{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DONNA   M JIBBEN","gend":1,"add":"1991 CELLAR CREEK ROAD","city":"BLACKSTONE","state":"VA","zip":"23824-9998","dob":"1960-09-11","age":"","mstatus":"","insh":"20039355*01","cliId":"","pno":"434\/294-0651","cno":"","email":"","ename":"","eno":"","pphy":"HALL, CLARENCE E MD","ppno":"434\/645-9191","pcpadd":"12522 W COLONIAL TRAIL HWY","pcpcity":"CREWE","pcpstate":"VA","pcpzip":23930,"pcpcounty":"","pcpid":"","pcpname":"CREWE MEDICAL CENTER INC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/645-1859","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D64.9","K57.32","M79.7","J44.9","L30.4","Z90.5","K59.00","M25.571","M25.572","D17.5","F17.210","K63.9","K66.0","Z88.8","Z82.49","Z80.0","Z83.3","Z90.49","Z48.3","D12.0","Z48.815","J96.91","M41.9","M54.9","M25.561","M19.90","F33.9","E78.00","Z91.81","Z96.651","R10.9","K63.89","G89.18","M54.5","M62.81","M99.03","M79.604","S72.331A","W07.XXXA","S72.144A","M16.11","V58.89","E66.9","F41.9","G47.33","G40.909","G89.29","K21.9","G25.81","Z72.0","Z09.","R09.02","R52.","I95.9","S72.301A","W20.8XXA","M97.8XXA","W18.30XA","M79.609","V54.23","Z79.891","N39.0","G62.9","G25.0","G40.409","G43.709","F32.2","R10.84","M47.816","Q60.0","R82.998","Z51.81","E55.9","S72.301K","R06.09","R05.","G47.19","M50.30","R11.2","S22.41XA","L02.214","S72.91XA","S72.001A","S82.91XA","D62.","E78.5","Z20.822","Z23.","NO DATA","Z90.710","R73.09","J44.1","S72.8X1A","M97.01XA","F17.200","F41.0","I10.","J45.909","K29.70","Z79.899","V54.26","G47.10","D47.2","C7A.020","Z01.810","M97.11XA","S72.341A","M97.9XXA","Z68.34","Z11.59","F32.9","R33.9","M21.751","Z01.818","V54.15","V54.29","R56.9","Z79.01","T81.49XA","R10.31","R11.0","G44.89","R03.0","Z12.11","G51.0","Z87.898","R06.83","R51.","G43.009","M85.80","D49.0","D12.3","K57.30","K64.1","Z96.659","R07.81","M25.361","R73.03","K57.92","E53.8","S40.011A","J96.01","R06.02","R60.0","I87.2","I89.0","G40.309","G43.909","G40.911","E11.9","R26.89","R30.0","J30.9","Z91.89","Z68.33","G47.63","R06.2","R07.89","R06.03","R00.0","F17.219","G47.00","M80.859A","M89.8X5","Z87.81","Z96.649","M25.551"],"date":["2022-08-29","2020-02-28","2021-06-28","2022-08-29","2020-01-03","2020-05-12","2020-11-16","2020-02-06","2020-02-06","2020-03-09","2021-11-08","2020-03-09","2020-03-09","2021-11-07","2021-11-08","2020-03-09","2021-11-08","2021-11-08","2020-05-12","2020-05-12","2020-05-12","2020-05-12","2020-11-13","2022-02-03","2022-09-19","2020-05-12","2020-05-12","2022-03-04","2022-02-03","2022-09-19","2020-02-23","2020-03-09","2020-03-09","2020-12-03","2020-08-05","2020-08-05","2022-03-04","2020-11-12","2020-11-13","2021-06-28","2021-09-28","2021-09-28","2021-09-28","2022-02-03","2020-12-03","2020-11-16","2022-08-29","2022-02-03","2022-04-12","2020-11-16","2021-09-28","2021-11-06","2021-11-06","2021-11-06","2021-11-07","2021-11-08","2022-02-28","2021-11-08","2021-11-09","2022-02-28","2022-02-03","2022-08-29","2020-08-26","2020-08-26","2020-02-10","2020-02-10","2020-02-10","2020-07-07","2020-07-30","2021-04-23","2021-04-23","2021-04-23","2022-08-29","2021-11-10","2020-02-19","2020-02-19","2020-04-20","2020-05-13","2020-07-07","2020-07-07","2020-07-07","2020-11-12","2020-11-13","2020-11-16","2021-11-08","2021-11-08","2021-11-08","2022-04-12","2021-11-08","2021-11-08","2022-08-29","2021-10-14","2021-11-07","2021-11-07","2022-02-28","2021-11-07","2021-11-07","2021-11-07","2021-11-07","2021-11-07","2021-11-29","2020-07-29","2020-10-27","2020-10-27","2020-11-12","2021-11-09","2020-11-13","2020-11-13","2020-11-13","2020-11-13","2020-12-24","2020-11-13","2020-11-13","2020-11-13","2020-12-03","2020-12-03","2020-12-03","2020-12-03","2021-01-04","2020-02-23","2020-02-23","2020-08-05","2020-08-05","2020-01-21","2020-10-19","2020-08-26","2020-03-23","2020-08-26","2020-08-26","2020-12-24","2020-01-21","2020-01-21","2020-01-21","2020-01-21","2020-02-15","2020-07-02","2021-09-28","2019-03-18","2019-12-17","2022-08-29","2019-12-14","2019-04-09","2019-03-17","2019-06-25","2019-07-05","2019-07-05","2019-10-01","2019-10-01","2019-04-09","2019-04-09","2019-04-09","2019-08-08","2019-08-08","2019-03-18","2019-10-09","2019-03-17","2019-03-17","2019-03-17","2019-03-17","2019-03-17","2019-04-02","2022-08-29","2022-09-19","2022-09-19","2022-06-13","2022-02-28","2022-08-29"],"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":[["","00093083205","CLONAZEPAM","TAB 