{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"G   ILLEKRECNEPS ","gend":1,"add":"LAHSRAM W 102312 TPA TS L","city":"RICHMOND","state":"VA","zip":"23220-9998","dob":"1967-08-02","age":"","mstatus":"","insh":"53500210*30","cliId":"","pno":"46\/4080010-7","cno":"804\/647-0100","email":"","ename":"","eno":"","pphy":"WALLACE, NANCY V NP","ppno":"804\/783-2505","pcpadd":"517 WEST GRACE ST","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23220,"pcpcounty":"","pcpid":"","pcpname":"","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":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z11.3","F33.3","R07.9","R06.02","S31.103A","W26.0XXA","S31.139A","S29.9XXA","F10.20","F19.94","R39.81","N32.9","A59.03","R52.","V54.12","R53.81","F10.129","R20.0","F33.1","R13.19","G47.00","F41.1","F39.","J44.9","F41.9","Z29.9","F31.32","F10.10","F10.929","R69.","S83.91XA","W19.XXXA","J96.01","J96.02","D62.","K74.60","X99.1XXA","Z99.11","Z20.822","M81.0","M79.7","F32.9","F17.210","Z90.710","Z87.11","Z88.5","F10.99","G47.33","H02.121","H02.539","H53.2","H02.124","R51.","M13.0","M26.609","K22.70","J44.1","R09.02","Z72.0","S80.211A","S80.212A","F33.2","S31.130A","W26.9XXA","I10.","E66.9","S31.149A","R00.0","S36.428A","S36.898A","K66.0","I97.88","S31.639A","R32.","Z96.0","Z03.818","F14.10","N39.41","Z46.2","H02.024","G89.18","G89.11","R10.10","R57.9","R26.9","S31.119S","Z93.1","Z23.","A59.9","F17.200","K25.9","F10.229","S31.113A","G89.29","E66.01","Z79.51","K21.9","R13.10","NO DATA","M25.561","H16.213","H57.9","H02.201","H02.204","Z20.828","K20.9","K22.8","K44.9","S31.633A","T79.4XXA","F10.239","S35.8X1A","S36.438A","S36.893A","N73.6","I95.9","M54.9","S31.119A","T71.9XXA","S52.571A","F10.920","G45.9","M48.02","Z68.25","I65.23","S39.81XA","R06.89","S52.531A","S20.212A","R10.13","V62.84","Z48.815","G44.89","Z79.899","K29.70","R25.1"],"date":["2022-07-11","2022-10-18","2022-09-24","2022-09-23","2020-12-24","2020-12-24","2020-12-27","2021-01-04","2022-10-24","2021-04-19","2022-03-06","2022-03-06","2021-12-01","2021-12-20","2022-05-16","2022-05-28","2022-05-28","2022-09-24","2022-10-24","2022-09-20","2022-09-07","2022-09-07","2022-10-23","2022-09-24","2022-10-23","2022-09-24","2020-01-05","2022-05-28","2021-04-14","2020-07-13","2020-09-16","2022-01-15","2020-12-27","2020-12-27","2020-12-28","2020-12-25","2020-12-28","2020-12-25","2021-04-14","2021-04-14","2021-04-14","2021-04-14","2022-05-28","2021-04-14","2021-04-14","2021-04-14","2021-12-23","2022-09-20","2022-08-26","2022-05-13","2022-05-13","2022-08-26","2020-02-04","2020-05-12","2020-04-21","2022-09-20","2020-06-05","2020-06-05","2020-06-05","2020-07-14","2020-07-14","2021-12-23","2021-02-05","2020-12-27","2022-09-20","2022-09-20","2020-12-24","2020-12-24","2020-12-24","2020-12-24","2020-12-24","2020-12-24","2020-12-24","2020-08-17","2020-08-17","2020-10-21","2020-06-02","2022-01-03","2020-08-17","2020-11-19","2020-12-26","2020-12-26","2020-12-26","2020-12-26","2020-12-30","2020-12-30","2020-12-30","2021-12-23","2022-07-02","2020-06-12","2020-10-21","2020-10-21","2020-12-27","2021-02-05","2021-02-05","2022-05-28","2022-04-26","2022-09-20","2022-05-28","2020-01-20","2020-07-22","2020-07-22","2020-07-22","2020-07-22","2020-09-21","2020-05-14","2020-05-14","2020-05-14","2020-12-24","2020-12-24","2020-12-24","2020-12-24","2020-12-24","2020-12-24","2020-12-24","2020-12-24","2022-01-15","2020-12-28","2020-12-28","2022-01-15","2022-01-15","2022-09-24","2022-09-24","2022-09-24","2022-09-26","2020-12-24","2020-12-28","2022-02-28","2022-08-18","2022-09-20","2020-06-02","2021-01-08","2020-02-14","2020-02-14","2020-05-14","2020-07-10"],"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":[["","00781286810","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","65862069790","VENLAFAXINE","CAP 