{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KIMBERLY   N TIERNEY","gend":1,"add":"6015 BILLINGSWOOD DR","city":"MECHANICSVILLE","state":"VA","zip":"23111-9998","dob":"1998-10-26","age":"","mstatus":"","insh":"900035553*01","cliId":"","pno":"804\/299-8580","cno":"","email":"","ename":"","eno":"","pphy":"CZAJKOWSKI, STANLEY B DO","ppno":"804\/764-1253","pcpadd":"8200 MEADOWBRIDGE ROAD SUITE 306","pcpcity":"MECHANICSVILLE","pcpstate":"VA","pcpzip":23116,"pcpcounty":"","pcpid":"","pcpname":"MEMORIAL MEDICAL CENTER","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/764-1259","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G80.8","R13.10","G40.909","R63.3","Z93.1","G47.33","G47.19","G80.9","R06.89","G80.0","M54.9","M41.35","Z66.","Z87.01","G47.30","Z71.9","K59.00","M79.18","Z00.00","R39.81","R15.9","N20.0","K21.9","N39.0","R82.998","Z79.899","R63.30","Z99.81","R68.89","M41.9","Z99.89","R62.7","M25.552","G40.814","R13.12","M41.05","R63.6","H54.3","R56.9","F70.","Z28.21","R35.0"],"date":["2021-09-23","2021-09-23","2021-10-29","2021-09-23","2021-10-29","2021-12-15","2021-12-15","2021-10-29","2019-12-12","2021-09-20","2020-07-21","2020-07-21","2021-01-20","2021-10-22","2021-07-21","2021-07-21","2021-10-20","2021-07-13","2021-10-29","2020-10-09","2020-10-09","2021-04-08","2021-10-20","2020-01-09","2021-02-08","2021-02-08","2021-10-20","2021-10-22","2021-10-22","2021-10-29","2021-10-29","2019-08-22","2020-02-21","2021-09-20","2021-09-20","2021-09-20","2021-07-21","2020-09-08","2020-09-08","2020-09-08","2019-10-28","2020-09-17"],"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":[]}]},{"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":[["","50383079216","VALPROIC ACID                                                         ","250\/5ML","810","Select","Select",""],["","54932050181","PHENOBARBITAL                                                         ","20MG\/5ML","1350","Select","Select",""],["","00713022515","TRIAMCINOLONE ACETONIDE                                               ","0.10%","15","Select","Select",""],["","00487020160","IPRATROPIUM BROMIDE\/ALBUTEROL SULFATE                                 ","ALBUTER","360","Select","Select",""],["","68382013201","TAMSULOSIN HYDROCHLORIDE                                              ","0.4MG","90","Select","Select",""],["","00093101042","MUPIROCIN                                                             ","2%","22","Select","Select",""],["","31722057447","LEVETIRACETAM                                                         ","100MG\/ML","720","Select","Select",""],["","00172392570","DIAZEPAM                                                              ","2MG","90","Select","Select",""],["","55111012601","CIPROFLOXACIN HYDROCHLORIDE                                           ","250MG","10","Select","Select",""],["","23155060701","GLYCOPYRROLATE                                                        ","2MG","150","Select","Select",""],["","00591352530","LIDOCAINE                                                             ","5%","30","Select","Select",""],["","68682065220","DIAZEPAM RECTAL GEL                                                   ","10MG","2","Select","Select",""],["","70127010010","EPIDIOLEX                                                             ","100MG\/ML","120","Select","Select",""],["","59762453802","MEDROXYPROGESTERONE ACETATE                                           ","150MG\/ML","1","Select","Select",""],["","00527133001","BACLOFEN                                                              ","10MG","45","Select","Select",""],["","00378875006","DICLOFENAC SODIUM                                                     ","1%","-500","Select","Select",""],["","16571040250","CETIRIZINE HYDROCHLORIDE                                              ","10MG","30","Select","Select",""],["","68682099030","OMEPRAZOLE\/SODIUM BICARBONATE                                         ","20-1680","60","Select","Select",""],["","57896048914","POLYETHYLENE GLYCOL 3350                                              ","3350 NF","238","Select","Select",""],["","49100040025","CULTURELLE ADVANCED IMMUNE DEFENSE                                    ","IMMUNE","90","Select","Select",""],["","00121087316","LACTULOSE                                                             ","10GM\/15","500","Select","Select",""],["","70010077001","METHOCARBAMOL                                                         ","750MG","84","Select","Select",""],["","86790001362","BENEFIBER                                                             ","","236","Select","Select",""],["","55111018015","TIZANIDINE HYDROCHLORIDE                                              ","4MG","90","Select","Select",""],["","68180016011","AZITHROMYCIN                                                          ","250MG","6","Select","Select",""],["","00069306075","ZITHROMAX Z-PAK                                                       ","Z-PAK","6","Select","Select",""],["","68462010630","ONDANSETRON HYDROCHLORIDE                                             ","8MG","50","Select","Select",""],["","13811071910","NITROFURANTOIN MONOHYDRATE\/MACROCRYSTALS                              ","100MG","10","Select","Select",""],["","60846050201","PYRIDIUM                                                              ","200MG","21","Select","Select",""],["","00713052612","PROMETHEGAN                                                           ","25MG","20","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE                                                ","50MCG","48","Select","Select",""],["","50474050015","NAYZILAM                                                              ","5MG","2","Select","Select",""],["","00187065820","DIASTAT ACUDIAL                                                       ","5-10MG","2","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":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"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":""}]}]}