{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" L ASILPOHSIB","gend":1,"add":"GIH   711TEERTS  H","city":"DUBLIN","state":"VA","zip":24084,"dob":"1964-05-28","age":"","mstatus":"","insh":"50012443","cliId":"","pno":"0304546657","cno":5403075664,"email":"","ename":"","eno":"","pphy":"OSEMOBOR, EHIKIOYA","ppno":5403075664,"pcpadd":"1867 AMHERST ST,","pcpcity":"WINCHESTER","pcpstate":"VA","pcpzip":22601,"pcpcounty":"","pcpid":"","pcpname":"AMHERST FAMILY PRACTICE","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"ROANOKE\/ALLEGHANY","aligned":"","ano":"","add2":"117   HIGH  STREET","add3":"","madd1":"117 HIGH STREET","madd2":"                                                            ","madd3":"","mcity":"DUBLIN                        ","mstate":"VA","mzip":"24084-3338","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10","K29.30","R11.0","R63.4","K21.0","K25.9","K44.9","K31.84","K76.0","E78.00","F41.9","F31.9","F17.200","Z98.0","Z90.49","Z87.11","Z01.818","K20.8","K29.70","K21.9","J43.9","K27.9","R60.0","G40.909","R53.82","G47.30","E66.01","E78.5","Z72.0","S80.11XA","S86.011D","M72.2","Z01.810","M76.61","S86.019A","X58.XXXA","S86.011A","M25.774","J44.9","E66.9","Z68.34","Z99.81","R20.2","M77.31","G47.33","F41.0","K91.1","M79.671","M67.873","F32.9","Z68.36","M79.2","R11.2","Z87.19","R12","K59.09","S86.001D","M25.571","K31.9","F17.210","K29.60","K31.89","K20.9","S82.54XA","S99.921A","X50.9XXA","X50.1XXA","S82.64XA","L02.611","L02.91","J32.9","Z79.899","E55.9","J20.9","J01.00","B37.0","T81.30XA","E11.9","Z68.41","Z86.73","R10.13","Z01.812","Z11.59","R11.10","R56.9","S93.401A","L97.419","W07.XXXA","K57.32","R10.11","K42.9","R91.8","R10.9","S82.54XD","T81.30XD","L03.115","M79.89","L53.9","L08.9","M76.60","Z20.828","I96","T81.49XA","T81.41XA","T81.40XA","T81.40XD","M79.673","D72.829","F17.211","Z90.3","K21.00","M79.7","Z20.822","Z79.84","K29.00","D13.0","K22.9","M19.071","W18.39XA","S91.301A","Z91.19","G89.18","E11.621","F44.5","Z71.6","R51.9","T81.31XA","Z48.817","L97.412","B37.3","M19.90","I87.8","K57.90","E03.9","E53.9","R05","R09.89","S22.31XA","R07.81","R07.9","X50.0XXA","Y92.810","Z68.37","M72.6","F32.A","D64.9","D55.9","F41.1","M25.562"],"date":["2021-12-03","2019-11-12","2021-07-07","2019-01-09","2020-01-22","2021-01-14","2021-12-03","2021-07-07","2020-07-15","2021-01-13","2021-12-03","2019-01-09","2021-08-15","2019-10-23","2019-01-09","2021-07-07","2021-10-08","2019-01-11","2021-03-04","2021-10-08","2020-12-21","2021-03-04","2021-12-16","2021-12-03","2020-09-16","2021-03-04","2020-09-16","2021-12-03","2019-10-23","2019-02-13","2019-07-11","2019-02-13","2020-09-18","2019-07-09","2019-02-25","2021-08-15","2019-07-11","2019-02-25","2021-12-03","2021-10-08","2019-02-25","2019-02-25","2019-02-25","2021-02-06","2021-12-03","2019-04-08","2019-07-23","2021-03-04","2019-07-09","2021-06-24","2019-12-17","2021-10-22","2020-07-15","2019-11-12","2021-01-06","2019-10-23","2021-10-06","2020-09-09","2019-11-12","2021-12-03","2020-01-22","2021-01-14","2019-11-14","2020-02-28","2019-12-02","2019-12-02","2020-07-08","2019-12-02","2021-10-06","2019-12-17","2020-12-21","2021-12-16","2021-05-20","2020-02-27","2020-02-27","2020-02-27","2021-02-23","2021-12-16","2020-03-03","2020-03-03","2020-06-26","2020-06-26","2020-06-26","2020-06-26","2020-06-26","2020-07-08","2021-03-05","2020-07-08","2020-07-15","2020-07-15","2020-07-15","2020-07-15","2020-07-15","2021-10-06","2020-11-20","2020-09-09","2020-09-09","2020-09-09","2021-12-16","2020-09-18","2020-11-23","2020-09-24","2021-02-23","2021-03-04","2021-02-23","2021-10-06","2021-12-16","2020-12-21","2020-12-21","2021-07-07","2021-01-13","2021-01-13","2021-03-04","2021-10-08","2021-01-25","2021-01-14","2021-07-07","2021-02-06","2021-02-06","2021-12-03","2021-02-23","2021-03-02","2021-06-24","2021-12-03","2021-03-04","2021-03-05","2021-04-05","2021-04-05","2021-06-24","2021-10-22","2021-12-03","2021-12-03","2021-12-03","2021-10-22","2021-05-20","2021-06-04","2021-06-04","2021-08-15","2021-08-15","2021-08-15","2021-08-15","2021-08-15","2021-10-08","2021-10-25","2021-12-03","2021-10-22","2021-10-22","2021-12-16","2021-12-16"],"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":[["","54629794101","VITAMIN","TAB 