{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GLORIA   J MASON","gend":1,"add":"163 SEABOARD ST","city":"PETERSBURG","state":"VA","zip":"23803-9998","dob":"1970-07-08","age":"","mstatus":"","insh":"20052411*01","cliId":"","pno":"804\/861-1358","cno":"804\/861-1358","email":"","ename":"","eno":"","pphy":"FLEENOR, ELLEN T MD","ppno":"804\/733-5591","pcpadd":"321 C POPLAR DRIVE","pcpcity":"PETERSBURG","pcpstate":"VA","pcpzip":23805,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/733-3506","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H91.92","H73.892","H65.22","R42.","H61.22","J40.","Z11.59","I10.","F41.9","F32.9","M79.7","N32.81","G89.29","K21.9","F41.8","R05.","E78.5","Z12.31","G47.00","F39.","M79.601","Z71.89","Z71.3","R07.89","F17.210","R94.31","Z71.6","E05.90","D72.829","E55.9","J42.","E78.2","Z86.69","M72.2","M20.11","M20.12","G57.61","G57.62","R10.32","R10.814","R19.7","NO DATA","L20.9","M79.671","M54.6","Z23.","Z01.810","Z20.822","H66.92","R21.","M19.90","K29.50","Z13.1","Z13.220","R10.30","M94.0","E28.319","F33.3","R61.","R10.84","R70.0","R74.0","H54.7","H92.02","N30.00","L21.9","R63.4","Z11.4","Z11.1","R10.9","H16.143","H10.13","H11.153","H02.843","H57.13","H53.9","R06.00","R07.1","H90.12","Z68.1","M54.9","M62.838","G43.001","N95.1","J20.9","Z12.11","K05.10","H11.32","H90.6"],"date":["2020-05-21","2020-05-21","2022-05-17","2020-05-21","2020-05-21","2020-07-31","2021-04-21","2022-02-03","2021-07-09","2021-06-04","2022-06-01","2022-02-03","2022-06-01","2022-02-03","2022-02-03","2020-11-30","2021-06-11","2022-06-01","2021-07-30","2021-07-30","2021-05-26","2021-10-29","2021-10-29","2021-06-18","2021-06-18","2021-06-11","2021-06-11","2022-02-03","2022-02-03","2022-02-03","2022-02-03","2022-02-03","2022-02-03","2021-06-22","2021-06-22","2021-06-22","2021-06-22","2021-06-22","2021-09-21","2021-09-21","2021-09-21","2022-06-01","2022-06-01","2020-07-31","2020-07-31","2021-10-29","2021-06-16","2021-06-16","2021-08-11","2021-01-21","2021-07-30","2021-07-30","2021-03-22","2021-03-22","2021-03-22","2021-03-22","2020-04-21","2020-06-29","2020-02-28","2020-02-28","2020-02-28","2020-02-28","2020-02-28","2020-05-15","2020-09-25","2020-06-05","2021-04-21","2021-04-21","2021-05-25","2021-09-03","2020-08-18","2020-08-18","2020-08-18","2020-08-18","2020-06-19","2020-06-19","2020-06-19","2020-07-14","2021-06-03","2022-05-17","2021-07-30","2021-07-30","2021-09-03","2020-04-10","2020-07-07","2021-10-29","2020-06-05","2020-06-05","2020-06-24"],"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":[]},{"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":[["","61314064511","NEO\/POLY\/HC","SUS 1% OTIC","10","Select","Select",""],["","16571020210","DICLOFENAC","TAB 50MG DR","60","Select","Select",""],["","67877043003","ARIPIPRAZOLE","TAB 2MG","30","Select","Select",""],["","55111012205","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","00173085910","BREO","INH 100-25","60","Select","Select",""],["","27241009903","DULOXETINE","CAP 60MG","60","Select","Select",""],["","00085113204","PROVENTIL","AER HFA","13","Select","Select",""],["","13811071910","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","68180098003","LISINOPRIL","TAB 10MG","90","Select","Select",""],["","62175011843","OMEPRAZOLE","CAP 20MG","90","Select","Select",""],["","29300012810","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","00115165901","PROPRANOLOL","TAB 10MG","60","Select","Select",""],["","70954000520","OXYBUTYNIN","TAB 5MG","60","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","23155050105","HYDROXYZ","TAB 25MG","120","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00254100752","ALBUTEROL","AER HFA","7","Select","Select",""],["","55111017915","TIZANIDINE","TAB 2MG","42","Select","Select",""],["","65162010250","GABAPENTIN","CAP 300MG","240","Select","Select",""],["","57896022110","ACETAMIN","TAB 500MG","180","Select","Select",""],["","00713022615","TRIAMCINOLON","CRE 0.00025","15","Select","Select",""],["","31722072690","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","55111029398","SUMATRIPTAN","TAB 100MG","9","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","68180052002","LISINOP\/HCTZ","TAB 20-25MG","30","Select","Select",""],["","00173069600","ADVAIR","AER 250\/50","60","Select","Select",""],["","66993013597","FLUTIC\/VILAN","INH 100-25","60","Select","Select",""],["","00378932132","WIXELA","AER 250\/50","180","Select","Select",""],["","51293081101","PHENAZOPYRID","TAB 200MG","6","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","6","Select","Select",""],["","80681005000","DAILY-VITE","TAB ","5","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","90","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","00173060002","FLOVENT","AER 50MCG","60","Select","Select",""],["","00591544305","PREDNISONE","TAB 20MG","10","Select","Select",""],["","00310737220","BUDES\/FORMOT","AER 80-4.5","10","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","14","Select","Select",""],["","60432060816","PROMETHAZINE","SYP 6.25\/5ML","280","Select","Select",""],["","68180016613","VANCOMYCIN","CAP 125MG","40","Select","Select",""],["","45802086803","POLYETH","POW 3350 NF","510","Select","Select",""],["","00363030603","SMOOTH","POW ","510","Select","Select",""],["","11917020159","MAG","SOL GRAPE","296","Select","Select",""],["","00093321915","KETOCONAZOLE","CRE 0.02","15","Select","Select",""],["","70156011118","SELENIUM","SHA 0.0225","180","Select","Select",""],["","00115164301","NITROFUR","CAP 50MG","20","Select","Select",""],["","11917010396","LUBRICATING","GEL JELLY","113","Select","Select",""],["","57237004001","PENICILLN","TAB 250MG","30","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","68462018905","NAPROXEN","TAB 375MG","60","Select","Select",""],["","60432060616","PROMETH\/COD","SOL 6.25-10","140","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":""}]}]}