{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHELSEA L ANDRE","gend":1,"add":"5620 LUCAS ST","city":"FREDERICKSBURG","state":"VA","zip":"22407-9998","dob":"1986-01-21","age":"","mstatus":"","insh":"1264520*01","cliId":"","pno":7572518027,"cno":7572518027,"email":"","ename":"","eno":"","pphy":"ARNATT, NATHANIEL A FNP","ppno":5409727798,"pcpadd":"4376 GERMANNA HIGHWAY BOX 577,","pcpcity":"LOCUST GROVE","pcpstate":"VA","pcpzip":"22508-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5409723536,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N94.6","N39.0","N93.9","R10.9","N30.00","B37.3","R73.01","R53.83","L29.9","L50.9","Z88.3","M62.512","G43.119","K02.9","E11.9","J40.","E87.1","T38.0X5A","F17.200","R20.2","R10.30","R11.2","R63.0","R50.9","R07.89","H92.03","H93.13","H93.293","Z20.828","Z09.","R42.","M76.31","M25.551","M70.61","M25.561","G89.29","B30.9","M54.9","R19.7","R73.03","R53.81","J45.909","S43.002A","M25.512","R94.31","G43.909","Z20.822","R10.13","R11.0","M26.629","Z77.22","E86.0","N89.8","R39.15","N94.5","R55.","R11.10","N76.0","D64.9","K52.9","K85.90","Z88.9","R00.0","R11.11","M77.9","F33.1","F41.1","T50.901A","J10.1","R05.9","M13.812","Z01.419","Z13.31","K76.0","K29.70","R79.89","Z11.59","E78.00","R73.9","J06.9","J30.9","K21.9","R09.82","S50.11XA","H93.8X1","H90.3","E11.65","R51.9","J01.90","H10.9","H66.92","H66.93","K12.30","R68.84","K02.61","H10.33","G57.91","G57.61","M77.41","Q66.72","Q66.71","M24.571","M24.572","M79.89","M79.672","M79.671","K12.1"],"date":["2021-01-04","2021-01-18","2022-03-01","2023-07-20","2021-04-14","2022-01-31","2021-04-14","2021-04-14","2022-02-16","2022-02-16","2022-02-16","2022-04-19","2022-01-26","2022-03-29","2023-04-06","2022-07-04","2022-07-11","2022-10-07","2023-09-02","2022-07-11","2023-04-06","2023-07-20","2023-04-06","2023-07-20","2023-07-22","2023-09-20","2023-09-20","2023-09-20","2021-02-06","2021-10-09","2023-07-20","2022-08-03","2022-08-03","2022-08-03","2022-08-03","2023-07-20","2023-05-22","2023-07-20","2023-07-20","2023-07-20","2023-07-20","2023-07-20","2021-05-01","2021-05-01","2021-08-10","2021-09-10","2022-08-04","2022-02-01","2022-02-01","2022-03-07","2022-07-04","2022-08-04","2023-05-24","2023-05-24","2021-01-04","2021-08-10","2021-08-13","2023-08-13","2022-02-01","2022-02-01","2022-02-01","2022-04-05","2022-08-04","2022-08-04","2021-05-28","2021-09-27","2021-09-27","2022-07-11","2023-02-18","2023-02-18","2021-05-28","2022-01-31","2022-01-31","2022-02-01","2022-02-01","2022-02-01","2022-03-25","2022-10-07","2022-10-07","2023-03-12","2023-05-08","2023-05-08","2023-05-08","2023-05-13","2021-08-18","2021-08-18","2021-09-17","2021-09-17","2023-05-04","2023-05-04","2023-09-02","2023-09-02","2023-09-02","2023-09-02","2022-03-29","2023-04-30","2023-08-22","2023-08-22","2023-08-22","2023-08-22","2023-08-22","2023-08-22","2023-08-22","2023-08-22","2023-08-22","2023-08-22","2023-09-02"],"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":[["","69097012203","TOPIRAMATE","TAB 25MG","60","Select","Select",""],["","72618300002","NURTEC","TAB 75MG ODT","8","Select","Select",""],["","70710113908","FLUCONAZOLE","150 MG","7","Select","Select",""],["","65162074510","PROMETHAZINE","TAB 12.5MG","20","Select","Select",""],["","00143122701","DICYCLOMINE","TAB 20MG","20","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00116200116","CHLORHEX