150MG ER","30","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","45802065078","LORATADINE","TAB 10MG","90","Select","Select",""],["","65162046510","IBUPROFEN","TAB 600MG","60","Select","Select",""],["","69238131409","PREGABALIN","CAP 150MG","60","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","23155050101","HYDROXYZ","TAB 25MG","90","Select","Select",""],["","13668033201","TRAZODONE","TAB 150MG","60","Select","Select",""],["","70461032003","FLUCLVX","INJ 2020-21","0","Select","Select",""],["","65162004710","OXYCODONE","TAB 5MG","15","Select","Select",""],["","16714063301","ALENDRONATE","TAB 70MG","4","Select","Select",""],["","65162003310","APAP\/CODEINE","TAB 300-30MG","40","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","00761022120","VITAMIN","TAB 1000 CR","30","Select","Select",""],["","00555015904","CHLORDIAZEP","CAP 25MG","15","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","15","Select","Select",""],["","65162027210","SMZ\/TMP","TAB 800-160","6","Select","Select",""],["","16571066401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","51672413001","LAMOTRIGINE","TAB 25MG","15","Select","Select",""],["","29300041510","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","65862035790","CLOPIDOGREL","TAB 75MG","30","Select","Select",""],["","43598044870","NICOTINE","DIS 21MG\/24H","14","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","59746017506","PREDNISONE","TAB 20MG","10","Select","Select",""],["","00904713470","GG\/DM","LIQ 100-10\/5","100","Select","Select",""],["","69315090405","LORAZEPAM","TAB 0.5MG","2","Select","Select",""],["","00406117003","NALTREXONE","TAB 50MG","30","Select","Select",""],["","35046000063","CALCIUM","TAB \/VIT D","30","Select","Select",""],["","00005555623","CALTRATE+D","TAB 600-800","30","Select","Select",""],["","65862064163","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","08290324912","INSULIN","MIS 1ML\/31G","30","Select","Select",""],["","70010077001","METHOCARBAM","TAB 750MG","90","Select","Select",""],["","64980032430","PROCTOZONE","CRE -HC 2.5%","30","Select","Select",""],["","11822880070","RA","TAB 1000 TR","30","Select","Select",""],["","68462043518","ACAMPRO","TAB 333MG","180","Select","Select",""],["","69097012303","TOPIRAMATE","TAB 50MG","150","Select","Select",""],["","67877025130","TRIAMCINOLON","CRE 0.001","60","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","58160081552","TWINRIX","INJ ","1","Select","Select",""],["","00173088710","TRELEGY","AER ELLIPTA","60","Select","Select",""],["","58160082652","HAVRIX","INJ 1440UNIT","1","Select","Select",""],["","58160082152","ENGERIX-B","INJ 20MCG\/ML","1","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00093031101","LOPERAMIDE","CAP 2MG","60","Select","Select",""],["","69315030805","CIPROFLOXACN","SOL 0.3% OP","5","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","31722093612","OMEGA-3-ACID","CAP 1GM","15","Select","Select",""],["","00832059011","DIPHEN\/ATROP","TAB ","30","Select","Select",""],["","00078042957","GENTEAL","GEL 0.003","10","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":""}]}]}