{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TERESA   L RIVERA","gend":1,"add":"PO BOX 918","city":"BROADWAY","state":"VA","zip":"22815-9998","dob":"1969-09-23","age":"","mstatus":"","insh":"20060649*01","cliId":"","pno":"540\/435-3342","cno":"540\/435-3342","email":"","ename":"","eno":"","pphy":"DOMINGUS, JEFF DO","ppno":"540\/298-9900","pcpadd":"800 SHENANDOAH AVE SUITE 170","pcpcity":"ELKTON","pcpstate":"VA","pcpzip":22827,"pcpcounty":"","pcpid":"","pcpname":"Healthy Community Health Center - Stone Port (HCHC-Stone Port)","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/298-8991","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G89.29","F45.42","M54.16","N39.498","K59.00","M54.6","M41.9","M54.2","M54.12","M54.5","E11.40","Z73.6","J44.9","R51.9","G50.0","G50.8","E11.29","Z79.4","NO DATA","M51.26","M51.36","M65.331","M54.9","Z79.899","E11.9","I10.","Z85.850","Z86.73","Z92.3","Z88.0","R73.9","S82.831A","N17.9","R42.","L97.522","E11.621","L97.511","E11.42","E78.5","F41.9","L85.1","J96.01","E11.49","E11.65","M48.061","M51.34","M79.601","R13.19","R11.2","E11.628","L08.9","Z79.84","U07.1","R05.1","G89.4","L03.115","S82.831K","W19.XXXD","R53.1","L97.519","L03.031","D32.0","Z98.890","E83.42","E03.9","E10.42","J18.9","J45.901","G43.709","M67.441","I44.0","L97.512","M79.604","E11.649","E66.01","E89.0","M48.00","R29.6","V54.16","R25.2","G60.9","J45.21","L97.509","M25.551","E87.1","Z82.49","E66.9","E86.0","I95.9","E86.1","R19.7","M79.641","Z86.16","M79.674","M79.671","I73.9","L85.3","M79.2","R10.84","R11.0","M51.16","M50.10","M47.26","M99.49","G89.21","Z51.0","C34.31","M47.816","Z01.812","Z01.810","Z20.822","K29.70","K22.9","K56.2","K63.5","K64.8","K57.30","Z83.3","R13.14","R79.1","R22.41","R51.","R09.02","Z79.891","Z12.11","R13.10","D12.5","R12.","K22.4","K29.50","M51.37","M50.323","D86.9","Z79.82","M50.30","M65.88","M25.841","Z98.51","Z79.890","G47.09","Z83.49","Z53.20","M79.661","E11.69","E11.59","E11.22","C73.","I15.2","F32.9","L85.8","I82.401"],"date":["2022-09-19","2022-09-19","2022-09-19","2021-07-22","2022-09-19","2022-09-19","2022-09-19","2022-09-19","2022-09-19","2021-09-30","2022-09-30","2021-07-22","2021-10-01","2022-09-09","2022-09-09","2021-09-09","2022-09-30","2022-09-30","2022-09-22","2022-09-19","2022-09-19","2022-02-02","2022-03-10","2022-05-25","2022-07-27","2022-09-15","2022-06-15","2022-06-15","2022-03-10","2022-06-15","2022-03-10","2022-08-05","2022-07-27","2022-07-25","2022-10-06","2022-10-06","2020-12-08","2022-09-22","2022-09-22","2022-07-25","2020-12-15","2021-01-15","2022-05-21","2022-09-22","2021-07-06","2022-06-13","2021-12-08","2022-05-19","2022-05-19","2022-05-31","2022-05-31","2022-06-03","2022-07-27","2022-07-12","2022-07-27","2022-07-27","2022-07-27","2022-07-27","2022-07-27","2022-09-22","2022-07-25","2020-03-01","2022-05-25","2020-02-21","2022-09-15","2020-05-20","2021-01-13","2021-01-13","2021-04-23","2022-02-02","2022-05-21","2022-10-03","2022-06-17","2022-07-25","2022-07-25","2022-09-22","2022-07-25","2022-07-25","2022-09-08","2022-08-23","2020-12-08","2020-08-25","2020-08-25","2021-01-04","2021-01-10","2022-06-15","2021-01-10","2021-01-10","2021-01-10","2021-01-10","2021-01-10","2021-09-16","2022-06-02","2020-11-30","2020-05-13","2020-05-20","2020-05-20","2021-04-21","2022-03-10","2022-05-25","2022-06-13","2022-06-13","2022-06-13","2022-06-13","2022-06-17","2022-07-05","2022-07-05","2022-01-26","2022-05-21","2022-05-21","2022-05-21","2022-05-25","2022-05-25","2022-05-25","2022-05-25","2022-05-25","2022-05-25","2022-06-15","2022-05-25","2022-07-26","2022-07-26","2020-06-11","2021-01-10","2021-09-30","2022-05-25","2022-05-25","2022-05-25","2022-05-25","2022-05-25","2022-05-25","2020-03-01","2020-03-01","2020-03-01","2022-02-02","2021-11-23","2022-02-02","2022-02-02","2022-02-02","2022-02-02","2022-04-25","2022-06-15","2022-06-15","2022-06-15","2022-09-22","2022-09-22","2022-09-22","2022-09-22","2022-09-22","2020-02-19","2020-11-30","2022-09-15"],"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":[["","72205001590","PREGABALIN","CAP 