{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"YARANOMHTIMS E","gend":1,"add":"LAH 955TS XAFI","city":"EMPORIA","state":"VA","zip":"23847-9998","dob":"1978-10-09","age":"","mstatus":"","insh":"4631510*32","cliId":"","pno":"22\/7570221-7","cno":"757\/227-1220","email":"","ename":"","eno":"","pphy":"TEMPLE, AMANDA NP","ppno":"","pcpadd":"511 BELFIELD DRIVE","pcpcity":"EMPORIA","pcpstate":"VA","pcpzip":23847,"pcpcounty":"","pcpid":"","pcpname":"SOUTHSIDE PHYSICIANS NETWORK - FAMILY MEDICINE","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E10.40","R20.2","L85.1","L60.1","R26.2","M79.672","L85.3","L60.2","Z45.02","I47.2","Z45.09","G47.33","I10.","F33.0","I21.4","E10.3599","E10.51","I11.0","I50.9","E78.5","F17.200","I25.10","I35.0","J44.9","Z79.02","Z79.4","Z79.82","Z79.899","Z90.49","Z95.0","Z95.5","H54.7","E11.3523","H21.1X1","H40.89","S81.802A","Z68.41","E10.3523","H25.13","H25.042","H25.812","Z11.59","H35.372","N83.201","N76.4","N90.89","I42.0","I25.5","R07.9","D07.1","M65.4","Z20.828","R51.","R43.0","R43.2","J30.9","E11.3521","H26.9","L02.214","F17.210","E11.9","I25.2","G47.30","Z83.3","Z88.6","Z95.810","Z82.49","E11.42","E78.2","I24.9","E87.2","R51.9","E78.00","E11.319","E66.01","R06.02","M79.7","E55.9","M70.62","E11.3411","R05.","F43.20","J45.909","E66.9","I25.119","E11.65","I73.9","Z20.822","E10.3593","NO DATA","I20.8","Z80.3","R07.89","Z45.018","I42.9","E11.3543","K59.09","H54.8","R10.2","R19.00","A59.00","B37.3","I70.219","R10.9","Z01.810","I21.29","E10.3531","L02.91","M26.621","E10.36","H25.12","I25.82","I95.9","M62.838","G43.909","Z96.1","H35.81","E11.311","H35.373","H43.11","H25.813","H33.41","Z98.890","R25.2","Z87.891","K76.0","J20.9","I70.203","H33.001","E11.3553","S90.424A","Z01.411","Z12.11","F41.9","R79.89","Z12.31","E10.3522","S70.02XA","S30.0XXA","S00.03XA","E10.42","E11.3531","R89.5","M35.00","M06.4","M79.643","E87.6","E83.42","A59.9","Z86.16","Z79.84","Z28.310","Z28.9","I21.09","I08.1","Z86.79","H33.40","Z01.818","E11.39"],"date":["2022-08-17","2022-08-17","2022-08-17","2022-08-17","2022-08-17","2022-08-17","2022-08-17","2022-08-17","2022-07-20","2022-07-20","2022-02-15","2022-03-15","2022-10-21","2021-12-12","2021-11-16","2021-11-14","2021-11-14","2021-12-13","2021-12-13","2022-08-30","2022-08-22","2022-08-18","2021-11-14","2022-08-10","2021-11-14","2022-08-30","2021-11-14","2021-11-16","2021-11-14","2021-12-13","2021-11-14","2022-11-14","2022-03-25","2022-11-18","2022-02-21","2022-01-21","2022-08-30","2022-11-18","2022-02-21","2022-02-21","2022-03-11","2022-03-11","2022-11-18","2022-07-18","2022-07-18","2022-08-08","2022-07-20","2022-07-20","2022-08-10","2022-10-21","2022-09-15","2020-07-15","2020-07-15","2020-07-15","2020-07-15","2020-07-15","2021-01-07","2021-08-13","2021-06-13","2021-12-13","2022-10-21","2022-08-03","2022-10-21","2021-12-13","2021-12-13","2022-10-24","2021-12-13","2022-02-18","2022-02-18","2021-11-14","2021-11-15","2021-11-15","2022-08-18","2022-08-03","2022-08-30","2022-08-18","2022-09-15","2022-09-15","2022-09-15","2020-03-19","2020-01-09","2022-08-03","2020-11-17","2022-03-15","2021-02-18","2021-04-21","2022-02-18","2021-08-13","2021-10-25","2022-10-24","2021-12-13","2021-12-13","2022-08-12","2022-02-15","2022-10-24","2022-02-18","2022-02-18","2022-05-17","2022-06-30","2022-05-17","2022-05-17","2022-05-17","2020-02-25","2020-03-19","2020-12-16","2021-03-22","2021-05-28","2021-06-15","2021-10-19","2021-10-25","2022-03-15","2021-11-16","2021-11-16","2021-11-16","2021-11-16","2022-03-25","2020-02-07","2020-02-07","2020-02-07","2021-03-25","2020-12-22","2021-03-26","2021-03-26","2021-07-14","2022-07-27","2022-08-30","2020-02-17","2021-03-11","2021-04-16","2021-09-09","2021-09-13","2021-10-28","2021-10-28","2021-11-24","2022-08-10","2021-11-24","2020-12-22","2021-02-11","2021-02-11","2021-02-11","2021-02-11","2021-03-25","2022-04-28","2022-06-15","2022-06-15","2022-06-15","2022-08-10","2022-08-10","2022-10-26","2022-08-30","2022-08-30","2022-08-30","2022-08-30","2021-01-04","2021-02-18","2021-02-18","2021-03-22","2021-11-05","2022-03-15"],"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":[["","43598029690","PREGABALIN","CAP 