{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KYAH TAYLOR","gend":1,"add":"50 LOCUST LN","city":"RUCKERSVILLE","state":"VA","zip":"22968-9998","dob":"2003-09-02","age":"","mstatus":"","insh":"8904677*01","cliId":"","pno":4349909414,"cno":4349909414,"email":"","ename":"","eno":"","pphy":"CHANG, ANDREW S MD","ppno":4345899030,"pcpadd":"2335 SEMINOLE LN STE 200,","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":"22901-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4345899040,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O24.112","E11.9","Z79.4","V23.89","Z3A.20","Z3A.21","O28.8","O24.113","Z3A.31","O76.","O24.119","O77.0","Z3A.37","Z37.0","K08.89","M54.6","R10.13","E11.65","K85.90","R10.9","Z79.899","O24.92","F32.9","O99.344","E11.22","N18.9","Z91.5","Z83.49","Z83.3","Z82.79","Z82.49","Z14.1","Z77.22","F41.9","O99.893","R51.9","O90.89","M54.5","O24.13","O26.893","R42.","Z3A.29","Z3A.35","L02.214","K29.00","NO DATA","R16.0","K85.00","Z3A.19","Z34.02","V23.9","O24.812","O24.12","O99.892","O99.214","E66.9","N94.89","N83.292","A60.9","S93.602A","O24.111","Z3A.09","O98.311","B00.9","Z3A.12","Z3A.36","O99.343","O98.313","A60.00","Z79.84","R11.0","O09.893","O99.213","O98.512","O99.342","Z3A.24","O98.513","M54.9","M54.89","L08.9","K86.1","G47.9","R06.2","Z36.3","Z36.9","Z31.5","Z13.79","Z34.01","Z3A.11","K85.80","D63.8","K86.89","Z91.52","Z80.3","R19.7","K04.7","R22.0","Z98.818","R59.0","Z98.890","J02.9","K61.1","L02.31"],"date":["2021-06-10","2023-06-25","2022-09-26","2021-07-19","2021-04-01","2021-04-05","2021-06-15","2021-07-25","2021-06-15","2021-07-26","2021-07-26","2021-07-26","2021-07-26","2021-07-26","2023-06-25","2022-09-01","2022-09-26","2022-10-17","2022-10-24","2023-05-06","2022-09-25","2021-07-25","2021-07-25","2021-07-25","2022-09-26","2022-09-26","2021-07-25","2022-09-26","2022-09-26","2022-09-26","2022-09-26","2022-09-26","2022-09-26","2022-09-26","2021-08-02","2021-08-02","2021-09-18","2021-09-18","2021-09-18","2021-05-29","2021-05-29","2021-05-29","2021-07-15","2022-01-02","2022-08-29","2022-09-26","2022-08-29","2022-10-24","2021-03-25","2021-03-25","2021-07-19","2021-04-05","2021-07-26","2021-07-26","2021-07-26","2021-07-26","2021-07-26","2021-07-26","2021-09-23","2022-11-24","2021-02-04","2021-01-14","2021-02-04","2021-07-19","2021-02-04","2021-07-19","2021-07-19","2021-07-19","2021-07-19","2022-08-29","2022-08-29","2021-07-15","2021-07-15","2021-04-01","2021-04-29","2021-06-10","2021-07-19","2021-09-23","2021-09-18","2021-09-23","2022-09-26","2022-10-17","2022-10-17","2021-01-28","2021-01-28","2021-01-28","2021-01-28","2021-01-28","2021-01-28","2022-09-26","2022-09-26","2022-09-26","2022-09-26","2022-09-26","2023-05-06","2023-04-21","2023-06-25","2023-05-04","2023-06-24","2023-06-24","2023-06-24","2023-09-01","2023-09-01"],"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":[["","53885044801","ONETOUCH","KIT ULTRA 2","1","Select","Select",""],["","53885004401","ONE TOUCH","KIT VERIO FL","1","Select","Select",""],["","00002803101","GLUCAGON","KIT 1MG","2","Select","Select",""],["","08290324911","INSULIN SYRG","MIS 0.5\/31G","200","Select","Select",""],["","00088222033","LANTUS","INJ 100\/ML","10","Select","Select",""],["","00002751001","HUMALOG","INJ 100\/ML","20","Select","Select",""],["","00536408501","PRENATAL","TAB 28-0.8MG","60","Select","Select",""],["","45802086866","POLYETH GLYC","POW 3350 NF","14","Select","Select",""],["","31722070530","VALACYCLOVIR","TAB 1GM","10","Select","Select",""],["","68462019005","NAPROXEN","500 MG","14","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","35","Select","Select",""],["","57896010410","ACETAMINOPHE","TAB 325MG","30","Select","Select",""],["","50428050854","CVS PURELAX","PAK ","14","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","56","Select","Select",""],["","00093226301","AMOXICILLIN","TAB 500MG","14","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","28","Select","Select",""],["","00002771559","BASAGLAR","INJ 100UNIT","6","Select","Select",""],["","08290328233","BD MAGNIGUID","MIS MAGNIFIR","1","Select","Select",""],["","00193737701","CONTOUR","KIT NEXT","1","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","3","Select","Select",""],["","00002879959","HUMALOG KWIK","INJ 100\/ML","9","Select","Select",""],["","96295012914","BLOOD GLUCOS","KIT SYSTEM","1","Select","Select",""],["","65702012410","SOFTCLIX","MIS