150MG","60","Select","Select",""],["","68645055754","LISINOP\/HCTZ","TAB 20-12.5","60","Select","Select",""],["","57237001830","DULOXETINE","CAP 30MG","60","Select","Select",""],["","68645019059","METOPROL","TAB 50MG","60","Select","Select",""],["","68645058459","METFORMIN","TAB 1000MG","60","Select","Select",""],["","00093505998","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","31722053301","METHOCARBAM","TAB 500MG","240","Select","Select",""],["","24510005860","NUCYNTA","TAB 50MG","60","Select","Select",""],["","43598065530","BUPROPN","TAB 150MG XL","30","Select","Select",""],["","70756020111","AMITRIPTYLIN","TAB 10MG","120","Select","Select",""],["","50458014130","INVOKANA","TAB 300MG","30","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","15","Select","Select",""],["","73070010315","INSULIN","INJ FLEXPEN","15","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","30","Select","Select",""],["","63868093510","MAG","SOL LEMON","296","Select","Select",""],["","72305015030","EUTHYROX","TAB 150MCG","30","Select","Select",""],["","00173086910","ANORO","AER 62.5-25","60","Select","Select",""],["","69238110002","DOXYCYCL","CAP 100MG","14","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","00527512570","LACTULOSE","SOL 10GM\/15","473","Select","Select",""],["","49502025175","SEMGLEE","INJ 100U\/ML","45","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","65162027250","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","00093224001","CEPHALEXIN","TAB 500MG","28","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","43386009019","GAVILYTE-G","SOL ","4000","Select","Select",""],["","67877021660","CEFUROXIME","TAB 500MG","28","Select","Select",""],["","31722072250","LEVOFLOXACIN","TAB 500MG","4","Select","Select",""],["","00003089421","ELIQUIS","TAB 5MG","60","Select","Select",""],["","00093598627","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","28","Select","Select",""],["","10702005650","OXYCODONE","TAB 10MG","120","Select","Select",""],["","00002143380","TRULICITY","INJ 0.75\/0.5","2","Select","Select",""],["","65162063609","PANTOPRAZOLE","TAB 20MG","30","Select","Select",""],["","00169255013","TRESIBA","INJ 200UNIT","63","Select","Select",""],["","72065012112","GVOKE","INJ 1MG\/.2ML","0","Select","Select",""],["","65862007701","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","00173088210","BREO","INH 200-25","60","Select","Select",""],["","59746017310","PREDNISONE","TAB 10MG","42","Select","Select",""],["","63304061650","DOXYCYC","CAP 100MG","8","Select","Select",""],["","68645057154","CITALOPRAM","TAB 40MG","30","Select","Select",""],["","08290320749","BD  PEN NEEDL","MIS 32GX6MM","100","Select","Select",""],["","60432060616","PROMETH\/COD","SOL 6.25-10","120","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","52817032010","BACLOFEN","TAB 10MG","120","Select","Select",""],["","00781518792","LEVOTHYROXIN","TAB 150MCG","30","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","57599080300","FREESTY","MIS 2 READER","1","Select","Select",""],["","00067815203","VOLTAREN","GEL 0.01","100","Select","Select",""],["","00173087310","INCRUSE","INH 62.5MCG","30","Select","Select",""],["","67877022310","GABAPENTIN","CAP 300MG","180","Select","Select",""],["","68462018022","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","00904642213","PEG","POW ","30","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":""}]}]}