{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" TERAGRAMEROMHSA A","gend":1,"add":"RESIRC E 114203 TPA DR ","city":"Front Royal","state":"VA","zip":"22630-9998","dob":"1972-03-22","age":"","mstatus":"","insh":"10112817","cliId":"","pno":"7604561791","cno":"","email":"","ename":"","eno":"","pphy":"BOTROS, EMAD","ppno":5406782800,"pcpadd":"104 SELMA DR,","pcpcity":"Winchester","pcpstate":"VA","pcpzip":"22601-3834","pcpcounty":"","pcpid":"","pcpname":"SELMA MEDICAL ASSOCIATES","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"411 E CRISER RD APT 302","madd2":"","madd3":"","mcity":"Front Royal","mstate":"VA","mzip":"22630-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N18.6","Z99.2","T22.232A","Z77.098","B02.9","F41.0","K59.03","I13.2","I50.9","K60.3","N25.81","D50.9","D63.1","N82.3","R52","K21.9","N20.0","K60.5","K61.1","L03.319","E87.5","I10","I95.9","R94.39","R00.1","M79.671","M79.672","Q82.9","L86","I73.9","K59.00","R10.30","N26.1","R09.89","R10.2","I12.0","E66.9","R79.89","Z79.899","S05.11XA","R07.9","X58.XXXA","R92.2","K62.3","U07.1","J02.9","R53.1","G89.29","R41.89","I11.0","R53.83","R61","Z53.29","R91.8","L03.314","E87.70","E83.39","E11.9","N95.1","Z23","R06.02","R05.9","I50.30","Z86.16","N39.0","B00.1","R91.1","F41.1","K61.0","R32","L30.4","E11.22","L03.90","B00.82","G47.00","K60.1","G43.109","Z12.31","R55","L03.311","R73.9","R21","S40.022A","M79.602","N30.01","N89.8","N18.5","I95.3","R19.7","B37.3","R77.8","K64.2","L29.9","Z90.710","R01.1","I50.32","R06.00","I20.8","D64.9","Z88.1","Z88.0","Z88.2","Z82.49","Z83.3","Z83.49","Z01.818","N76.4","J45.909","Z79.82","R07.89","K59.89","Z20.822","I25.119","N73.0","N76.0","R04.89","M79.603","R06.9","R50.9","R45.7","R10.32","L03.818","L03.315","I49.1","I13.0","N18.9","R42","G25.81"],"date":["2023-07-01","2023-07-01","2021-08-15","2021-08-15","2022-01-06","2023-01-10","2021-10-20","2022-12-28","2022-12-28","2022-02-27","2023-03-01","2023-06-01","2023-07-01","2022-08-18","2022-02-27","2022-12-28","2022-11-20","2022-02-27","2021-06-03","2021-03-19","2022-12-28","2023-01-10","2021-03-19","2021-03-30","2021-02-25","2021-03-23","2021-03-23","2021-03-23","2021-03-23","2021-03-23","2021-10-20","2021-10-20","2021-10-20","2022-09-16","2022-11-20","2022-09-16","2022-09-16","2022-09-16","2022-12-28","2022-12-28","2022-12-28","2022-12-28","2022-09-22","2021-01-07","2021-11-27","2021-11-27","2022-12-28","2022-11-20","2022-11-20","2022-11-20","2022-11-20","2022-11-20","2022-11-20","2022-11-20","2021-03-18","2023-07-01","2023-07-01","2022-03-03","2022-03-03","2022-11-02","2022-06-14","2021-11-28","2021-12-14","2021-12-14","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-06-03","2023-07-06","2022-08-18","2023-01-10","2021-01-12","2021-01-12","2021-07-22","2021-07-22","2023-01-10","2022-09-27","2022-11-20","2021-03-16","2022-03-03","2022-01-27","2022-08-04","2022-08-04","2021-08-10","2021-08-10","2021-10-07","2021-03-16","2021-03-16","2021-03-16","2021-03-16","2021-03-16","2021-03-16","2021-03-16","2022-06-14","2022-06-14","2022-06-14","2021-03-30","2021-10-07","2021-03-30","2021-03-30","2021-03-30","2021-06-03","2021-03-30","2021-03-30","2021-02-04","2021-06-03","2021-06-03","2021-06-03","2021-01-26","2021-10-20","2021-11-28","2021-03-25","2021-03-25","2021-03-25","2022-08-04","2022-08-04","2021-11-27","2021-11-27","2021-11-27","2021-10-20","2021-01-19","2021-03-16","2021-02-25","2021-02-25","2021-02-25","2022-11-20","2023-01-10"],"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":[["","69076014601","ACYCLOVIR","CAP 