{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"R YLLEKNOTSYO","gend":1,"add":"SIRRAH TS RIOVRESER 5221BAHER DNA HTLAEH GRUBNO","city":"HARRISONBURG","state":"VA","zip":"22801-9998","dob":"1976-06-06","age":"","mstatus":"","insh":"7599110*74","cliId":"","pno":"83\/0454213-3","cno":"540\/383-3124","email":"","ename":"","eno":"","pphy":"BEHIRI, AMR H DO","ppno":"347\/761-7200","pcpadd":"41816 FENWAY CIRCLE","pcpcity":"ASHBURN","pcpstate":"VA","pcpzip":20148,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"","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":["NO DATA","R32.","R39.81","R03.0","I10.","R21.","E11.9","F41.9","M62.82","G25.81","E87.3","E87.1","E87.6","G93.41","R41.0","R79.89","R74.01","G89.0","R60.9","F32.9","E78.1","E66.01","E55.9","K59.00","U07.1","Z23.","E11.65","Z02.6","M62.81","B37.9","L98.9","R26.81","G82.20","Z71.2","R60.0","R06.2","E11.41","Z11.59","R10.11","R74.8","R13.19","E11.69","Z79.4","E78.5","Z98.818","I25.10","Z91.81","J06.9","H60.91","N77.1","J01.90","H65.01","G71.09","R00.2","M79.672","E11.40","F33.0","G89.4","N39.46","R53.1","E83.52","N32.81","N39.41","R33.9","I50.33","E86.0","G25.3","R13.14","F39.","Z68.38","E66.9","K76.0","K59.03","L73.9","J30.2","M79.641","M79.642","R41.82","I89.0","K04.7","M17.0","S91.312A","S99.922A","Z74.01","Z76.89","R68.89","L03.90","R42.","R20.2","F17.210","E87.8","M54.5","G89.29","Z20.828","F06.30","F51.04","R40.4","R09.02","W19.XXXA","I49.3","Z51.81","J30.9","S91.112A","S90.32XA","M25.572","Z99.3","Z79.899","Z88.2","Z88.8","Z91.013","Z88.0","G47.09","J18.9","E11.59","I70.213","R22.43","R23.0","G62.9","L29.8","R51.9","E83.51","Z01.419","F43.21","L98.491","E10.9","H25.13","R25.3","G51.0","R06.09","R06.83","R06.89","Z72.0","J34.89","R11.0","L03.115","M62.89","R22.9","G90.09","G60.9","G25.0","Z68.41","R10.9","E11.39","H43.813","R68.84","B37.3","R29.810","H10.12","G89.11","R06.02"],"date":["2022-11-04","2022-11-04","2022-08-12","2022-08-12","2022-08-12","2022-07-15","2022-11-04","2022-11-04","2021-02-26","2022-11-04","2021-03-26","2022-07-12","2022-11-05","2021-03-26","2021-04-07","2021-04-07","2021-04-07","2022-10-01","2022-10-01","2022-10-17","2022-10-01","2022-10-01","2022-10-01","2022-10-04","2022-04-01","2022-03-01","2022-11-16","2021-11-10","2022-10-04","2021-11-22","2021-11-22","2022-08-12","2022-08-12","2022-09-30","2022-11-04","2022-05-13","2022-10-01","2022-10-01","2022-10-03","2022-10-03","2022-10-03","2022-11-16","2022-11-16","2022-11-16","2022-07-21","2022-09-30","2022-11-04","2021-04-02","2021-06-24","2021-06-24","2022-01-06","2021-06-24","2021-07-16","2021-07-16","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2022-07-11","2022-11-04","2022-05-02","2022-07-11","2022-07-11","2022-07-11","2022-11-04","2022-11-04","2022-11-04","2022-11-04","2022-11-04","2022-11-04","2022-11-04","2022-11-04","2022-11-04","2020-03-13","2020-04-16","2020-04-16","2020-04-16","2021-04-12","2021-07-01","2021-10-12","2021-10-12","2021-11-27","2021-11-27","2022-11-04","2022-06-07","2022-01-06","2022-01-11","2022-05-06","2022-07-05","2022-10-26","2022-05-06","2021-03-24","2021-03-24","2020-09-27","2021-03-01","2021-03-01","2021-03-23","2021-03-23","2021-03-23","2021-03-29","2021-03-29","2021-09-14","2021-11-27","2021-11-27","2021-11-27