{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RAYMOND   P HEISHMAN","gend":0,"add":"2107 BIRDSONG ROAD","city":"PETERSBURG","state":"VA","zip":"23805-9998","dob":"1962-10-18","age":"","mstatus":"","insh":"2228518*01","cliId":"","pno":"804\/691-8351","cno":"804\/691-8351","email":"","ename":"","eno":"","pphy":"MADRID MALO BOHORQUEZ, VALERIA MD","ppno":"","pcpadd":"50 MEDICAL PARK BLVD SUITE C","pcpcity":"PETERSBURG","pcpstate":"VA","pcpzip":23805,"pcpcounty":"","pcpid":208807,"pcpname":"SOUTHSIDE PHYSICIANS NETWORK - INTERNAL MEDICINE","plan":"OHP","program":"MEDICAID","lob":"M4","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":["M10.9","G57.90","E83.42","F10.10","R73.9","F17.210","G62.1","M16.11","M87.859","K72.90","K72.00","N17.9","K70.10","D64.9","E86.0","D72.829","D69.6","E87.0","D68.9","R50.9","R78.81","N17.8","K70.30","E87.2","E87.6","R41.0","K70.31","R65.10","K65.2","K70.11","K92.1","R71.0","K92.2","K31.819","K76.6","K31.89","A41.9","K85.90","R16.0","E44.0","R19.7","L25.9","K26.9","E87.1","K70.9","A04.8","Z86.2","E83.52","V58.89","C22.0","M62.84","Z86.59","L89.613","NO DATA","B37.41","K70.40","M16.31","G62.9","Z91.81","R20.2","R29.6","R53.1","K26.4","Z85.05","Z92.3","Z12.11","K64.4","K64.8","Z01.810","K74.60","I77.810","R03.1","R15.9","R39.81","Z99.3","L22.","Z47.1","Z96.641","Z79.82","Z79.891","I85.00","Z87.11","Z48.23","Z79.899","Z79.4","J18.9","B18.2","Z94.4","R74.8","R94.5","E11.9","R45.1","R53.81","M25.559","N39.0","F10.21","R94.31","Z11.59","Z76.82","J96.01","J93.83","Z20.822","R00.0","N28.9","D63.8","D50.0","T38.0X5A","J93.9","J15.6","K27.0","G89.18","T86.49","J90.","R91.8","R18.8","N28.89","B19.20","K83.1","K83.8","K91.89","R52.","R10.9","R93.3","R17.","E87.70","K44.9","K29.70","K76.89","B95.8","I85.10","R93.7","R93.2","M87.059","Z01.818","K72.10","N28.1","S27.809A","Y83.0","R74.9","R79.89","N18.9","R93.89","I51.7","I34.0","I35.0","Z87.891","Z04.9","G93.40","Z72.89","Q65.89","Z90.49","R41.82","N43.0","R58.","Z51.81","M25.551","R44.3","F10.20","K59.00","M87.051","I10.","Z68.23","R20.0","K76.7","G93.41","E11.42","N43.3","D69.59","E87.5","Z71.89","F10.231","B95.7","B96.81","M25.561","R11.0","Z48.815","Z79.2","L97.429","E86.1","Z74.01","K76.9","Z75.1","R06.02","R06.03","R09.02","T86.41","F10.11","Z79.52","Z94.5","I49.3","A41.2","Z20.828","J69.0","N17.0","D68.59","E46.","I36.1","A41.1","B37.7","D62.","F05.","M00.9","N50.89","L89.611","Z95.828","C22.9","E11.40","A41.01","G93.49","J98.11","R05.","D50.9","M16.7","R94.4","J43.9","K83.2","N18.2","F17.290","G89.29","Z23.","Z01.812","Z46.59","T85.520A","D84.9","Z86.19"],"date":["2020-01-03","2020-11-28","2020-01-03","2021-09-01","2021-04-23","2021-05-27","2021-03-31","2021-05-04","2020-07-06","2021-03-26","2020-07-10","2021-06-07","2020-08-05","2021-04-23","2020-07-16","2021-05-11","2021-03-25","2020-05-25","2020-05-14","2021-10-28","2020-06-23","2020-05-14","2021-03-29","2020-05-14","2020-05-14","2020-07-10","2021-03-25","2020-05-19","2020-05-19","2020-06-29","2020-05-28","2020-05-28","2020-07-21","2020-05-28","2020-05-28","2020-05-29","2020-05-29","2020-06-03","2020-05-31","2020-07-13","2021-10-28","2020-06-14","2020-08-05","2020-07-13","2020-12-08","2020-06-22","2020-06-23","2020-07-17","2020-07-17","2021-05-04","2020-07-21","2020-07-21","2020-08-05","2021-10-28","2020-08-05","2020-08-05","2021-01-20","2021-05-12","2021-03-10","2020-08-27","2020-08-27","2020-08-27","2020-09-15","2021-09-01","2020-09-15","2020-11