200MG","10","Select","Select",""],["","16714069803","VALACYCLOVIR","TAB 500MG","15","Select","Select",""],["","16714081401","SEVELAMER","TAB 800MG","330","Select","Select",""],["","69097012312","TOPIRAMATE","TAB 50MG","60","Select","Select",""],["","29300022701","METRONIDAZOL","TAB 500MG","21","Select","Select",""],["","68382079401","OXYCODONE","TAB 10MG","10","Select","Select",""],["","00591293201","CLINDAMYCIN","CAP 300MG","21","Select","Select",""],["","00245021311","MIDODRINE","TAB 10MG","72","Select","Select",""],["","45963053830","ONDANSETRON","TAB 4MG","30","Select","Select",""],["","59762372001","ALPRAZOLAM","TAB 0.5MG","45","Select","Select",""],["","51672128902","NYSTATIN","CRE 100000","30","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","16714053211","SUMATRIPTAN","TAB 50MG","9","Select","Select",""],["","00093645056","ESOMEPRA MAG","CAP 20MG DR","90","Select","Select",""],["","51672128402","TRIAMCINOLON","OIN 0.001","30","Select","Select",""],["","68462056417","MUPIROCIN","CRE 0.02","30","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","27241002238","ZOLMITRIPTAN","TAB 5MG","6","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA","100","Select","Select",""],["","69315090405","LORAZEPAM","TAB 0.5MG","30","Select","Select",""],["","00185001001","LABETALOL","TAB 100MG","45","Select","Select",""],["","16714008110","HYDROXYZ HCL","TAB 10MG","30","Select","Select",""],["","00781717612","NALOXONE","SPR 4MG","2","Select","Select",""],["","58468013001","RENVELA","TAB 800MG","390","Select","Select",""],["","65862059805","TAMSULOSIN","CAP 0.4MG","30","Select","Select",""],["","56151014401","TRUPLUS LANC","MIS 30G","100","Select","Select",""],["","00781729685","ALBUTEROL","AER HFA","6.7","Select","Select",""],["","65862001801","CEPHALEXIN","CAP 250MG","20","Select","Select",""],["","65862007601","CIPROFLOXACN","TAB 250MG","14","Select","Select",""],["","49884072704","DOXYCYC MONO","CAP 100MG","14","Select","Select",""],["","72618300002","NURTEC","TAB 75MG ODT","8","Select","Select",""],["","00168005546","BETAMETH DIP","CRE 0.0005","45","Select","Select",""],["","00093738456","VENLAFAXINE","CAP 37.5 ER","90","Select","Select",""],["","00487020103","IPRATROPIUM\/","SOL ALBUTER","90","Select","Select",""],["","68382080505","TRAZODONE","TAB 50MG","30","Select","Select",""],["","16714087801","LIDOCAINE","OIN 0.05","35.44","Select","Select",""],["","16714066102","GABAPENTIN","CAP 100MG","9","Select","Select",""],["","00143314250","DOXYCYCL HYC","CAP 100MG","14","Select","Select",""],["","00093645056","ESOMEPRA","CAP 20MG DR","90","Select","Select",""],["","16714008110","HYDROXYZ","TAB 10MG","30","Select","Select",""],["","56151014401","TRUPLUS","MIS 