0.5MG","120","Select","Select",""],["","00597015561","STIOLTO","AER 2.5-2.5","4","Select","Select",""],["","00406911276","FENTANYL","DIS 12MCG\/HR","5","Select","Select",""],["","00406012410","HYDROCO\/APAP","TAB 7.5-325","84","Select","Select",""],["","","VITAMIN","CAP 50000UNT","","Select","Select",""],["","55111017915","TIZANIDINE","TAB 2MG","30","Select","Select",""],["","68001025604","DULOXETINE","CAP 30MG","60","Select","Select",""],["","13668009390","PRAMIPEXOLE","TAB 0.5MG","180","Select","Select",""],["","00781717612","NALOXONE","SPR ","2","Select","Select",""],["","68001051106","QUETIAPINE","TAB 50MG ER","30","Select","Select",""],["","11534016503","FOLIC","TAB 1MG","60","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","30","Select","Select",""],["","45802065078","LORATADINE","TAB 10MG","30","Select","Select",""],["","68462039610","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","69238110005","DOXYCYCL","CAP 100MG","56","Select","Select",""],["","","CEFUROXIME","TAB 500MG","","Select","Select",""],["","42571016242","AMOX\/K","TAB 875-125","20","Select","Select",""],["","","ENOXAPARIN","INJ 30\/0.3ML","","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","49884072703","DOXYCYC","CAP 100MG","56","Select","Select",""],["","55111012705","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","00904572889","ALLERGY","TAB 10MG","30","Select","Select",""],["","68382014005","TOPIRAMATE","TAB 100MG","90","Select","Select",""],["","","PROVENTIL","AER HFA","","Select","Select",""],["","","TRIAMCINOLON","CRE 0.001","","Select","Select",""],["","","DOCUSATE","CAP 100MG","","Select","Select",""],["","","NYSTATIN","CRE 100000","","Select","Select",""],["","60505257908","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","68001000603","GABAPENTIN","TAB 600MG","90","Select","Select",""],["","00173086910","ANORO","AER 62.5-25","60","Select","Select",""],["","","VENTOLIN","AER ","","Select","Select",""],["","","MAG","SOL LEMON","","Select","Select",""],["","50111078710","AZITHROMYCIN","TAB 250MG","2","Select","Select",""],["","","BISACODYL","TAB 5MG EC","","Select","Select",""],["","45802086803","POLYETH","POW 3350 NF","510","Select","Select",""],["","","GNP","POW ","","Select","Select",""],["","","DICYCLOMINE","CAP 10MG","","Select","Select",""],["","","MONTELUKAST","TAB 10MG","","Select","Select",""],["","68001024617","ONDANSETRON","TAB 4MG ODT","15","Select","Select",""],["","","SUCRALFATE","TAB 1GM","","Select","Select",""],["","65862053820","LEVOFLOXACIN","TAB 750MG","10","Select","Select",""],["","68001036503","METRONIDAZOL","TAB 500MG","30","Select","Select",""],["","","TRAMADOL","TAB 50MG","","Select","Select",""],["","","APAP\/CODEINE","TAB 300-30MG","","Select","Select",""],["","","CHOLESTYRAM","POW 4GM","","Select","Select",""],["","","LIDOCAINE","PAD 0.05","","Select","Select",""],["","","CLINDAMYCIN","CAP 300MG","","Select","Select",""],["","","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","","VOLTAREN","GEL 0.01","","Select","Select",""],["","","NAPROXEN","TAB 500MG","","Select","Select",""],["","","PREGABALIN","CAP 200MG","","Select","Select",""],["","","DICLOFENAC","GEL 0.01","","Select","Select",""],["","","LIDODERM","DIS 0.05","","Select","Select",""],["","","FAMCICLOVIR","TAB 500MG","","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","","METHYLPRED","TAB 4MG","","Select","Select",""],["","","OXYCODONE","TAB 5MG","","Select","Select",""],["","","ALENDRONATE","TAB 35MG","","Select","Select",""],["","13668001005","CITALOPRAM","TAB 20MG","30","Select","Select",""],["","00536589688","NICOTINE","DIS 21MG\/24H","14","Select","Select",""],["","65862001205","SERTRALINE","TAB 50MG","30","Select","Select",""],["","68001036206","CEFDINIR","CAP 300MG","20","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","59746017310","PREDNISONE","TAB 10MG","18","Select","Select",""],["","69315011610","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","63736012301","VITRON-C","TAB 65-125","60","Select","Select",""],["","49281041950","FLUZONE","INJ 2019-20","0","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":""}]}]}