{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHAUTIA CARTER","gend":1,"add":"218 BRIARWOOD DR APT 102","city":"DANVILLE","state":"VA","zip":"24540-9998","dob":"1985-12-22","age":"","mstatus":"","insh":"7492553*01","cliId":"","pno":4342033775,"cno":4342033775,"email":"","ename":"","eno":"","pphy":"BEATTY, GARRETT DO","ppno":4347994488,"pcpadd":"SUITE 201 109 BRIDGE STREET,","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":"24541-9998","pcpcounty":"","pcpid":"","pcpname":"Sovah Family Medical Residency Clinic","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4347736977,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O44.13","M54.31","Z3A.30","Z37.0","U07.1","Z20.822","R50.9","R05.9","F41.9","I10.","J45.909","R11.2","V62.84","F14.10","F32.9","K80.80","K80.10","K42.9","K80.18","L03.011","R51.9","R06.02","G43.909","K92.2","D64.9","K29.70","NO DATA","F41.0","F17.210","R07.9","R10.13","F41.8","K92.1","R10.32","K21.9","K58.1","F41.1","Z83.71","R63.4","R63.0","D50.9","T50.995A","R42.","F33.2","Z20.828","O99.335","O99.325","Z01.89","O09.523","T39.1X2A","O10.02","O99.324","O99.334","O10.92","O80.","K80.20","R10.9","R07.89","J18.9","O44.02","O99.012","O99.212","O10.012","O99.612","O99.332","Z3A.27","E66.9","Z68.41","K59.00","R10.84","N20.0","Z09.","K62.5","E87.6","K29.50","K58.9","E66.01","Z68.39","J40.","T14.91XA","F33.9","T50.991A","O44.03","Z72.0","M54.5","K30.","K29.00","Z86.16","Z85.028","R53.83","I16.0","Z01.818","R53.1","F98.5","R93.89","G43.809","I16.1","F14.129","I66.03","R47.1","Z68.36","Z79.899","F44.4","R13.10","G43.709","R52.","R55.","R23.1","T40.5X2A","T46.1X2A","T46.5X2A","T45.0X2A","T36.8X2A","T43.222A","F12.10","Z28.310","Z68.42","K80.71","G43.009","F17.200","O44.33","N93.9","L98.9","R11.0","Z11.7","H93.8X1","I77.6","S09.90XA","W21.03XA","Z86.73","Z79.02","I67.81","I63.50","F44.7","F10.129","I11.9","R47.9","S46.002A","G47.9","J02.9","R05.1","R19.7","N17.9"],"date":["2021-07-19","2021-07-13","2021-07-19","2021-07-20","2022-02-01","2023-01-01","2022-11-04","2022-01-13","2023-01-01","2023-09-02","2022-12-13","2022-05-28","2022-09-17","2023-01-03","2023-05-16","2022-10-24","2022-11-01","2022-11-08","2022-11-08","2022-12-09","2023-01-01","2021-02-17","2023-05-16","2022-03-19","2022-06-04","2022-05-20","2023-01-01","2022-05-22","2023-04-02","2022-11-04","2022-07-06","2022-07-08","2022-07-06","2022-07-06","2022-07-06","2022-07-06","2023-01-03","2022-07-06","2022-07-06","2022-07-06","2022-08-02","2022-12-18","2022-12-18","2023-08-21","2021-03-02","2021-07-20","2021-07-20","2022-05-17","2022-05-28","2022-10-06","2021-07-19","2021-07-19","2021-07-19","2021-07-19","2021-07-19","2022-10-15","2022-10-15","2023-01-01","2022-11-04","2021-06-22","2021-06-22","2021-06-22","2021-06-22","2021-06-22","2021-06-22","2021-06-22","2023-01-19","2022-12-15","2022-03-11","2022-10-04","2022-07-08","2022-03-11","2022-03-11","2023-09-02","2022-05-20","2022-05-20","2023-05-16","2022-05-20","2022-06-04","2022-10-04","2022-10-04","2022-10-04","2021-07-13","2021-07-13","2021-07-13","2022-05-20","2022-05-20","2022-07-08","2022-08-10","2023-05-16","2022-10-06","2022-11-03","2023-09-02","2022-12-15","2022-12-15","2023-01-01","2023-01-01","2023-01-01","2023-01-01","2023-01-19","2023-01-01","2023-01-01","2023-01-03","2023-01-03","2023-01-03","2022-08-10","2022-08-10","2022-08-10","2022-10-04","2022-10-04","2022-10-04","2022-10-04","2022-10-04","2022-10-04","2022-10-04","2022-12-15","2023-05-16","2022-10-15","2023-01-19","2023-07-30","2021-07-16","2021-10-11","2021-10-11","2022-02-01","2022-02-01","2022-08-22","2023-01-11","2023-04-02","2023-04-02","2023-04-02","2023-04-02","2023-09-02","2023-09-08","2023-09-18","2023-07-30","2022-12-15","2023-09-02","2023-05-16","2023-05-16","2023-08-23","2023-08-23","2023-08-23","2023-09-02"],"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":[["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","15","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","24","Select","Select",""],["","00904671960","ACETAMINOPHE","TAB 325MG","100","Select","Select",""],["","68682010810","NIFEDIPINE","TAB 30MG ER","30","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","10","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","60","Select","Select",""],["","00406051205","OXYCOD\/APAP","TAB 