","2021-11-27","2021-11-27","2021-11-27","2021-11-27","2021-11-27","2021-11-27","2022-01-06","2022-01-06","2022-02-08","2022-02-08","2022-02-08","2022-02-08","2022-08-09","2022-03-03","2022-04-12","2022-07-12","2022-09-02","2022-10-17","2020-04-16","2021-05-19","2021-05-19","2022-06-01","2022-08-10","2022-10-26","2022-10-26","2022-10-26","2022-10-26","2020-01-16","2022-01-19","2022-03-22","2021-04-19","2022-02-11","2022-02-11","2022-02-11","2022-02-11","2021-03-24","2021-07-05","2021-09-16","2021-09-16","2021-10-01","2021-10-21","2022-07-05","2022-07-05","2022-07-15","2022-11-04"],"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":[["","42806071505","BENZONATATE","CAP 200MG","21","Select","Select",""],["","16714074102","FENOFIBRATE","CAP 200MG","30","Select","Select",""],["","10702020101","OXYBUTYNIN","TAB 5MG","90","Select","Select",""],["","00832532411","POT  CL MICRO","TAB 10MEQ ER","30","Select","Select",""],["","00088222033","LANTUS","INJ 100\/ML","10","Select","Select",""],["","49502039380","INSULIN","SOL 100U\/ML","10","Select","Select",""],["","00597015390","JARDIANCE","TAB 25MG","14","Select","Select",""],["","57237001930","DULOXETINE","CAP 60MG","60","Select","Select",""],["","16729000116","GLIMEPIRIDE","TAB 1MG","30","Select","Select",""],["","43547040350","FUROSEMIDE","TAB 80MG","90","Select","Select",""],["","00832105415","BACLOFEN","TAB 10MG","90","Select","Select",""],["","49884046565","CHOLESTYRAM","POW 4GM","60","Select","Select",""],["","00115521116","COLESTIPOL","TAB 1GM","90","Select","Select",""],["","55111014512","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","65162004710","OXYCODONE","TAB 5MG","30","Select","Select",""],["","00169406012","VICTOZA","INJ 18MG\/3ML","9","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","14","Select","Select",""],["","00574027501","POT  CHLORIDE","TAB 10MEQ ER","30","Select","Select",""],["","00093224001","CEPHALEXIN","TAB 500MG","14","Select","Select",""],["","00904404360","FISH","CAP 1000MG","30","Select","Select",""],["","69238154001","URSODIOL","CAP 300MG","60","Select","Select",""],["","65162074510","PROMETHAZINE","TAB 12.5MG","12","Select","Select",""],["","86790021620","BENEFIBER","POW ","248","Select","Select",""],["","67877022210","GABAPENTIN","CAP 100MG","19","Select","Select",""],["","55111027950","LEVOFLOXACIN","TAB 250MG","1","Select","Select",""],["","13668009290","PRAMIPEXOLE","TAB 0.25MG","90","Select","Select",""],["","00781223410","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00143314250","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","65162027250","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","23155050110","HYDROXYZ","TAB 25MG","60","Select","Select",""],["","00185005501","METOLAZONE","TAB 5MG","180","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","30","Select","Select",""],["","48582000330","BIOTENE","LIQ DRY MTH","473","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","7","Select","Select",""],["","00169750111","NOVOLOG","INJ 100\/ML","10","Select","Select",""],["","00338004948","SOD","INJ 0.009","100","Select","Select",""],["","00799000104","CALMOSEPTINE","OIN ","113","Select","Select",""],["","43547028111","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","00904423960","MAGNESIUM","TAB 