{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHATNER  D WOMACK","gend":0,"add":"2003 CRAWFORD ROAD","city":"HALIFAX","state":"VA","zip":"24558-9998","dob":"1974-09-17","age":"","mstatus":"","insh":"2193346*01","cliId":"","pno":4342228445,"cno":4342228445,"email":"","ename":"","eno":"","pphy":"ROBERTS, MAURICE NP","ppno":4348354876,"pcpadd":"3130 HALIFAX ROAD SUITE C,","pcpcity":"SOUTH BOSTON","pcpstate":"VA","pcpzip":"24592-9998","pcpcounty":"","pcpid":"","pcpname":"GoDocs - South Boston","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4348354875,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","A74.9","R36.0","Z72.51","G47.00","A63.0","K92.1","C21.0","D50.9","C44.520","F17.200","Z79.899","K62.89","Z01.818","A41.9","C20.","I08.0","S31.839A","S36.60XA","G89.3","E87.70","D50.0","R10.32","D64.9","NO DATA","C44.82","N17.9","R11.2","Z43.3","Z93.3","S36.60XS","K61.1","T14.8XXA","C19.","F17.210","Z20.822","K62.5","R22.43","N50.89","T66.XXXS","R00.0","G89.29","E87.1","G89.18","Z00.00","U07.1","I21.3","R07.2","M54.9","L02.91","Z85.048","Z92.21","Z92.3","Z79.891","L08.9","N43.3","C21.8","K21.9","I11.9","I25.2","Z79.82","R07.9","F32.9","F41.9","D62.","E87.2","E86.0","N28.9","R10.9","F10.20","Z79.1","I20.1","D84.9","R07.89","T45.1X5A","T81.31XA","M62.81","Z00.8","Z82.49","Z82.3","Z53.29","R10.30","Z98.890","Z51.5","I30.9","R06.00","J98.11","R60.0","R06.02","R41.82","R06.6","D72.829","T81.40XA","R59.0","R79.82","I25.111","I11.0","I50.21","E78.5","Z86.16","N17.8","K56.7","S37.30XA","I97.3","K91.89","B07.9","K43.9","Z85.828","Z03.818","D70.1","R62.7","F10.10","E87.6","X58.XXXA","R52.","Z51.81","Z72.0","I50.9","M79.89","R11.0","R11.10","Z91.19","K66.0","F12.90","J30.2","K64.4","Z86.718","Z93.2","R58.","S31.30XA","K62.9","D63.0","D63.8","S31.109S","R63.0","S37.30XS","Z48.3","T81.41XA","I89.0","N39.0","Z97.8","R22.41","M79.604","R45.4","Z96.0"],"date":["2023-06-09","2021-02-01","2021-02-01","2021-02-01","2023-01-24","2023-06-21","2022-05-03","2023-06-21","2022-08-12","2023-06-08","2022-08-21","2023-02-22","2023-06-21","2022-06-03","2023-03-10","2023-06-21","2022-08-10","2022-09-28","2023-01-10","2023-06-21","2023-02-03","2023-06-01","2022-06-03","2023-06-08","2023-06-01","2022-06-15","2023-03-10","2022-07-19","2023-06-03","2023-03-28","2023-02-14","2023-02-14","2023-01-09","2023-01-05","2023-06-21","2023-02-22","2023-02-22","2023-01-31","2023-01-31","2023-02-17","2023-02-22","2023-06-15","2023-02-22","2023-06-16","2022-05-21","2022-08-20","2022-08-20","2022-08-20","2022-11-28","2022-11-28","2023-06-13","2022-12-29","2023-02-28","2023-06-21","2023-01-09","2023-02-14","2023-02-14","2023-05-04","2023-02-14","2023-02-28","2023-02-14","2023-03-16","2023-03-26","2023-03-26","2022-08-21","2022-07-19","2022-07-19","2023-01-05","2022-07-20","2022-08-20","2022-07-26","2022-08-10","2022-08-10","2022-08-20","2022-08-20","2023-03-28","2023-03-28","2022-05-21","2022-07-15","2022-07-15","2023-06-08","2022-07-19","2022-07-19","2022-08-11","2022-08-12","2022-05-11","2022-05-11","2023-06-21","2022-05-11","2022-05-21","2022-07-02","2023-02-28","2022-07-15","2023-06-13","2022-07-15","2022-08-20","2023-02-03","2022-08-20","2022-08-20","2022-08-20","2023-01-10","2023-02-28","2023-02-28