{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DIANA  H THOMPSON","gend":1,"add":"89 BELLE TERRE DR APT 303","city":"LYNCHBURG","state":"VA","zip":"24501-9998","dob":"1971-06-15","age":"","mstatus":"","insh":"2393620*01","cliId":"","pno":4344856582,"cno":4344856582,"email":"","ename":"","eno":"","pphy":"CARROLL, GINA J PA","ppno":4342003366,"pcpadd":"800 5TH STREET,","pcpcity":"LYNCHBURG","pcpstate":"VA","pcpzip":"24504-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4348472521,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D49.6","F41.9","J30.2","Z68.41","F33.41","Z51.0","D32.9","R05.","R00.2","I10.","Z20.822","F41.8","R11.0","C71.9","H04.123","H91.92","Z98.890","R51.9","E87.6","D72.829","Z71.2","D50.8","H90.72","H61.22","B97.21","S70.12XA","F10.20","R10.32","R00.1","N83.201","R79.89","Z98.84","R07.89","J02.9","H92.09","D64.9","R68.89","F39.","G93.89","M25.561","M17.11","R53.83","R10.13","Z91.14","R10.12","M15.9","NO DATA","R10.9","F11.20","Z72.89","E66.01","F33.9","R93.0","Z86.018","Z91.040","E66.9","W19.XXXA","F10.10","J01.90","M79.671","M25.571","M76.61","S00.03XA","S29.012A","W22.09XA","Z87.828","R73.09","Z11.3","R05.9","R19.7","R06.02","Z86.59","I65.22","R59.9","R07.9","Z86.011","Z86.2","E11.8","R53.82","H57.00","Z79.899","Z79.891","D32.0","R29.6","M50.10","H66.92","E78.5","E04.1","E55.9","R42.","R20.0","R10.2","N95.9","Z01.419","M47.812","M50.323","M50.322","M50.321","M54.10","M54.12","M54.2","R53.1","R55.","M43.12","M50.30","M92.61","S86.011A","G89.29","F32.9","H92.02","M25.60","U07.1","M50.31","Z09.","K59.09","Z87.898"],"date":["2021-06-11","2023-05-24","2023-05-24","2022-08-04","2021-07-12","2021-08-02","2023-04-24","2021-08-29","2022-07-14","2023-07-24","2023-03-14","2022-08-27","2022-07-14","2022-08-03","2022-08-03","2023-04-24","2023-06-12","2023-03-14","2022-08-15","2022-08-15","2022-08-15","2022-08-29","2023-07-19","2022-10-19","2022-10-28","2022-11-29","2023-03-23","2023-07-24","2023-04-21","2023-03-31","2023-03-14","2023-03-13","2023-03-14","2023-03-14","2023-03-14","2023-03-14","2021-11-03","2022-03-08","2022-02-01","2022-08-03","2023-02-28","2023-04-24","2022-08-27","2022-08-27","2022-08-27","2022-12-22","2023-03-31","2023-04-24","2023-03-15","2021-06-02","2022-03-08","2022-04-05","2021-11-03","2021-11-03","2021-11-03","2022-07-19","2022-11-29","2022-04-05","2022-05-19","2022-05-19","2023-05-11","2023-05-11","2022-11-02","2022-11-02","2022-11-02","2021-06-02","2022-08-09","2022-08-09","2023-02-27","2021-09-13","2022-07-14","2022-10-09","2021-06-09","2021-06-09","2023-04-24","2022-10-28","2021-08-04","2021-11-03","2021-11-03","2021-11-03","2023-03-18","2023-03-18","2023-06-12","2023-04-24","2023-04-24","2023-04-24","2023-04-24","2023-07-19","2023-04-24","2023-04-24","2023-04-24","2023-03-31","2023-03-31","2023-03-31","2023-07-21","2023-04-25","2023-04-18","2023-05-26","2023-04-22","2023-05-26","2023-07-21","2023-07-17","2023-04-21","2023-04-25","2023-07-21","2023-05-04","2023-07-17","2023-05-25","2023-06-13","2023-06-01","2023-07-21","2022-10-30","2023-05-26","2023-06-12","2023-07-14","2023-07-19"],"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":[["","69315090405","LORAZEPAM","TAB 0.5MG","30","Select","Select",""],["","59267100001","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","00054418125","DEXAMETHASON","TAB 1MG","28","Select","Select",""],["","55111015330","ONDANSETRON","TAB 4MG","15","Select","Select",""],["","70436015542","PROMETHAZINE","SOL DM","140","Select","Select",""],["","43547028111","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","57237002801","AMOXICILLIN","500 MG","42","Select","Select",""],["","00536109194","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","16571040250","CETIRIZINE","TAB 10MG","34","Select","Select",""],["","69230031703","ALLERGY RELF","TAB 10MG","30","Select","Select",""],["","16571082201","LORATADINE","10 MG","30","Select","Select",""],["","16729021716","SERTRALINE","TAB 100MG","30","Select","Select",""],["","81131031251","IRON","TAB 