{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HOLLI   J COLBERT","gend":1,"add":"14910 BRADLEY BRIDGE ROAD","city":"CHESTERFIELD","state":"VA","zip":"23838-9998","dob":"1977-12-06","age":"","mstatus":"","insh":"1074187*01","cliId":"","pno":"804\/451-8207","cno":"804\/451-8207","email":"","ename":"","eno":"","pphy":"ROSE, ANDREW MD","ppno":"804\/717-5300","pcpadd":"#117 11601 IRONBRIDGE RD","pcpcity":"CHESTERFIELD","pcpstate":"VA","pcpzip":23832,"pcpcounty":"","pcpid":105605,"pcpname":"IRONBRIDGE FAMILY PRACTICE","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/748-7269","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J45.21","F98.8","E04.1","F31.62","R73.01","E78.00","F31.9","N30.00","N95.1","M54.9","J01.00","F90.1","H10.13","R21.","S62.660A","Z68.28","J11.1","F90.0","F33.1","Z01.812","K57.30","K64.4","K64.8","F90.9","J45.909","E03.9","Z85.850","Z79.899","Z80.0","K59.04","R19.4","K64.1","K58.1"],"date":["2020-08-25","2021-07-07","2020-06-23","2020-06-23","2020-06-23","2020-06-23","2021-10-07","2021-01-13","2021-01-13","2021-07-04","2020-02-27","2021-07-15","2021-02-10","2021-06-02","2021-07-06","2020-02-06","2020-02-06","2021-10-07","2021-10-07","2021-09-13","2021-09-17","2021-09-17","2021-09-17","2021-09-17","2021-09-17","2021-09-17","2021-09-17","2021-09-17","2021-09-17","2021-09-17","2021-09-17","2021-09-17","2021-09-22"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","00527458237","METHYLPHENID ","40MG ER","30","Select","Select",""],["","00173069600","ADVAIR ","250\/50","60","Select","Select",""],["","57237000630","FLUCONAZOLE ","200MG","2","Select","Select",""],["","65862001705","AMOXICILLIN ","500MG","21","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","66993060536","ETONOGESTERE ","ETHY EST","1","Select","Select",""],["","65862022701","LAMOTRIGINE ","25MG","150","Select","Select",""],["","00378181710","LEVOTHYROXIN ","175MCG","30","Select","Select",""],["","69238126601","OSELTAMIVIR ","75MG","10","Select","Select",""],["","31722070530","VALACYCLOVIR ","1GM","12","Select","Select",""],["","62856052960","BELVIQ ","10MG","60","Select","Select",""],["","00378081005","HYDROCHLOROT ","12.5MG","30","Select","Select",""],["","58657050016","CODEINE\/GG ","10-100\/5","118","Select","Select",""],["","45802065078","LORATADINE ","10MG","30","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","50111064801","FLUOXETINE ","20MG","90","Select","Select",""],["","65862096901","ESZOPICLONE ","3MG","30","Select","Select",""],["","67877021560","CEFUROXIME ","250MG","20","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","33342032815","TRIAMCINOLON ","0.50%","15","Select","Select",""],["","66993060536","ETONOGESTREL ","ETHY EST","3","Select","Select",""],["","00378932132","WIXELA ","250\/50","60","Select","Select",""],["","60505025103","TIZANIDINE ","2MG","30","Select","Select",""],["","37000014343","ALIGN ","4MG","28","Select","Select",""],["","23155060601","GLYCOPYRROL ","1MG","60","Select","Select",""],["","00527150537","AMPHET\/DEXTR ","20MG","90","Select","Select",""],["","71093014105","METHOCARBAM ","750MG","30","Select","Select",""],["","65862052890","VENLAFAXINE ","75MG ER","30","Select","Select",""],["","16571020106","DICLOFENAC ","75MG DR","20","Select","Select",""],["","52268001201","SUPREP ","PREP KIT","354","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","50111043401","TRAZODONE ","100MG","30","Select","Select",""],["","63402030230","LATUDA ","20MG","30","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","58160088552","FLUARIX ","2020-21","0","Select","Select",""],["","51660052601","ALLERGY ","10MG","30","Select","Select",""],["","65862007701","CIPROFLOXACN ","500MG","14","Select","Select",""],["","60505057501","OLOPATADINE ","0.10%","5","Select","Select",""],["","69238153106","LARISSIA ","","84","Select","Select",""],["","11917020311","MELATONIN ","5MG","30","Select","Select",""],["","67877024201","QUETIAPINE ","25MG","30","Select","Select",""],["","00378730053","DROSPIR\/ETHI ","3-0.03MG","84","Select","Select",""],["","00527143501","METAXALONE ","800MG","20","Select","Select",""],["","00093005805","TRAMADOL ","50MG","20","Select","Select",""],["","00591565810","CYCLOBENZAPR ","10MG","20","Select","Select",""],["","80777027310","MODERNA ","COVID-19","0","Select","Select",""],["","35573041830","ATOMOXETINE ","40MG","30","Select","Select",""],["","00456120130","LINZESS ","145MCG","30","Select","Select",""],["","70700011585","SYEDA ","3-0.03MG","84","Select","Select",""],["","52268020101","SUTAB ","","24","Select","Select",""],["","00527458237","METHYLPHENID","40MG ER","30","Select","Select",""],["","00173069600","ADVAIR","250\/50","60","Select","Select",""],["","66993060536","ETONOGESTERE","ETHY EST","1","Select","Select",""],["","50111064801","FLUOXETINE","20MG","90","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","00378081005","HYDROCHLOROT","12.5MG","30","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","45802065078","LORATADINE","10MG","30","Select","Select",""],["","65862022701","LAMOTRIGINE","25MG","150","Select","Select",""],["","62856052960","BELVIQ","10MG","60","Select","Select",""],["","00378181710","LEVOTHYROXIN","175MCG","30","Select","Select",""],["","69238126601","OSELTAMIVIR","75MG","10","Select","Select",""],["","58657050016","CODEINE\/GG","10-100\/5","118","Select","Select",""],["","65862096901","ESZOPICLONE","3MG","30","Select","Select",""],["","55111014512","FLUCONAZOLE","150MG","1","Select","Select",""],["","67877021560","CEFUROXIME","250MG","20","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","65862001705","AMOXICILLIN","500MG","21","Select","Select",""],["","37000014343","ALIGN","4MG","28","Select","Select",""],["","60505025103","TIZANIDINE","2MG","30","Select","Select",""],["","31722070530","VALACYCLOVIR","1GM","12","Select","Select",""],["","00378932132","WIXELA","250\/50","60","Select","Select",""],["","33342032815","TRIAMCINOLON","0.50%","15","Select","Select",""],["","66993060536","ETONOGESTREL","ETHY EST","1","Select","Select",""],["","16571020106","DICLOFENAC","75MG DR","20","Select","Select",""],["","63402030230","LATUDA","20MG","30","Select","Select",""],["","23155060601","GLYCOPYRROL","1MG","60","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","58160088552","FLUARIX","2020-21","0","Select","Select",""],["","51660052601","ALLERGY","10MG","30","Select","Select",""],["","69238153106","LARISSIA","","84","Select","Select",""],["","65862007701","CIPROFLOXACN","500MG","14","Select","Select",""],["","60505057501","OLOPATADINE","0.10%","5","Select","Select",""],["","00527150537","AMPHET\/DEXTR","20MG","90","Select","Select",""],["","50111043401","TRAZODONE","100MG","30","Select","Select",""],["","00378730053","DROSPIR\/ETHI","3-0.03MG","84","Select","Select",""],["","67877024201","QUETIAPINE","25MG","30","Select","Select",""],["","65862052890","VENLAFAXINE","75MG ER","30","Select","Select",""],["","80777027310","MODERNA","COVID-19","0","Select","Select",""],["","11917020311","MELATONIN","5MG","30","Select","Select",""],["","00456120130","LINZESS","145MCG","30","Select","Select",""],["","52268001201","SUPREP","PREP KIT","354","Select","Select",""],["","70710134403","RAMELTEON","8MG","30","Select","Select",""],["","23155050105","HYDROXYZ","25MG","60","Select","Select",""],["","70700011585","SYEDA","3-0.03MG","84","Select","Select",""],["","00527143501","METAXALONE","800MG","20","Select","Select",""],["","00093005805","TRAMADOL","50MG","20","Select","Select",""],["","00591565810","CYCLOBENZAPR","10MG","20","Select","Select",""],["","35573041830","ATOMOXETINE","40MG","30","Select","Select",""],["","65862015901","ZOLPIDEM","5MG","30","Select","Select",""],["","52268020101","SUTAB","","24","Select","Select",""],["","71093014105","METHOCARBAM","750MG","30","Select","Select",""],["","68462030929","NORGEST\/ETHI ","TAB 0.25\/35","84","Select","Select",""],["","70710134403","RAMELTEON ","TAB 8MG","30","Select","Select",""],["","23155050105","HYDROXYZ ","TAB 25MG","60","Select","Select",""],["","65862015901","ZOLPIDEM ","TAB 5MG","30","Select","Select",""],["","50428043890","VITAMIN ","CAP 1000UNIT","90","Select","Select",""],["","70461032103","FLUCLVX ","INJ 2021-22","0","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}