{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LISA   H PROUTY","gend":1,"add":"183 LAKELAND ROAD","city":"STAFFORD","state":"VA","zip":"22556-9998","dob":"1968-02-22","age":"","mstatus":"","insh":"20063529*01","cliId":"","pno":"540\/295-8262","cno":"540\/295-8262","email":"","ename":"","eno":"","pphy":"KIRCHGESSNER, RICHARD NP","ppno":"540\/374-3290","pcpadd":"125 HOSPITAL CENTER BLVD STE 329","pcpcity":"STAFFORD","pcpstate":"VA","pcpzip":22554,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/374-3289","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.84","I12.9","N18.9","Z82.49","Z85.118","Z87.891","K59.00","Z79.891","R53.1","K52.9","R10.9","D70.1","C34.90","C21.1","D69.6","K52.0","R11.2","E43.","E86.0","E87.6","E83.51","L59.8","L59.9","K62.7","NO DATA","C21.0","R11.0","R19.7","I10.","F17.210","Z85.048","Z87.442","Z93.2","Z90.49","C34.11","D61.810","D59.4","C34.91","G40.909","D61.818","R63.0","J02.9","R05.9","R09.02","G40.209","G62.0","G25.81","D72.818","T45.1X5A","R10.30","R11.10","N17.9","G89.29","R53.81","Z93.3","E87.2","Z43.2","K51.319","C44.520","C51.9","D63.1","V58.89","D53.9","N20.0","R63.4","Z45.2","R55.","E87.1","E87.8","K75.9","R42.","K92.0","Z92.3","R94.5","D01.3","F17.200","R06.01","R91.1","R91.8","G40.919","M79.669","J44.1","R56.9","Z51.5","T68.XXXA","V89.2XXA","Z87.11","Z85.44","Z92.21","Z90.2","R79.89","G89.18","Z86.69","R10.31","R10.32","J90.","R74.01","W19.XXXA","I62.02","G93.40","K31.89","K59.03","T40.2X5A","C21.8","K31.1","F11.20","K29.80","F17.290","K63.3","I95.9","F43.23","E83.42","K94.19","K51.312","C52.","I16.9","K94.13","Z85.89","K62.89","R53.83","Z66.","D68.51","E46.","J98.11","R29.6","D69.59","I16.0","Z68.23","I71.2","I34.0","I07.1","K86.9","Z08.","Z85.59","N17.8","G62.9","K29.70","Z88.1","R62.7","Z72.3","K66.0","Z12.12","Z93.0","K62.4","S09.90XA","S13.9XXA","S00.83XA","D64.9","W01.0XXA","Y92.89","Y93.89","D63.0","J43.9","Z95.828","Z87.01","Z91.81","R51.","D69.9","R06.02","I62.00","D58.9","R74.02","H66.001","R10.33"],"date":["2022-04-21","2022-09-22","2022-09-22","2022-10-08","2022-10-11","2022-09-28","2022-03-04","2022-02-28","2022-09-28","2022-03-27","2022-10-14","2022-09-23","2022-09-23","2022-10-12","2022-09-23","2022-09-23","2022-10-11","2022-06-02","2022-10-11","2022-07-09","2022-07-09","2022-10-06","2022-10-06","2022-10-06","2022-10-13","2022-09-25","2022-10-15","2022-10-01","2022-10-11","2022-10-11","2022-10-11","2022-10-11","2022-10-11","2022-10-08","2022-03-04","2020-02-28","2020-02-21","2022-05-03","2022-09-22","2020-02-18","2022-02-18","2021-11-09","2021-11-09","2021-11-29","2022-08-19","2022-08-19","2022-08-19","2021-12-06","2022-08-19","2022-03-07","2022-04-02","2022-04-17","2022-10-08","2022-04-11","2022-06-13","2022-05-05","2022-09-22","2022-09-22","2022-04-26","2022-05-03","2022-05-03","2022-05-03","2022-06-13","2022-05-03","2022-06-13","2022-04-26","2022-04-17","2022-05-05","2022-05-05","2022-05-09","2022-05-09","2022-05-27","2022-10-08","2022-10-04","2021-12-13","2021-12-13","2021-11-22","2021-12-13","2021-12-13","2021-12-13","2021-12-13","2021-12-13","2022-03-24","2022-03-22","2022-04-02","2022-04-17","2022-10-11","2022-08-28","2022-10-08","2022-09-11","2022-10-04","2022-10-15","2020-02-14","2022-09-22","2022-03-21","2022-09-22","2022-10-08","2020-01-25","2020-02-18","2020-02-18","2022-02-14","2022-03-04","2022-03-04","2022-03-04","2022-03-04","2022-03-04","2022-03-04","2022-03-04","2022-03-21","2022-04-07","2022-04-07","2022-05-15","2022-05-27","2022-03-24","2022-03-19","2022-03-19","2022-04-21","2022-04-21","2022-09-16","2022-09