30G","100","Select","Select",""],["","49884072704","DOXYCYC","CAP 100MG","14","Select","Select",""],["","00168005546","BETAMETH","CRE 0.0005","45","Select","Select",""],["","00143314250","DOXYCYCL","CAP 100MG","14","Select","Select",""],["","69076014601","ACYCLOVIR CAP","200MG","10","Select","Select",""],["","16714069803","VALACYCLOVIR TAB","500MG","15","Select","Select",""],["","16714081401","SEVELAMER TAB","800MG","330","Select","Select",""],["","69097012312","TOPIRAMATE TAB","50MG","60","Select","Select",""],["","29300022701","METRONIDAZOL TAB","500MG","21","Select","Select",""],["","68382079401","OXYCODONE TAB","10MG","10","Select","Select",""],["","00591293201","CLINDAMYCIN CAP","300MG","21","Select","Select",""],["","00245021311","MIDODRINE TAB","10MG","72","Select","Select",""],["","45963053830","ONDANSETRON TAB","4MG","30","Select","Select",""],["","59762372001","ALPRAZOLAM TAB","0.5MG","45","Select","Select",""],["","51672128902","NYSTATIN CRE","100000","30","Select","Select",""],["","69547035302","NARCAN SPR","","2","Select","Select",""],["","16714053211","SUMATRIPTAN TAB","50MG","9","Select","Select",""],["","00093645056","ESOMEPRA MAG CAP","20MG DR","90","Select","Select",""],["","45802006435","TRIAMCINOLON CRE","0.1%","15","Select","Select",""],["","68462056417","MUPIROCIN CRE","2%","30","Select","Select",""],["","57237000511","FLUCONAZOLE TAB","150MG","1","Select","Select",""],["","00406012305","HYDROCO\/APAP TAB","5-325MG","12","Select","Select",""],["","27241002238","ZOLMITRIPTAN TAB","5MG","6","Select","Select",""],["","53885024510","ONETOUCH TES ULTRA","","100","Select","Select",""],["","69315090405","LORAZEPAM TAB","0.5MG","30","Select","Select",""],["","00185001001","LABETALOL TAB","100MG","45","Select","Select",""],["","16714008110","HYDROXYZ HCL TAB","10MG","30","Select","Select",""],["","00781717612","NALOXONE SPR","4MG","2","Select","Select",""],["","58468013001","RENVELA TAB","800MG","390","Select","Select",""],["","65862059805","TAMSULOSIN CAP","0.4MG","30","Select","Select",""],["","56151014401","TRUPLUS LANC MIS","30G","100","Select","Select",""],["","00781729685","ALBUTEROL AER HFA","","6.7","Select","Select",""],["","65862001801","CEPHALEXIN CAP","250MG","20","Select","Select",""],["","65862007601","CIPROFLOXACN TAB","250MG","14","Select","Select",""],["","49884072704","DOXYCYC MONO CAP","100MG","14","Select","Select",""],["","72618300002","NURTEC TAB","75MG ODT","8","Select","Select",""],["","00168005546","BETAMETH DIP CRE","0.05%","45","Select","Select",""],["","00093738456","VENLAFAXINE CAP","37.5 ER","90","Select","Select",""],["","53885004601","ONETOUCH KIT ULTRA","2","1","Select","Select",""],["","00487020103","IPRATROPIUM\/ SOL ALBUTER","","90","Select","Select",""],["","68382080505","TRAZODONE TAB","50MG","30","Select","Select",""],["","16714087801","LIDOCAINE OIN","5%","35.44","Select","Select",""],["","16714066102","GABAPENTIN CAP","100MG","9","Select","Select",""],["","00143314250","DOXYCYCL HYC CAP","100MG","14","Select","Select",""],["","51672128402","TRIAMCINOLON OIN","0.1%","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":""}]}]}