500MG","30","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","30","Select","Select",""],["","00378064210","PREDNISONE","TAB 20MG","21","Select","Select",""],["","43386006019","GAVILYTE-C","SOL ","4000","Select","Select",""],["","00023485745","VANIQA","CRE 0.139","45","Select","Select",""],["","08290329515","AUTOSHIELD","MIS 30GX5MM","100","Select","Select",""],["","69315090410","LORAZEPAM","TAB 0.5MG","27","Select","Select",""],["","68462052001","METFORMIN","TAB 500MG ER","30","Select","Select",""],["","47335061930","DRIZALMA","CAP 60MG DR","60","Select","Select",""],["","59651001990","NIACIN","TAB 750MG","30","Select","Select",""],["","00135024205","NICORETTE","GUM 4MGFRUIT","480","Select","Select",""],["","00536589688","NICOTINE","DIS 21MG\/24H","14","Select","Select",""],["","49035019402","EQ","DIS 21MG\/24H","28","Select","Select",""],["","57599080000","FREESTY","KIT 2 SENSOR","6","Select","Select",""],["","00069108530","PAXLOVID","TAB 300-100","30","Select","Select",""],["","00904677361","ACETAMINOPHE","TAB 325MG","30","Select","Select",""],["","00904698640","MUCUS","TAB 600MG ER","12","Select","Select",""],["","59746011306","PROCHLORPER","TAB 5MG","30","Select","Select",""],["","41167000841","ICY","PAD 0.05","5","Select","Select",""],["","13668019090","TOLTERODINE","CAP 4MG ER","30","Select","Select",""],["","80681013100","VITAMIN","CAP 5000UNIT","30","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","14","Select","Select",""],["","88008800949","OC","TRU M IV PUMP","1","Select","Select",""],["","08290306546","NORMAL","INJ 0.009","10","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","08290320109","BD  PEN NEEDL","MIS 31GX8MM","50","Select","Select",""],["","00093100301","BUSPIRONE","TAB 15MG","180","Select","Select",""],["","43292055862","MAG","TAB 250MG","30","Select","Select",""],["","55111015330","ONDANSETRON","TAB 4MG","20","Select","Select",""],["","40985021104","B-12","TAB 1000 CR","30","Select","Select",""],["","74312001110","POTASSIUM     TAB 9","TAB 99MG","30","Select","Select",""],["","45802086866","POLYETH","POW 3350 NF","14","Select","Select",""],["","00245531790","KLOR-CON","TAB 10MEQ ER","30","Select","Select",""],["","10310031840","ORAJEL","GEL MOUTHAID","5","Select","Select",""],["","60505036301","OFLOXACIN","DRO 0.3%OTIC","5","Select","Select",""],["","31722057230","ESOMEPRA","CAP 20MG DR","5","Select","Select",""],["","00781618667","CIPRO\/DEXA","SUS 0.3-0.1%","8","Select","Select",""],["","00065853110","CIPRO","SUS OTIC","10","Select","Select",""],["","50458014090","INVOKANA","TAB 100MG","14","Select","Select",""],["","00904676130","12HOUR","SPR 0.0005","30","Select","Select",""],["","00310620530","FARXIGA","TAB 5MG","30","Select","Select",""],["","00536250676","SALINE","SPR 0.0065","44","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","68382005005","MELOXICAM","TAB 7.5MG","60","Select","Select",""],["","00054004544","IPRATROPIUM","SPR 0.0003","30","Select","Select",""],["","53885027150","ONETOUCH","TES VERIO","50","Select","Select",""],["","45802005911","NYSTATIN","CRE 100000","30","Select","Select",""],["","68462018022","MUPIROCIN","OIN 0.02","22","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":""}]}]}