","2023-02-28","2023-02-28","2023-02-28","2023-02-28","2022-09-14","2022-12-29","2023-01-05","2023-01-05","2023-01-05","2023-01-05","2023-01-05","2023-06-11","2023-06-15","2023-01-24","2023-02-03","2023-06-15","2021-09-20","2021-09-20","2022-03-30","2022-06-13","2023-06-21","2022-06-13","2022-08-21","2022-08-21","2022-08-21","2022-08-21","2023-01-04","2023-03-10","2022-06-06","2022-07-19","2023-06-21","2023-06-21","2023-06-01","2023-05-04","2023-06-08","2023-06-21","2023-06-08","2023-06-08","2023-06-08","2023-06-21","2023-06-21","2023-06-21"],"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":[["","00093101042","MUPIROCIN","2 %","22","Select","Select",""],["","67877019910","AMLODIPINE BESYLATE","10 MG","9","Select","Select",""],["","23155050201","HYDROXYZINE HCL","50 MG","30","Select","Select",""],["","00469260190","MYRBETRIQ","25 MG","5","Select","Select",""],["","00832601800","CHLORPROMAZINE HCL","25 MG","90","Select","Select",""],["","00281032630","NITRO-BID","2 %","30","Select","Select",""],["","50228014605","HYDROCHLOROTHIAZIDE","12.5 MG","30","Select","Select",""],["","70700015010","OMEPRAZOLE","20 MG","30","Select","Select",""],["","67877052730","SOLIFENACIN SUCCINATE","5 MG","30","Select","Select",""],["","00116200116","CHLORHEXIDINE GLUCONATE","0.12 %","473","Select","Select",""],["","42858000301","OXYCODONE HCL","15 MG","120","Select","Select",""],["","64380016202","OXYBUTYNIN CHLORIDE","5 MG","30","Select","Select",""],["","00406052301","OXYCODONE-ACETAMINOPHEN","10MG-325MG","120","Select","Select",""],["","50111056001","TRAZODONE HCL","50 MG","45","Select","Select",""],["","00378034501","DIAZEPAM","5 MG","2","Select","Select",""],["","69784018014","POLYETHYLENE GLYCOL","3350 17 G","6","Select","Select",""],["","00713063737","METRONIDAZOLE","0.75 %","45","Select","Select",""],["","43547040111","FUROSEMIDE","20 MG","4","Select","Select",""],["","68382025501","OXYBUTYNIN CHLORIDE ER","5 MG","30","Select","Select",""],["","65162027250","SULFAMETHOXAZOLE-TRIMETHOPRIM","800-160 MG","20","Select","Select",""],["","68462015713","ONDANSETRON ODT","4 MG","15","Select","Select",""],["","00781324664","ENOXAPARIN SODIUM","40MG\/0.4ML","4","Select","Select",""],["","49035029812","VEGETABLE LAXATIVE","8.6 MG","60","Select","Select",""],["","68645056354","IBUPROFEN","800 MG","60","Select","Select",""],["","68382037001","NYSTATIN","100000\/G","30","Select","Select",""],["","49884094499","VARENICLINE","0.5 (11)-1","53","Select","Select",""],["","49035030602","CLEARLAX","17 G\/DOSE","238","Select","Select",""],["","69547035302","NARCAN","4 MG","2","Select","Select",""],["","67877021905","CEPHALEXIN","500 MG","20","Select","Select",""],["","65862007701","CIPROFLOXACIN HCL","500 MG","1","Select","Select",""],["","49035032712","GENTLE LAXATIVE","5 MG","2","Select","Select",""],["","68645019059","METOPROL TAR","TAB 50MG","30","Select","Select",""],["","00832601800","CHLORPROMAZ","TAB 25MG","90","Select","Select",""],["","31722052001","HYDRALAZINE","TAB 25MG","60","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","30","Select","Select",""],["","00536468010","VITAMIN B-1","TAB 100MG","30","Select","Select",""],["","31722099701","HYDROCO\/APAP","TAB 