-13","2020-11-13","2020-11-13","2021-03-25","2021-11-04","2020-11-25","2020-11-25","2021-03-31","2021-03-31","2021-03-31","2021-03-31","2021-03-10","2021-03-10","2021-05-27","2021-03-10","2021-03-09","2021-05-04","2021-09-14","2021-05-27","2021-05-27","2021-04-19","2021-09-01","2021-11-04","2021-06-07","2021-05-27","2021-09-01","2020-06-01","2020-06-23","2020-06-14","2020-06-26","2020-06-26","2020-07-10","2020-11-11","2021-01-20","2021-03-30","2021-03-31","2021-09-10","2021-04-21","2021-03-25","2021-03-25","2021-03-25","2021-03-25","2021-03-30","2021-04-02","2021-04-02","2021-04-02","2021-05-27","2021-04-10","2021-04-07","2021-04-10","2021-04-10","2021-06-02","2021-09-14","2021-05-28","2021-09-14","2020-04-12","2020-05-25","2020-05-01","2021-03-30","2020-07-10","2020-05-26","2020-05-26","2020-07-11","2020-06-05","2020-07-11","2020-06-05","2020-06-05","2020-11-28","2020-11-11","2021-03-26","2021-03-27","2021-03-31","2021-05-04","2020-05-02","2021-04-04","2020-05-02","2020-05-12","2020-05-16","2020-05-16","2020-05-16","2020-06-03","2020-06-27","2020-07-15","2021-06-02","2021-01-20","2021-05-27","2020-07-13","2020-05-23","2020-05-25","2020-08-10","2020-07-11","2020-07-10","2020-07-16","2020-07-13","2020-10-15","2021-09-01","2020-08-10","2020-01-09","2020-04-30","2020-04-30","2021-05-04","2020-05-14","2020-05-01","2021-05-27","2020-05-11","2020-05-14","2020-06-09","2020-06-09","2020-06-09","2020-06-09","2020-06-09","2020-06-09","2020-06-23","2020-07-10","2020-06-30","2020-06-24","2020-07-16","2021-03-25","2021-03-30","2021-04-08","2021-05-04","2021-05-27","2021-05-27","2021-05-08","2021-03-26","2020-05-01","2020-05-01","2020-05-01","2020-05-01","2020-05-01","2020-05-01","2020-05-03","2020-05-25","2020-05-25","2020-05-25","2020-05-25","2020-05-25","2020-05-25","2020-06-18","2020-07-10","2020-08-26","2021-05-27","2020-05-10","2020-05-14","2020-05-14","2020-05-14","2020-06-30","2020-12-22","2021-07-14","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2020-08-26","2021-09-01","2021-09-10","2021-09-14","2021-09-14","2021-11-04","2021-11-04"],"priorHcc":["","","","","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","",null,"","","","","","","","","","","","","","","",null,"","","","","","","","","","","","",null,"","","","",null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,"",null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,null,null,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":[["","76439021712","MAG ","400MG","30","Select","Select",""],["","29300034901","ALLOPURINOL ","100MG","30","Select","Select",""],["","42806016005","HYDROXYZ ","25MG","30","Select","Select",""],["","68180095603","CLOBETASOL ","0.05%","45","Select","Select",""],["","00093762498","PREGABALIN ","75MG","60","Select","Select",""],["","68462012605","GABAPENTIN ","600MG","90","Select","Select",""],["","11917009215","FERROUS ","325MG","90","Select","Select",""],["","00121087316","LACTULOSE ","10GM\/15","2700","Select","Select",""],["","00536354701","DAILY-VITE ","","90","Select","Select",""],["","00904759080","FEROSUL ","325MG","15","Select","Select",""],["","00406055201","OXYCODONE ","5MG","21","Select","Select",""],["","65649030302","XIFAXAN ","550MG","60","Select","Select",""],["","29300012510","MELOXICAM ","15MG","30","Select","Select",""],["","00591544305","PREDNISONE ","20MG","18","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","12","Select","Select",""],["","65162062711","TRAMADOL ","50MG","21","Select","Select",""],["","43598081115","CETIRIZINE ","10MG","30","Select","Select",""],["","11534016503","FOLIC ","1MG","90","Select","Select",""],["","43598044770","NICOTINE ","14MG\/24H","7","Select","Select",""],["","65862056090","PANTOPRAZOLE ","40MG","60","Select","Select",""],["","96295012777","VITAMIN ","100MG","30","Select","Select",""],["","00054429931","FUROSEMIDE ","40MG","90","Select","Select",""],["","16729004201","TACROLIMUS ","1MG","240","Select","Select",""],["","65862075360","VALGANCICLOV ","450MG","30","Select","Select",""],["","16729022701","SPIRONOLACT ","100MG","90","Select","Select",""],["","11917017101","MULTIVITAMIN ","IRON-FRE","365","Select","Select",""],["","74312015745","MELATONIN ","5MG","30","Select","Select",""],["","00536100836","ASPIRIN ","81MG","30","Select","Select",""],["","16729009401","MYCOPHENOLAT ","250MG","180","Select","Select",""],["","55111014601","FLUCONAZOLE ","200MG","8","Select","Select",""],["","00088221905","LANTUS ","100\/ML","15","Select","Select",""],["","53885013610","ONETOUCH ","LANCETS","100","Select","Select",""],["","56151014260","TRUPLUS ","28G","100","Select","Select",""],["","65162027150","SMZ-TMP ","400-80MG","30","Select","Select",""],["","56151146001","TRUE ","GLUCOSE","100","Select","Select",""],["","42806050301","URSODIOL ","300MG","60","Select","Select",""],["","00781217660","CEFDINIR ","300MG","2","Select","Select",""],["","42571016201","AMOX\/K ","875-125","10","Select","Select",""],["","68992304001","ENVARSUS ","4MG","30","Select","Select",""],["","00591352530","LIDOCAINE ","5%","30","Select","Select",""],["","68585000801","ZINC ","220MG","90","Select","Select",""],["","45802086802","POLYETH ","3350 NF","238","Select","Select",""],["","00002879959","HUMALOG ","100\/ML","6","Select","Select",""],["","57896045401","GERI-KOT ","8.6MG","60","Select","Select",""],["","00093314701","CEPHALEXIN ","500MG","28","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","30","Select","Select",""],["","51224000760","METFORMIN ","500MG ER","180","Select","Select",""],["","00074262528","MAVYRET ","100-40MG","84","Select","Select",""],["","60432003816","GENERLAC ","10GM\/15","2838","Select","Select",""],["","31722062921","ATOVAQUONE ","750\/5ML","300","Select","Select",""],["","08222710031","PEN  NEEDLES  ","32GX4MM","100","Select","Select",""],["","40985028028","","","30","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","20","Select","Select",""],["","55111012705","CIPROFLOXACN ","500MG","14","Select","Select",""],["","08290320550","BD  PEN NEEDL","32GX5\/32","100","Select","Select",""],["","64980033912","MAGNESIUM-OX ","400MG","120","Select","Select",""],["","50111033401","METRONIDAZOL ","500MG","42","Select","Select",""],["","00363021807","ASPIRIN-81 ","81MG","30","Select","Select",""],["","12843013105","BAYER ","81MG","30","Select","Select",""],["","68462030201","INDOMETHACIN ","50MG","30","Select","Select",""],["","16729013401","ALLOPURINOL","100MG","30","Select","Select",""],["","00603020922","MAG","400MG","30","Select","Select",""],["","68462030201","INDOMETHACIN","50MG","30","Select","Select",""],["","68462012605","GABAPENTIN","600MG","90","Select","Select",""],["","11917007923","VITAMIN","100MG","90","Select","Select",""],["","42806016005","HYDROXYZ","25MG","30","Select","Select",""],["","68180095603","CLOBETASOL","0.05%","45","Select","Select",""],["","43598081115","CETIRIZINE","10MG","30","