-17","2020-01-25","2020-01-25","2020-02-28","2020-01-25","2020-01-25","2020-01-25","2020-01-25","2020-01-25","2021-04-12","2021-04-12","2021-04-12","2022-01-21","2022-02-15","2022-02-15","2022-02-21","2022-02-21","2022-02-21","2022-02-21","2022-03-18","2022-03-18","2022-03-24","2022-09-16","2022-10-04","2022-10-13","2020-01-22","2020-01-22","2020-01-22","2022-05-15","2020-01-22","2020-01-22","2020-01-22","2020-02-28","2020-02-28","2020-02-28","2020-02-28","2020-02-28","2020-02-14","2020-02-14","2020-02-14","2020-02-14","2020-02-14","2022-10-08","2020-01-04","2022-02-20"],"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":[["","62756079888","DIVALPROEX","TAB 500MG DR","120","Select","Select",""],["","43547026910","ROPINIROLE","TAB 0.5MG","60","Select","Select",""],["","23155000810","HYDROCHLOROT","TAB 25MG","60","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","76385011350","CARVEDILOL","TAB 25MG","120","Select","Select",""],["","00228202950","ALPRAZOLAM","TAB 0.5MG","2","Select","Select",""],["","42858030101","HYDROMORPHON","TAB 2MG","12","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","65162052110","PROMETHAZINE","TAB 25MG","20","Select","Select",""],["","65862098799","POT  CHLORIDE","TAB 10MEQ ER","10","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","12","Select","Select",""],["","00173086910","ANORO","AER 62.5-25","60","Select","Select",""],["","16571041250","CIPROFLOXACN","TAB 500MG","20","Select","Select",""],["","27241009903","DULOXETINE","CAP 60MG","30","Select","Select",""],["","62332004790","VALSARTAN","TAB 320MG","30","Select","Select",""],["","50111039801","HYDRALAZINE","TAB 10MG","90","Select","Select",""],["","65862056099","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","45802048678","DOCUSATE","CAP 100MG","20","Select","Select",""],["","10702005601","OXYCODONE","TAB 10MG","60","Select","Select",""],["","00536589688","NICOTINE","DIS 21MG\/24H","28","Select","Select",""],["","49100040007","CULTURELLE","CAP ","30","Select","Select",""],["","62559039050","VANCOMYCIN","CAP 125MG","32","Select","Select",""],["","00093010901","CARBAMAZEPIN","TAB 200MG","450","Select","Select",""],["","69618003410","SODIUM","TAB 10GR","30","Select","Select",""],["","62332002991","LOSARTAN","TAB 100MG","30","Select","Select",""],["","00378041501","DIPHEN\/ATROP","TAB 2.5MG","120","Select","Select",""],["","00245003623","PREVALITE","POW 4GM","231","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","00054023749","MORPHINE","SOL 10MG\/5ML","125","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","67877052330","COLESEVELAM","PAK 3.75GM","30","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","10","Select","Select",""],["","19515080852","FLULAVAL","INJ 2022-23","0","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","30","Select","Select",""],["","43598029290","PREGABALIN","CAP 50MG","60","Select","Select",""],["","61874007560","VIBERZI","TAB 75MG","60","Select","Select",""],["","00378064110","PREDNISONE","TAB 10MG","30","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","7","Select","Select",""],["","00378647099","SCOPOLAMINE","DIS 1MG\/3DAY","10","Select","Select",""],["","68180016006","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","51672402301","ACETAZOLAMID","TAB 250MG","60","Select","Select",""],["","59746011506","PROCHLORPER","TAB 10MG","30","Select","Select",""],["","43598056601","FLUOXETINE","TAB 20MG","30","Select","Select",""],["","68382031910","TRAMADOL","TAB 50MG","20","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":""}]}]}