GLU","SOL 0.0012","473","Select","Select",""],["","49483060450","IBUPROFEN","800 MG","50","Select","Select",""],["","69842087651","CVS ACETAMIN","TAB 325MG","80","Select","Select",""],["","17772010230","TROKENDI XR","CAP 50MG","30","Select","Select",""],["","00054414622","CLOTRIMAZOLE","TRO 10MG","50","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","30","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","00093342210","CYCLOBENZAPR","TAB 10MG","60","Select","Select",""],["","62135098505","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","47335075649","IPRATROPIUM\/","SOL ALBUTER","180","Select","Select",""],["","51672128901","NYSTATIN","100000\/G","15","Select","Select",""],["","00093936401","GLYBURIDE","TAB 5MG","30","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","14","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","68180086111","AZITHROMYCIN","250 MG","6","Select","Select",""],["","00193731221","CONTOUR","TES NEXT","100","Select","Select",""],["","68180012202","CEPHALEXIN","500 MG","15","Select","Select",""],["","63948016843","RIBOFLAVIN","TAB 400MG","30","Select","Select",""],["","70377003012","ATORVASTATIN","TAB 80MG","30","Select","Select",""],["","67877056310","METFORMIN","TAB 1000MG","60","Select","Select",""],["","00093221001","SUCRALFATE","TAB 1GM","40","Select","Select",""],["","00378064205","PREDNISONE","20 MG","7","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","47335070349","ALBUTEROL SULFATE","2.5 MG\/3ML","75","Select","Select",""],["","08627007701","DEXCOM G","7 SENSOR","1","Select","Select",""],["","24208091055","ERYTHROMYCIN","5 MG\/GRAM","3.5","Select","Select",""],["","00574403105","TOBRAMYCIN-DEXAMETHASONE","0.3 %-0.1%","5","Select","Select",""],["","59779050301","OMEPRAZOLE","20 MG","30","Select","Select",""],["","61314063136","NEOMYCIN-POLYMYXIN-DEXAMETH","3.5-10K-.1","3.5","Select","Select",""],["","00143122701","DICYCLOMINE HCL","20 MG","20","Select","Select",""],["","65862050320","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","20","Select","Select",""],["","70436015542","PROMETHAZINE-DM","6.25-15\/5","120","Select","Select",""],["","67877054360","CEFDINIR","300 MG","20","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","69238126601","OSELTAMIVIR PHOSPHATE","75 MG","10","Select","Select",""],["","00169418113","OZEMPIC .","25 OR 0.5","3","Select","Select",""],["","47781030301","NITROFURANTOIN MONO-MACRO","100 MG","14","Select","Select",""],["","65862039010","ONDANSETRON ODT","4 MG","20","Select","Select",""],["","65862001501","AMOXICILLIN","875 MG","20","Select","Select",""],["","65162019050","NAPROXEN","500 MG","20","Select","Select",""],["","10702002501","PHENTERMINE HCL","37.5 MG","30","Select","Select",""],["","69097015907","MELOXICAM","15 MG","30","Select","Select",""],["","51672130406","TERCONAZOLE","0.4 %","45","Select","Select",""],["","00093342210","CYCLOBENZAPRINE HCL","10 MG","28","Select","Select",""],["","67877025130","TRIAMCINOLONE ACETONIDE","0.1 %","30","Select","Select",""],["","42571013725","KETOROLAC TROMETHAMINE","0.5 %","5","Select","Select",""],["","60758011905","PREDNISOLONE ACETATE","1 %","15","Select","Select",""],["","60505056001","OFLOXACIN","0.3 %","10","Select","Select",""],["","00172392670","DIAZEPAM","5 MG","15","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":""}]}]}