200MG","270","Select","Select",""],["","98302000198","COMFORT","MIS 31GX8MM","200","Select","Select",""],["","60505056000","OFLOXACIN","DRO 0.3% OP","5","Select","Select",""],["","00093206406","CILOSTAZOL","TAB 100MG","60","Select","Select",""],["","00002143480","TRULICITY","INJ 1.5\/0.5","6","Select","Select",""],["","00456120330","LINZESS","CAP 72MCG","30","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","100","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","4","Select","Select",""],["","65862001205","SERTRALINE","TAB 50MG","30","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","00002831501","HUMULIN","INJ U-100","100","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","45802065078","LORATADINE","TAB 10MG","34","Select","Select",""],["","00536123441","ASPIRIN","TAB 81MG EC","30","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","3","Select","Select",""],["","00002879959","HUMALOG","INJ 100\/ML","15","Select","Select",""],["","50742061710","METOPROL","TAB 100MG ER","30","Select","Select",""],["","68180051303","LISINOPRIL","TAB 5MG","90","Select","Select",""],["","00378518693","PRASUGREL","TAB 10MG","90","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","20","Select","Select",""],["","08290320122","BD  PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","00169413212","OZEMPIC","INJ 2\/1.5ML","2","Select","Select",""],["","60758011910","PREDNISOLONE","SUS 1% OP","10","Select","Select",""],["","68382065005","ISOSORB","TAB 30MG ER","90","Select","Select",""],["","00169406012","VICTOZA","INJ 18MG\/3ML","6","Select","Select",""],["","08290328468","INSULIN","MIS 0.5\/31G","100","Select","Select",""],["","10006073038","MAG","TAB 400MG","180","Select","Select",""],["","51672404801","CLOTRIM\/BETA","CRE DIPROP","15","Select","Select",""],["","74312030413","D3","CAP 25MCG","60","Select","Select",""],["","66993013697","FLUTIC\/VILAN","INH 200-25","28","Select","Select",""],["","59779060027","CVS","TAB 81MG EC","90","Select","Select",""],["","43199001101","HYOSCYAMINE","SUB 0.125MG","42","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","42","Select","Select",""],["","00591565810","CYCLOBENZAPR","TAB 10MG","28","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","30","Select","Select",""],["","45802048678","DOCUSATE","CAP 100MG","30","Select","Select",""],["","68462047301","URSODIOL","TAB 250MG","60","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","10","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","15","Select","Select",""],["","00378668910","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","20","Select","Select",""],["","71930005552","APAP\/CODEINE","TAB 300-30MG","42","Select","Select",""],["","57599080000","FREESTY","KIT 2 SENSOR","2","Select","Select",""],["","43598043601","NITROGLYCERN","SUB 0.4MG","300","Select","Select",""],["","00832105410","BACLOFEN","TAB 10MG","30","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","16","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","300","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","00093727098","PRAVASTATIN","TAB 80MG","90","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","50111064701","FLUOXETINE","CAP 10MG","90","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","MIS READER","1","Select","Select",""],["","42385090410","METFORMIN","TAB 500MG","60","Select","Select",""],["","00173088210","BREO","INH 200-25","60","Select","Select",""],["","00169183311","NOVOLIN","INJ U-100","10","Select","Select",""],["","00597010061","SPIRIVA","SPR 2.5MCG","4","Select","Select",""],["","60432060416","PROMETHAZINE","SYP DM","240","Select","Select",""],["","60432060616","PROMETH\/COD","SOL 6.25-10","240","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00310460039","BEVESPI","AER 9-4.8MCG","6","Select","Select",""],["","59651000305","OMEPRAZOLE","CAP 40MG","90","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":""}]}]}