LANCETS","200","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","3","Select","Select",""],["","55111015810","OMEPRAZOLE","CAP 20MG","14","Select","Select",""],["","67877056310","METFORMIN","TAB 1000MG","60","Select","Select",""],["","71930001752","ONDANSETRON","TAB 4MG","30","Select","Select",""],["","43547039950","CYCLOBENZAPR","TAB 5MG","10","Select","Select",""],["","65702072910","ACCU-CHEK","KIT GUIDE","1","Select","Select",""],["","56151211401","PEN NEEDLES","MIS 32GX4MM","100","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","300","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","00169643810","LEVEMIR","INJ FLEXTOUC","3","Select","Select",""],["","08290320122","BD PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","37000045503","PRILOSEC OTC","TAB 20MG","14","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","7","Select","Select",""],["","70710122501","AMITRIPTYLIN","TAB 10MG","30","Select","Select",""],["","00169266015","TRESIBA FLEX","INJ 100UNIT","3","Select","Select",""],["","66733082259","INSULIN LISPRO KWIKPEN U-","100 100\/ML","15","Select","Select",""],["","08290320550","NANO","2ND GEN PEN NEEDLE 32GX 5\/32\"","100","Select","Select",""],["","00002879959","HUMALOG KWIKPEN U-","100 100\/ML","15","Select","Select",""],["","42858010201","OXYCODONE-ACETAMINOPHEN","5 MG-325MG","12","Select","Select",""],["","00406012301","HYDROCODONE-ACETAMINOPHEN","5 MG-325MG","8","Select","Select",""],["","00116200116","CHLORHEXIDINE GLUCONATE","0.12 %","473","Select","Select",""],["","71930005552","ACETAMINOPHEN-CODEINE","300MG-30MG","20","Select","Select",""],["","67877032005","IBUPROFEN","600 MG","30","Select","Select",""],["","00093117410","PENICILLIN V POTASSIUM","500 MG","28","Select","Select",""],["","68180012202","CEPHALEXIN CAP","500MG","40","Select","Select",""],["","31722070530","VALACYCLOVIR TAB","1GM","10","Select","Select",""],["","65862042005","SMZ\/TMP DS TAB","800-160","56","Select","Select",""],["","00093226301","AMOXICILLIN TAB","500MG","14","Select","Select",""],["","53885004401","ONE TOUCH KIT VERIO FL","","1","Select","Select",""],["","65702072910","ACCU-CHEK KIT GUIDE","","1","Select","Select",""],["","53885044801","ONETOUCH KIT ULTRA","2","1","Select","Select",""],["","55111015810","OMEPRAZOLE CAP","20MG","14","Select","Select",""],["","00002879959","HUMALOG KWIK INJ","100\/ML","3","Select","Select",""],["","00002771559","BASAGLAR INJ","100UNIT","6","Select","Select",""],["","71930001752","ONDANSETRON TAB","4MG","30","Select","Select",""],["","10702001801","OXYCODONE TAB","5MG","35","Select","Select",""],["","53746010901","HYDROCO\/APAP TAB","5-325MG","12","Select","Select",""],["","53885000810","ONETOUCH DEL MIS PLUS","33G","300","Select","Select",""],["","00169633910","NOVOLOG INJ FLEXPEN","","3","Select","Select",""],["","56151211401","PEN NEEDLES MIS","32GX4MM","100","Select","Select",""],["","08290328233","BD MAGNIGUID MIS MAGNIFIR","","1","Select","Select",""],["","00193755301","CONTOUR KIT NEXT EZ","","1","Select","Select",""],["","53885027210","ONETOUCH TES VERIO","","300","Select","Select",""],["","00169266015","TRESIBA FLEX INJ","100UNIT","3","Select","Select",""],["","43547039950","CYCLOBENZAPR TAB","5MG","10","Select","Select",""],["","69097014260","ALBUTEROL AER HFA","","7","Select","Select",""],["","96295012914","BLOOD GLUCOS KIT SYSTEM","","1","Select","Select",""],["","53885013610","ONETOUCH MIS LANCETS","","300","Select","Select",""],["","65702012410","SOFTCLIX MIS LANCETS","","200","Select","Select",""],["","50924045001","ACCU-CHEK MIS MLTICLIX","","306","Select","Select",""],["","00088221905","LANTUS SOLOS INJ","100\/ML","3","Select","Select",""],["","00169643810","LEVEMIR INJ FLEXTOUC","","3","Select","Select",""],["","08290320122","BD PEN NEEDL MIS","32GX4MM","100","Select","Select",""],["","00193737701","CONTOUR KIT NEXT","","1","Select","Select",""],["","65862085901","FAMOTIDINE TAB","20MG","28","Select","Select",""],["","70000052102","OMEPRAZOLE TAB","20MG DR","30","Select","Select",""],["","67877056310","METFORMIN TAB","1000MG","60","Select","Select",""],["","37000045503","PRILOSEC OTC TAB","20MG","14","Select","Select",""],["","70710122501","AMITRIPTYLIN TAB","10MG","30","Select","Select",""],["","65862018601","CLINDAMYCIN HCL","300 MG","40","Select","Select",""],["","65162027250","SULFAMETHOXAZOLE-TRIMETHOPRIM","800-160 MG","14","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":""}]}]}