Select","Select",""],["","00591544305","PREDNISONE","20MG","18","Select","Select",""],["","00093762498","PREGABALIN","75MG","60","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","12","Select","Select",""],["","29300012510","MELOXICAM","15MG","30","Select","Select",""],["","53746051505","SPIRONOLACT","100MG","30","Select","Select",""],["","00054429931","FUROSEMIDE","40MG","30","Select","Select",""],["","50383077932","LACTULOSE","10GM\/15","480","Select","Select",""],["","65162062710","TRAMADOL","50MG","14","Select","Select",""],["","65649030302","XIFAXAN","550MG","60","Select","Select",""],["","00904759080","FEROSUL","325MG","15","Select","Select",""],["","00406055201","OXYCODONE","5MG","21","Select","Select",""],["","55111014601","FLUCONAZOLE","200MG","8","Select","Select",""],["","11917009215","FERROUS","325MG","90","Select","Select",""],["","00781217660","CEFDINIR","300MG","2","Select","Select",""],["","43598044770","NICOTINE","14MG\/24H","14","Select","Select",""],["","00591352530","LIDOCAINE","5%","30","Select","Select",""],["","65162036111","FOLIC","1MG","30","Select","Select",""],["","74312015745","MELATONIN","5MG","30","Select","Select",""],["","00536354701","DAILY-VITE","","90","Select","Select",""],["","68585000801","ZINC","220MG","90","Select","Select",""],["","65862056090","PANTOPRAZOLE","40MG","60","Select","Select",""],["","45802086802","POLYETH","3350 NF","238","Select","Select",""],["","57896090101","ASPIRIN","325MG","28","Select","Select",""],["","60432003816","GENERLAC","10GM\/15","2838","Select","Select",""],["","11917017101","MULTIVITAMIN","IRON-FRE","365","Select","Select",""],["","31722062921","ATOVAQUONE","750\/5ML","300","Select","Select",""],["","16729004201","TACROLIMUS","1MG","240","Select","Select",""],["","65862075360","VALGANCICLOV","450MG","30","Select","Select",""],["","53885000810","ONETOUCH","PLUS 33G","100","Select","Select",""],["","16729009416","MYCOPHENOLAT","250MG","120","Select","Select",""],["","64380080707","IBUPROFEN","800MG","20","Select","Select",""],["","00088221905","LANTUS","100\/ML","15","Select","Select",""],["","56151014260","TRUPLUS","28G","100","Select","Select",""],["","65162027150","SMZ-TMP","400-80MG","30","Select","Select",""],["","56151146001","TRUE","GLUCOSE","100","Select","Select",""],["","42806050301","URSODIOL","300MG","60","Select","Select",""],["","00074262528","MAVYRET","100-40MG","84","Select","Select",""],["","68992304001","ENVARSUS","4MG","30","Select","Select",""],["","68180072003","AMLODIPINE","5MG","30","Select","Select",""],["","08222710031","PEN NEEDLES","32GX4MM","100","Select","Select",""],["","42571016201","AMOX\/K","875-125","10","Select","Select",""],["","55111012705","CIPROFLOXACN","500MG","28","Select","Select",""],["","00002879959","HUMALOG","100\/ML","6","Select","Select",""],["","64980033912","MAGNESIUM-OX","400MG","120","Select","Select",""],["","00363021807","ASPIRIN-81","81MG","30","Select","Select",""],["","51224000760","METFORMIN","500MG ER","30","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","42","Select","Select",""],["","08290320122","BD PEN NEEDL","32GX4MM","100","Select","Select",""],["","67877021901","CEPHALEXIN","500MG","28","Select","Select",""],["","12843013105","BAYER","81MG","30","Select","Select",""],["","57896045401","GERI-KOT","8.6MG","60","Select","Select",""],["","68382013201","TAMSULOSIN ","CAP 0.4MG","30","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}