5000UNIT","30","Select","Select",""],["","65162062711","TRAMADOL","TAB 50MG","30","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","31722088490","ROSUVASTATIN","TAB 20MG","30","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","00054429931","FUROSEMIDE","TAB 40MG","30","Select","Select",""],["","68462034690","LEVOCETIRIZI","TAB 5MG","30","Select","Select",""],["","68462012605","GABAPENTIN","TAB 600MG","56","Select","Select",""],["","65862069790","VENLAFAXINE","CAP 150MG ER","60","Select","Select",""],["","00115166001","PROPRANOLOL","TAB 20MG","90","Select","Select",""],["","29300012410","MELOXICAM","TAB 7.5MG","60","Select","Select",""],["","00169413013","OZEMPIC","INJ 4MG\/3ML","6","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","60","Select","Select",""],["","68462025401","ROPINIROLE","TAB 0.5MG","60","Select","Select",""],["","29300013701","CLONIDINE","TAB 0.3MG","30","Select","Select",""],["","70954008510","CHLORZOXAZON","TAB 500MG","90","Select","Select",""],["","51224012250","AZITHROMYCIN","TAB 500MG","126","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","28","Select","Select",""],["","59762040101","SUCRALFATE","TAB 1GM","120","Select","Select",""],["","00115180301","HYDROXYZ","CAP 25MG","60","Select","Select",""],["","43547034350","RISPERIDONE","TAB 3MG","30","Select","Select",""],["","00406012405","HYDROCO\/APAP","TAB 7.5-325","10","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","90","Select","Select",""],["","00378668999","PANTOPRAZOLE","TAB 40MG","180","Select","Select",""],["","11917010573","PROBIOTIC","CAP SUPER","30","Select","Select",""],["","00591544210","PREDNISONE","TAB 10MG","10","Select","Select",""],["","51293062601","PHENOBARB","TAB 32.4MG","90","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0.3","Select","Select",""],["","66689000816","NYSTATIN","SUS 100000","150","Select","Select",""],["","68382004001","PROMETHAZINE","TAB 12.5MG","30","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","00006027731","JANUVIA","TAB 100MG","30","Select","Select",""],["","55111032101","GLIMEPIRIDE","TAB 2MG","60","Select","Select",""],["","52817031910","BACLOFEN","TAB 5MG","60","Select","Select",""],["","65862053820","LEVOFLOXACIN","TAB 750MG","10","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","30","Select","Select",""],["","64380071206","BENZONATATE","CAP 100MG","60","Select","Select",""],["","33332032001","AFLURIA","INJ 2020-21","0.5","Select","Select",""],["","00173088710","TRELEGY","AER ELLIPTA","60","Select","Select",""],["","00378718705","METFORMIN","TAB 1000MG","30","Select","Select",""],["","00085075605","AFRIN","SPR 0.0005","60","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","08290320122","BD  PEN NEEDL","MIS 32GX4MM","200","Select","Select",""],["","52565000950","LIDOCAINE","SOL 0.04","300","Select","Select",""],["","66993093658","METRONIDAZOL","GEL 0.01","110","Select","Select",""],["","50484001030","SANTYL","OIN 250\/GM","60","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","200","Select","Select",""],["","00527155201","BUT\/ASA\/CAFF","CAP ","30","Select","Select",""],["","52817033010","CYCLOBENZAPR","TAB 5MG","90","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","68462024901","RANITIDINE","TAB 300MG","60","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":""}]}]}