5-325MG","18","Select","Select",""],["","69097083512","SERTRALINE","TAB 100MG","30","Select","Select",""],["","66689000802","NYSTATIN","SUS 100000","60","Select","Select",""],["","23155000910","HYDROCHLOROT","TAB 50MG","30","Select","Select",""],["","68382079801","LABETALOL","TAB 100MG","28","Select","Select",""],["","70710122701","AMITRIPTYLIN","TAB 50MG","30","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","62332002991","LOSARTAN POT","TAB 100MG","90","Select","Select",""],["","50428038158","VITAMIN C","TAB 500MG","30","Select","Select",""],["","00536100901","FERROUS SULF","TAB 325MG","90","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","14","Select","Select",""],["","68180016011","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","43386031208","GAVILAX","POW ","238","Select","Select",""],["","50428037837","CVS SENNA PL","TAB 8.6-50MG","120","Select","Select",""],["","00378668977","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","55111078401","FEXOFENADINE","TAB 180MG","15","Select","Select",""],["","70436015301","POT CHLORIDE","TAB 20MEQ ER","10","Select","Select",""],["","59779030602","CVS PURELAX","POW ","238","Select","Select",""],["","42806016005","HYDROXYZ HCL","TAB 25MG","30","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","45802086802","POLYETH GLYC","POW 3350 NF","238","Select","Select",""],["","63736012301","VITRON-C","TAB 65-125","60","Select","Select",""],["","00591079501","DICYCLOMINE","TAB 20MG","40","Select","Select",""],["","10572030201","PEG-3350\/KCL","SOL \/SODIUM","4000","Select","Select",""],["","00456120130","LINZESS","CAP 145MCG","30","Select","Select",""],["","82607066026","FLOWFLEX","KIT TEST","8","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","20","Select","Select",""],["","00536589488","NICOTINE TD","DIS 7MG\/24HR","28","Select","Select",""],["","57664049983","MIRTAZAPINE","15 MG","30","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","30","Select","Select",""],["","11877001140","BINAXNOW COV","KIT HOME TES","2","Select","Select",""],["","27241009706","DULOXETINE","CAP 20MG","60","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","242","Select","Select",""],["","65862051601","NAPROXEN SOD","TAB 550MG","20","Select","Select",""],["","70436001002","BUPROPN HCL","TAB 150MG XL","30","Select","Select",""],["","62756052269","SUMATRIPTAN","TAB 100MG","30","Select","Select",""],["","59779044374","CVS NICOTINE","DIS 7MG\/24HR","28","Select","Select",""],["","65162052110","PROMETHAZINE","TAB 25MG","30","Select","Select",""],["","69097012203","TOPIRAMATE","25 MG","60","Select","Select",""],["","68180072103","AMLODIPINE BESYLATE","10 MG","30","Select","Select",""],["","72618300002","NURTEC ODT","75 MG","16","Select","Select",""],["","42806016005","HYDROXYZINE HCL","25 MG","90","Select","Select",""],["","65862035790","CLOPIDOGREL","75 MG","30","Select","Select",""],["","53746052101","PROMETHAZINE HCL","25 MG","30","Select","Select",""],["","69097083512","SERTRALINE HCL","100 MG","30","Select","Select",""],["","23155000910","HYDROCHLOROTHIAZIDE","50 MG","30","Select","Select",""],["","49483034010","ACETAMINOPHEN","325 MG","14","Select","Select",""],["","70436001002","BUPROPION XL","150 MG","5","Select","Select",""],["","49483048112","ASPIRIN EC","81 MG","30","Select","Select",""],["","69452034572","SUMATRIPTAN SUCCINATE","50 MG","18","Select","Select",""],["","62332002991","LOSARTAN POTASSIUM","100 MG","90","Select","Select",""],["","27241009706","DULOXETINE HCL","20 MG","60","Select","Select",""],["","70710122701","AMITRIPTYLINE HCL","50 MG","30","Select","Select",""],["","82607066026","FLOWFLEX COVID-","19 AG HOME TEST","8","Select","Select",""],["","50111056001","TRAZODONE HCL","50 MG","30","Select","Select",""],["","60008040780","INDICAID COVID-","19 AG HOME TEST","8","Select","Select",""],["","69452015120","VITAMIN D","2 1250 MCG","12","Select","Select",""],["","65162019050","NAPROXEN","500 MG","14","Select","Select",""],["","72888003405","CARVEDILOL","3.125 MG","20","Select","Select",""],["","70436015542","PROMETHAZINE-DM","6.25-15\/5","118","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":""}]}]}