10-325MG","120","Select","Select",""],["","67877021660","CEFUROXIME","TAB 500MG","20","Select","Select",""],["","00093216568","NALOXONE HCL","SPR ","2","Select","Select",""],["","66993096245","METRONIDAZOL","GEL 0.0075","45","Select","Select",""],["","00093117701","NEOMYCIN","TAB 500MG","6","Select","Select",""],["","49035032712","GENTLE LAXAT","TAB 5MG EC","4","Select","Select",""],["","49035019402","EQ NICOTINE","DIS 21MG\/24H","28","Select","Select",""],["","49348014370","SM CLEARLAX","POW ","238","Select","Select",""],["","49035030602","EQ CLEARLAX","POW ","238","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","40","Select","Select",""],["","43386048024","ORPHENADRINE","TAB 100MG ER","18","Select","Select",""],["","59726019003",""," ","30","Select","Select",""],["","16714008110","HYDROXYZ HCL","TAB 10MG","28","Select","Select",""],["","59746011506","PROCHLORPER","TAB 10MG","60","Select","Select",""],["","00143924920","AMOX\/K CLAV","TAB 875-125","14","Select","Select",""],["","00548560200","ENOXAPARIN","INJ 40\/0.4ML","10","Select","Select",""],["","00904699880","DOCUSATE SOD","CAP 100MG","60","Select","Select",""],["","10006073002","UREA 10 HYDR","CRE 0.1","85","Select","Select",""],["","00406324301","HYDROMORPHON","TAB 2MG","180","Select","Select",""],["","00093505998","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","60","Select","Select",""],["","00093220301","METOCLOPRAM","TAB 10MG","120","Select","Select",""],["","65162027250","SMZ\/TMP DS","TAB 800-160","21","Select","Select",""],["","63739019861","PEG 3350","POW ","7","Select","Select",""],["","72205000792","CAPECITABINE","TAB 500MG","180","Select","Select",""],["","55111015430","ONDANSETRON","TAB 8MG","60","Select","Select",""],["","68382056610","METOPROL SUC","TAB 100MG ER","30","Select","Select",""],["","68645051654","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","70010000201","COLCHICINE","TAB 0.6MG","30","Select","Select",""],["","00406052301","OXYCOD\/APAP","TAB 10-325MG","30","Select","Select",""],["","00406831501","MORPHINE SUL","TAB 15MG ER","60","Select","Select",""],["","49035046708","ASPIRIN 81MG","CHE WABLE TABLETS","90","Select","Select",""],["","79903006410","EQVEGETABLE","TAB 8.6MG","60","Select","Select",""],["","43598044828","NICOTINE TD","DIS 21MG\/24H","30","Select","Select",""],["","00904720660","SIMETHICONE","CHW 80MG","30","Select","Select",""],["","10006073002","UREA","10 HYDR CRE 10%","85","Select","Select",""],["","49035007860","EQ STOOL","CAP SOFTENER","60","Select","Select",""],["","68382013201","TAMSULOSIN","CAP 0.4MG","30","Select","Select",""],["","42858000201","OXYCODONE","TAB 10MG","30","Select","Select",""],["","57664050658","METOPROL TAR TAB","25MG","30","Select","Select",""],["","00832601800","CHLORPROMAZ TAB","25MG","90","Select","Select",""],["","70700015010","OMEPRAZOLE CAP","20MG","60","Select","Select",""],["","68645056354","IBUPROFEN TAB","800MG","90","Select","Select",""],["","49035091503","OMEPRAZOLE TAB","20MG","60","Select","Select",""],["","31722052001","HYDRALAZINE TAB","25MG","60","Select","Select",""],["","31722099701","HYDROCO\/APAP TAB","10-325MG","120","Select","Select",""],["","00093216568","NALOXONE HCL SPR","","2","Select","Select",""],["","49348014370","SM