{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HTEBAZILESNEWO J ","gend":1,"add":"OB O P3421 X","city":"GATE CITY","state":"VA","zip":"24251-1243","dob":"1970-06-20","age":"","mstatus":"","insh":"60011930","cliId":"","pno":"9267278688","cno":2763862221,"email":"","ename":"","eno":"","pphy":"ARNETTE, BRYAN THOMAS","ppno":2763865980,"pcpadd":"1754 US HIGHWAY 23 N,","pcpcity":"Weber City","pcpstate":"VA","pcpzip":"24290-7071","pcpcounty":"","pcpid":"","pcpname":"HOLSTON MEDICAL GROUP PC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":"","add2":"P O BOX 1243","add3":"","madd1":"441 Academy Rd","madd2":"","madd3":"","mcity":"Hiltons","mstate":"VA","mzip":"24258-6667","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J06.9","Z20.822","E11.65","M62.838","F17.200","F31.31","E11.9","N92.0","R53.83","M54.5","R30.0","R39.9","N92.6","N95.1","R10.2","Q51.28","Z98.890","L02.92","E07.9","Z86.59","Z86.39","Z78.9","J01.00","R05","R06.2","Z01.818","D25.1","N83.8","D25.9","N93.9","G89.29","I10","E03.9","F41.9","F32.9","K21.9","F17.210","Z79.84","Z79.899","N73.6","N93.8","N30.90","R31.9","R10.30","N32.89","N20.0","C34.90","N39.0","R91.1","Z48.816","F13.20","Z87.440","Z90.710","Z87.898","E66.01","U07.1","Z11.52","R06.02","I48.91","Z72.0","Z79.82","T19.1XXA","F33.9","M25.562","R23.4","F11.20","J41.0","R07.0","J20.9","R51.9","R05.9","R09.89","M25.569","E78.5","M54.50","J02.9","M17.12","H90.3","Z12.31","Z78.0","G47.00","Z20.828","B34.9","Z20.818","M25.50","R73.9","B37.3","R11.0","E66.9","R35.0","Z80.42","N30.00","R10.31","R39.15","N30.01","R19.7","I31.39","R07.89","R07.9","B37.31","B37.9","J01.90","Z53.21"],"date":["2021-01-14","2023-04-23","2022-12-05","2021-02-11","2023-03-02","2022-12-05","2023-03-02","2021-05-19","2021-07-05","2021-05-19","2023-02-27","2023-05-26","2021-05-25","2021-05-25","2021-06-24","2021-05-25","2021-05-25","2021-05-25","2021-10-13","2021-05-25","2021-10-13","2021-10-13","2021-06-04","2021-06-04","2021-06-04","2021-06-22","2021-06-24","2021-06-24","2021-06-24","2021-06-24","2021-06-24","2021-10-21","2022-03-03","2022-12-05","2021-10-21","2023-02-27","2023-01-22","2021-10-21","2023-01-12","2021-06-24","2021-06-24","2021-07-05","2022-12-25","2023-01-21","2021-07-06","2021-07-06","2021-07-06","2023-05-26","2021-07-13","2021-07-28","2022-06-16","2023-03-02","2021-10-13","2022-12-15","2022-12-05","2022-07-26","2021-10-19","2023-04-23","2021-10-21","2021-10-21","2021-10-21","2021-11-22","2022-07-23","2021-12-07","2021-12-07","2022-06-16","2022-06-16","2022-02-24","2023-02-07","2022-02-01","2022-07-26","2022-02-01","2022-02-24","2022-03-03","2023-03-02","2022-03-21","2022-05-11","2022-05-24","2023-02-15","2023-02-15","2022-06-16","2022-07-18","2022-07-18","2022-07-18","2022-07-18","2022-07-18","2022-08-04","2023-01-21","2022-08-10","2022-11-29","2022-12-05","2023-01-21","2022-12-25","2022-12-25","2023-01-15","2023-01-15","2023-01-21","2023-04-23","2023-04-23","2023-01-22","2023-01-22","2023-02-07","2023-04-23"],"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":[["","65862067905","ALPRAZOLAM","TAB 2MG","60","Select","Select",""],["","00536589688","NICOTINE TD","DIS 21MG\/24H","28","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","15","Select","Select",""],["","67877032101","IBUPROFEN","TAB 800MG","60","Select","Select",""],["","70010006510","METFORMIN","TAB 1000MG","60","Select","Select",""],["","62756051818","CARB\/LEVO","TAB 25-100MG","30","Select","Select",""],["","68180096603","LEVOTHYROXIN","TAB 50MCG","90","Select","Select",""],["","65862016999","ATENOLOL","TAB 50MG","30","Select","Select",""],["","65862017760","CEFDINIR","CAP 300MG","14","Select","Select",""],["","70436005902","BUPROPION","TAB 150MG SR","60","Select","Select",""],["","45802057178","FEXOFENADINE","TAB 180MG","30","Select","Select",""],["","00006027731","JANUVIA","TAB 100MG","30","Select","Select",""],["","42571012290","LEVOCETIRIZI","TAB 5MG","30","Select","Select",""],["","43547027010","ROPINIROLE","TAB 1MG","30","Select","Select",""],["","00904645859","DOK","CAP 250MG","180","Select","Select",""],["","65162044210","MECLIZINE","TAB 25MG","90","Select","Select",""],["","47781023005","OXYCOD\/APAP","TAB 10-325MG","120","Select","Select",""],["","75826011410","PHENAZOPYRID","TAB 100MG","9","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","68382014005","TOPIRAMATE","TAB 100MG","60","Select","Select",""],["","00193709021","CONTOUR","TES BLD GLUC","50","Select","Select",""],["","00193654621","BAYER MICRLT","MIS LANCETS","100","Select","Select",""],["","69543038090","OLANZAPINE","TAB 2.5MG","30","Select","Select",""],["","00093317431","ALBUTEROL SUL","FAT E","8.5","Select","Select",""],["","16714001401","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","51224000160","BENZONATATE","CAP 200MG","10","Select","Select",""],["","00904699960","DOCUSATE SOD","CAP 250MG","60","Select","Select",""],["","65162089803","ARIPIPRAZOLE","TAB 10MG","30","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","67877025115","TRIAMCINOLON","CRE 0.001","15","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","59267100001","PFIZER VACC","INJ COVID-19","0.3","Select","Select",""],["","43547028210","ESCITALOPRAM","TAB 20MG","45","Select","Select",""],["","65862056099","PANTOPRAZOLE","TAB 40MG","60","Select","Select",""],["","00904698640","MUCUS RELIEF","TAB 600MG ER","20","Select","Select",""],["","16729000715","SIMVASTATIN","TAB 80MG","90","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","70461032103","FLUCLVX QUAD","INJ 2021-22","0.5","Select","Select",""],["","00143211205","DOXYCYCL HYC","TAB 100MG","20","Select","Select",""],["","69547035302","NARCAN","SPR","2","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","15","Select","Select",""],["","00799000104","CALMOSEPTINE","OIN ","113","Select","Select",""],["","65862009620","CEFPODOXIME","TAB 200MG","14","Select","Select",""],["","50111056003","TRAZODONE","TAB 50MG","30","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","60","Select","Select",""],["","55111028050","LEVOFLOXACIN","TAB 500MG","7","Select","Select",""],["","69097084615","CYCLOBENZAPR","TAB 10MG","42","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00069034530","PAXLOVID","TAB 300-100","30","Select","Select",""],["","58657050016","CODEINE\/GG","SOL 10-100\/5","240","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":""}]}]}