325MG","60","Select","Select",""],["","69315012710","FOLIC ACID","TAB 1000MCG","30","Select","Select",""],["","65862017260","TOPIRAMATE","TAB 50MG","60","Select","Select",""],["","50111078810","AZITHROMYCIN","TAB 500MG","5","Select","Select",""],["","68645051554","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","24208050707","LOTEMAX SM","GEL 0.0038","5","Select","Select",""],["","69097015915","MELOXICAM","15 MG","14","Select","Select",""],["","24208050307","LOTEMAX","GEL 0.005","5","Select","Select",""],["","11980022805","FML FORTE","SUS 0.25% OP","5","Select","Select",""],["","13668044201","CELECOXIB","200 MG","14","Select","Select",""],["","60758011905","PREDNISOLONE","SUS 1% OP","5","Select","Select",""],["","00065924007","DUREZOL","EMU 0.0005","5","Select","Select",""],["","17478083005","LOTEPREDNOL","GEL 0.005","5","Select","Select",""],["","00069034530","PAXLOVID","TAB 300-100","30","Select","Select",""],["","59267030402","PFIZER BIVAL","INJ BA4\/BA5","0","Select","Select",""],["","87701040729","VITAMIN B-1","TAB 100MG","21","Select","Select",""],["","00406117001","NALTREXONE","TAB 50MG","30","Select","Select",""],["","00228212750","CLONIDINE HCL","0.1 MG","60","Select","Select",""],["","69230031703","ALLERGY RELIEF","10 MG","30","Select","Select",""],["","16571020150","DICLOFENAC SODIUM","75 MG","60","Select","Select",""],["","69097083412","SERTRALINE HCL","50 MG","30","Select","Select",""],["","68382056928","ACAMPROSATE CALCIUM","333 MG","84","Select","Select",""],["","00093031401","KETOROLAC TROMETHAMINE","10 MG","8","Select","Select",""],["","68645051554","AMLODIPINE BESYLATE","5 MG","90","Select","Select",""],["","00406117003","NALTREXONE HCL","50 MG","14","Select","Select",""],["","69238207807","PROPRANOLOL HCL","20 MG","90","Select","Select",""],["","55111018015","TIZANIDINE HCL","4 MG","60","Select","Select",""],["","42806040021","METHYLPREDNISOLONE","4 MG","21","Select","Select",""],["","79854020010","VITAMIN B-","1 100 MG","28","Select","Select",""],["","00406012301","HYDROCODONE-ACETAMINOPHEN","5 MG-325MG","7","Select","Select",""],["","59651002655","AMOXICILLIN-CLAVULANATE POTASS","250-62.5\/5","150","Select","Select",""],["","72205001290","PREGABALIN","50 MG","60","Select","Select",""],["","50228017910","GABAPENTIN","100 MG","90","Select","Select",""],["","69452015120","VITAMIN D","2 1250 MCG","5","Select","Select",""],["","50111078810","AZITHROMYCIN TAB","500MG","5","Select","Select",""],["","70436015542","PROMETHAZINE SOL DM","","140","Select","Select",""],["","65862017260","TOPIRAMATE TAB","50MG","60","Select","Select",""],["","16571082201","LORATADINE TAB","10MG","30","Select","Select",""],["","16729021716","SERTRALINE TAB","100MG","30","Select","Select",""],["","69230031703","ALLERGY RELF TAB","10MG","30","Select","Select",""],["","29300039705","AMLODIPINE TAB","5MG","30","Select","Select",""],["","50383070016","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","57237002801","AMOXICILLIN TAB","500MG","20","Select","Select",""],["","24208029905","LOTEMAX SUS","0.5%","5","Select","Select",""],["","24208050707","LOTEMAX SM GEL","0.38%","5","Select","Select",""],["","60758011905","PREDNISOLONE SUS","1% OP","5","Select","Select",""],["","68382005005","MELOXICAM TAB","7.5MG","30","Select","Select",""],["","00065924007","DUREZOL EMU","0.05%","5","Select","Select",""],["","24208050307","LOTEMAX GEL","0.5%","5","Select","Select",""],["","11980022805","FML FORTE SUS","0.25% OP","5","Select","Select",""],["","50228015801","CELECOXIB CAP","200MG","30","Select","Select",""],["","17478083005","LOTEPREDNOL GEL","0.5%","5","Select","Select",""],["","59267030402","PFIZER BIVAL INJ BA","4\/BA5","0","Select","Select",""],["","00069034530","PAXLOVID TAB","300-100","30","Select","Select",""],["","00406117001","NALTREXONE TAB","50MG","30","Select","Select",""],["","49035030603","CLEARLAX","17 G\/DOSE","510","Select","Select",""],["","49035032712","GENTLE LAXATIVE","5 MG","2","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":""}]}]}