CLEARLAX POW","","238","Select","Select",""],["","49035030602","EQ CLEARLAX POW","","238","Select","Select",""],["","00093117701","NEOMYCIN TAB","500MG","6","Select","Select",""],["","00536468010","VITAMIN B-","1 TAB 100MG","30","Select","Select",""],["","50111033402","METRONIDAZOL TAB","500MG","3","Select","Select",""],["","49035032712","GENTLE LAXAT TAB","5MG EC","4","Select","Select",""],["","50111056001","TRAZODONE TAB","50MG","30","Select","Select",""],["","67877021660","CEFUROXIME TAB","500MG","20","Select","Select",""],["","00904699880","DOCUSATE SOD CAP","100MG","60","Select","Select",""],["","00548560200","ENOXAPARIN INJ","40\/0.4ML","10","Select","Select",""],["","00378251278","CAPECITABINE TAB","500MG","180","Select","Select",""],["","00406324301","HYDROMORPHON TAB","2MG","180","Select","Select",""],["","00406831501","MORPHINE SUL TAB","15MG ER","60","Select","Select",""],["","66993096245","METRONIDAZOL GEL","0.75%","45","Select","Select",""],["","68645051654","AMLODIPINE TAB","10MG","30","Select","Select",""],["","43386048024","ORPHENADRINE TAB","100MG ER","18","Select","Select",""],["","63304069301","CLINDAMYCIN CAP","300MG","40","Select","Select",""],["","63739019861","PEG","3350 POW","7","Select","Select",""],["","59746011506","PROCHLORPER TAB","10MG","60","Select","Select",""],["","00904720660","SIMETHICONE CHW","80MG","30","Select","Select",""],["","55111015430","ONDANSETRON TAB","8MG","60","Select","Select",""],["","00143924920","AMOX\/K CLAV TAB","875-125","14","Select","Select",""],["","31722071390","PANTOPRAZOLE TAB","40MG","60","Select","Select",""],["","68382056610","METOPROL SUC TAB","100MG ER","30","Select","Select",""],["","16714008110","HYDROXYZ HCL TAB","10MG","28","Select","Select",""],["","65162027250","SMZ\/TMP DS TAB","800-160","30","Select","Select",""],["","58980060530","UREA CRE","10%","85","Select","Select",""],["","00093505998","ATORVASTATIN TAB","20MG","30","Select","Select",""],["","00406052301","OXYCOD\/APAP TAB","10-325MG","120","Select","Select",""],["","49035019402","EQ NICOTINE DIS","21MG\/24H","28","Select","Select",""],["","42858000201","OXYCODONE TAB","10MG","30","Select","Select",""],["","00093220301","METOCLOPRAM TAB","10MG","120","Select","Select",""],["","49035046708","ASPIRIN","81MG CHEWABLE TABLETS","30","Select","Select",""],["","65162071009","COLCHICINE TAB","0.6MG","30","Select","Select",""],["","79903006410","EQVEGETABLE TAB","8.6MG","60","Select","Select",""],["","43598044828","NICOTINE TD DIS","21MG\/24H","30","Select","Select",""],["","49035007860","EQ STOOL CAP SOFTENER","","60","Select","Select",""],["","68382013201","TAMSULOSIN CAP","0.4MG","30","Select","Select",""],["","00281032630","NITRO-BID OIN","2%","30","Select","Select",""],["","68382037001","NYSTATIN POW","100000","30","Select","Select",""],["","00406324401","HYDROMORPHONE HCL","4 MG","45","Select","Select",""],["","63304045101","MORPHINE SULFATE ER","30 MG","45","Select","Select",""],["","00832027311","MORPHINE SULFATE","15 MG","120","Select","Select",""],["","70710111001","CYPROHEPTADINE HCL","4 MG","90","Select","Select",""],["","45963055650","GABAPENTIN","300 MG","90","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":""}]}]}