["","53746051501","SPIRONOLACTONE","100 MG","90","Select","Select",""],["","69097081312","GABAPENTIN","100 MG","180","Select","Select",""],["","50428031675","GAS RELIEF","80 MG","30","Select","Select",""],["","65862039010","ONDANSETRON ODT","4 MG","12","Select","Select",""],["","78670010001","CORGARD","20 MG","30","Select","Select",""],["","00603020922","MAGNESIUM OXIDE","400 MG","30","Select","Select",""],["","69097086707","NADOLOL","20 MG","90","Select","Select",""],["","65162006205","SUCRALFATE","1 G\/10 ML","420","Select","Select",""],["","62135030901","CIPROFLOXACIN HCL","500 MG","1","Select","Select",""],["","69238208105","PROPRANOLOL TAB","80MG","60","Select","Select",""],["","00378668910","PANTOPRAZOLE TAB","40MG","90","Select","Select",""],["","59651000305","OMEPRAZOLE CAP","40MG","30","Select","Select",""],["","23155050110","HYDROXYZ HCL TAB","25MG","30","Select","Select",""],["","69315011710","FUROSEMIDE TAB","40MG","90","Select","Select",""],["","00143312601","DICYCLOMINE CAP","10MG","30","Select","Select",""],["","13107008405","LORAZEPAM TAB","1MG","5","Select","Select",""],["","50111064803","FLUOXETINE CAP","20MG","90","Select","Select",""],["","00555003302","CHLORDIAZEP CAP","10MG","6","Select","Select",""],["","53746051401","SPIRONOLACT TAB","50MG","60","Select","Select",""],["","00121087332","LACTULOSE SOL","10GM\/15","1892","Select","Select",""],["","65862009620","CEFPODOXIME TAB","200MG","20","Select","Select",""],["","69315012710","FOLIC ACID TAB","1000MCG","30","Select","Select",""],["","68462015713","ONDANSETRON TAB","4MG ODT","20","Select","Select",""],["","10006070011","VITAMIN B","1 TAB 100MG","30","Select","Select",""],["","62135030901","CIPROFLOXACN TAB","500MG","30","Select","Select",""],["","65862042005","SMZ\/TMP DS TAB","800-160","30","Select","Select",""],["","53746010901","HYDROCO\/APAP TAB","5-325MG","4","Select","Select",""],["","69238126601","OSELTAMIVIR CAP","75MG","8","Select","Select",""],["","80681007600","MULTIVITAMIN TAB","","30","Select","Select",""],["","00378633380","ACAMPRO CAL TAB","333MG","180","Select","Select",""],["","45963043864","ENULOSE SOL","10GM\/15","240","Select","Select",""],["","70436001002","BUPROPION XL","150 MG","30","Select","Select",""],["","65162019050","NAPROXEN","500 MG","6","Select","Select",""],["","57237001401","TAMSULOSIN HCL","0.4 MG","7","Select","Select",""],["","55111015330","ONDANSETRON HCL","4 MG","30","Select","Select",""],["","00406324301","HYDROMORPHONE HCL","2 MG","30","Select","Select",""],["","27808008201","MORPHINE SULFATE","100 MG\/5ML","30","Select","Select",""],["","45802073030","ACETAMINOPHEN","650 MG","20","Select","Select",""],["","00378905593","LIDOCAINE","5 %","30","Select","Select",""],["","47781042447","FENTANYL","25 MCG\/HR","10","Select","Select",""],["","00574705050","BISACODYL","10 MG","5","Select","Select",""],["","42192033901","HYOSCYAMINE SULFATE","0.125 MG","30","Select","Select",""],["","00378967193","IPRATROPIUM-ALBUTEROL","0.5-3MG\/3","90","Select","Select",""],["","80681014800","MELATONIN","3 MG","30","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":""}]}]}