{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EDWINA   K JOHNSON","gend":1,"add":"257 ELM DR LOT 1","city":"PENNINGTON GAP","state":"VA","zip":"24277-9998","dob":"1963-11-19","age":"","mstatus":"","insh":"20030006*01","cliId":"","pno":"276\/318-0112","cno":"","email":"","ename":"","eno":"","pphy":"ALMATARI, ABDUL LATIEF MD","ppno":"276\/546-3001","pcpadd":"276 FIELDSTONE DRIVE","pcpcity":"JONESVILLE","pcpstate":"VA","pcpzip":24263,"pcpcounty":"","pcpid":"","pcpname":"ST CHARLES HEALTH COUNCIL INC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"SOUTHWEST","aligned":"","ano":"2764942453, 2765465002","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"276\/546-9705","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L02.01","Z11.4","I10.","M54.5","Z00.8","Z13.9","Z13.89","F17.200","R74.8","R39.15","K21.9","F32.9","F10.20","Z87.19","R13.10","I77.1","R94.5","R10.816","K59.00","G47.00","I65.23","Z95.820","R19.5","R13.14","R00.1","E55.9","F33.1","F12.20","F14.20","E78.00","I73.9","R10.32","R19.7","K57.30","K22.2","F11.23","E78.5","F17.210","Z79.899","R07.89","G89.4","R00.0","R22.0","F40.01","R51.","Z72.0","Z12.11","N39.41","G89.29","S32.9XXA","M62.830","M19.90","M15.9","M25.559","F41.8","M81.0","N32.89","J44.9","J43.9","F31.9","M79.7","M25.569","N32.81","N95.2","I20.9","I70.0","F41.1","V54.19","V54.13","S99.921A","M79.671","M79.89","K04.7","K08.89","Z79.82","T14.8XXA","M25.519","L03.211","R21.","E11.65","R06.02","W18.39XA","S93.401A","M06.9","M25.571","F41.9","M54.31","K86.0","Z86.79","NO DATA","F41.0","Z76.0","M54.41","R53.83","R19.00"],"date":["2020-06-27","2021-02-16","2022-11-03","2021-02-16","2021-02-16","2021-02-16","2021-02-16","2021-02-16","2021-04-27","2021-02-16","2022-11-03","2021-02-16","2021-03-31","2021-03-31","2021-10-05","2021-05-13","2020-05-29","2020-09-04","2020-09-04","2022-05-23","2021-05-17","2021-05-17","2021-08-10","2021-04-27","2020-12-15","2022-09-01","2020-09-21","2020-09-21","2020-09-21","2022-11-03","2022-11-03","2020-05-18","2021-08-10","2021-08-10","2021-10-05","2020-07-14","2022-11-03","2022-11-03","2022-11-03","2021-02-17","2020-01-24","2020-01-24","2022-06-16","2022-11-03","2020-06-27","2020-06-27","2019-07-15","2019-10-01","2019-02-11","2019-04-08","2019-02-11","2019-02-11","2019-02-11","2019-02-11","2019-02-11","2019-02-11","2019-04-08","2022-04-15","2019-04-08","2019-04-08","2019-04-08","2019-11-26","2019-10-01","2019-10-01","2019-10-01","2019-10-01","2019-10-01","2019-03-06","2019-03-06","2022-04-03","2022-04-03","2022-04-03","2022-07-04","2022-07-04","2022-11-03","2022-09-06","2022-09-06","2022-02-25","2022-02-25","2022-04-09","2022-04-15","2022-04-03","2022-04-09","2022-11-03","2022-04-09","2022-10-20","2022-11-03","2022-11-03","2022-11-03","2022-11-03","2022-10-20","2022-10-20","2022-11-03","2022-05-23","2022-05-23"],"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":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","68382000105","PAROXETINE","TAB 40MG","30","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","00143980305","DOXYCYCL","CAP 100MG","14","Select","Select",""],["","00093075210","ATENOLOL","TAB 50MG","60","Select","Select",""],["","","LOSARTAN","TAB 50MG","","Select","Select",""],["","51862001601","NORTRIPTYLIN","CAP 25MG","60","Select","Select",""],["","42806016105","HYDROXYZ","TAB 50MG","30","Select","Select",""],["","69238208105","PROPRANOLOL","TAB 80MG","60","Select","Select",""],["","00603497528","OXYBUTYNIN","TAB 5MG","60","Select","Select",""],["","80777027310","MODERNA","INJ COVID-19","0","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","63304069205","CLINDAMYCIN","CAP 150MG","28","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","76385012350","METHOCARBAM","TAB 500MG","20","Select","Select",""],["","00378064110","PREDNISONE","TAB 10MG","30","Select","Select",""],["","43547042509","LOSARTAN\/HCT","TAB 100-12.5","30","Select","Select",""],["","00228202796","ALPRAZOLAM","TAB 0.25MG","30","Select","Select",""],["","00378395277","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","43386009019","GAVILYTE-G","SOL ","8000","Select","Select",""],["","42858010401","OXYCOD\/APAP","TAB 10-325MG","60","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","10572010001","PEG-3350","SOL ELECTROL","8000","Select","Select",""],["","19515081852","FLULAVAL","INJ 2021-22","0","Select","Select",""],["","27241009903","DULOXETINE","CAP 60MG","30","Select","Select",""],["","","POLYETH","POW 3350 NF","","Select","Select",""],["","63481068447","VOLTAREN","GEL 0.01","100","Select","Select",""],["","","MIRALAX","POW 3350 NF","","Select","Select",""],["","16571020210","DICLOFENAC","TAB 50MG DR","60","Select","Select",""],["","","OMEPRAZOLE","CAP 40MG","","Select","Select",""],["","","SULFATRIM","SUS 200-40\/5","","Select","Select",""],["","33342009809","TOLTERODINE","TAB 2MG","60","Select","Select",""],["","33332031901","AFLURIA","INJ 2019-20","0","Select","Select",""],["","29300013510","CLONIDINE","TAB 0.1MG","30","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","20","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","50261011018","IMVEXXY","SUP 10MCG","18","Select","Select",""],["","10702005601","OXYCODONE","TAB 10MG","120","Select","Select",""],["","52817032110","BACLOFEN","TAB 20MG","60","Select","Select",""],["","00071101468","LYRICA","CAP 75MG","90","Select","Select",""],["","68462024901","RANITIDINE","TAB 300MG","30","Select","Select",""],["","52268001201","SUPREP","SOL PREP KIT","354","Select","Select",""],["","68180044601","QUETIAPINE","TAB 50MG","60","Select","Select",""],["","58160082311","SHINGRIX","INJ 50MCG","1","Select","Select",""],["","60505025203","TIZANIDINE","TAB 4MG","60","Select","Select",""],["","00069047103","CHANTIX","PAK 0.5& 1MG","53","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":""}]}]}