{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DIANA L TRIPODI","gend":1,"add":"3620 MILLERS GLEN LN APT 103","city":"HENRICO","state":"VA","zip":"23231-9998","dob":"1976-06-02","age":"","mstatus":"","insh":"1319113*01","cliId":"","pno":8048694836,"cno":8048694836,"email":"","ename":"","eno":"","pphy":"ALLGOOD, SHERRY NP","ppno":8042262444,"pcpadd":"4620 S LABURNUM AVE,","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":"23231-9998","pcpcounty":"","pcpid":"","pcpname":"Laburnum Medical Center","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8042220458,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K59.09","G35.","E11.8","E66.01","Z68.43","Z12.11","F34.1","NO DATA","F41.8","J45.998","K29.70","B37.81","E11.9","Z23.","F41.1","F33.1","G43.809","F43.10","F33.0","Z20.822","J45.51","K21.9","I10.","J30.2","J45.30","J06.9","K64.8","J45.40","Z92.29","K29.00","F32.1","T16.1XXA","J45.909","X58.XXXA","Z13.228","R76.8","R19.4","Z83.79","Z01.812","U07.1","F32.2","E78.00","R06.83","I89.0","F41.9","G43.109","E55.9","Z12.31","Z79.84"],"date":["2021-11-02","2023-07-18","2021-11-02","2023-07-18","2022-04-20","2021-11-15","2021-12-01","2023-07-18","2021-12-01","2022-01-14","2022-04-20","2022-04-20","2023-07-18","2022-10-27","2022-10-24","2022-07-19","2022-08-04","2023-07-18","2021-12-28","2023-01-17","2022-09-30","2022-09-30","2022-09-30","2022-09-30","2021-10-15","2023-01-17","2021-11-15","2021-11-15","2022-01-14","2022-04-20","2022-08-16","2022-09-21","2022-09-21","2022-09-21","2022-02-26","2022-03-24","2022-03-24","2022-03-24","2021-11-11","2021-11-11","2022-06-24","2023-07-18","2023-07-18","2023-07-18","2023-07-18","2023-07-18","2023-07-18","2023-07-18","2023-07-18"],"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":[["","43598065530","BUPROPN HCL","TAB 150MG XL","30","Select","Select",""],["","67877041301","METFORMIN","TAB 500MG ER","120","Select","Select",""],["","50111078710","AZITHROMYCIN","TAB 250MG","18","Select","Select",""],["","31722072690","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","68645059354","LISINOPRIL","40 MG","30","Select","Select",""],["","76204020060","ALBUTEROL","NEB 0.00083","180","Select","Select",""],["","63646001004","KETOCONAZOLE","2 %","120","Select","Select",""],["","45802006435","TRIAMCINOLON","CRE 0.001","30","Select","Select",""],["","00002143611","EMGALITY","INJ 120MG\/ML","1","Select","Select",""],["","66993058597","FLUTIC\/SALME","AER 250\/50","60","Select","Select",""],["","52268020101","SUTAB","TAB ","24","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","00173069600","ADVAIR DISKU","AER 250\/50","60","Select","Select",""],["","49281042150","FLUZONE QUAD","INJ 2021-22","0","Select","Select",""],["","59267100001","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","60432060616","PROMETH\/COD","SOL 6.25-10","150","Select","Select",""],["","69452014430","BENZONATATE","CAP 200MG","90","Select","Select",""],["","63824005636","MUCINEX DM","TAB 30-600ER","60","Select","Select",""],["","49035007021","EQ MUCUS ER","TAB 600MG","60","Select","Select",""],["","59746017310","PREDNISONE","TAB 10MG","30","Select","Select",""],["","76204010060","IPRATROPIUM","SOL 0.02%INH","150","Select","Select",""],["","00185012201","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","00078100768","KESIMPTA","INJ 20\/.4ML","1","Select","Select",""],["","69367020301","BUT\/APAP\/CAF","TAB ","30","Select","Select",""],["","55111014512","FLUCONAZOLE","150 MG","1","Select","Select",""],["","00069108530","PAXLOVID","TAB 300-100","30","Select","Select",""],["","00378932232","WIXELA INHUB","AER 500\/50","60","Select","Select",""],["","33342008841","RIZATRIPTAN","10 MG","9","Select","Select",""],["","00093030801","CLEMASTINE","TAB 2.68MG","90","Select","Select",""],["","50742050504","SCOPOLAMINE","DIS 1MG\/3DAY","2","Select","Select",""],["","00597015330","JARDIANCE","TAB 25MG","30","Select","Select",""],["","00228202710","ALPRAZOLAM","0.25 MG","10","Select","Select",""],["","59267030401","PFIZER BIVAL","INJ BA4\/BA5","0","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","69367020301","BUTALBITAL-ACETAMINOPHEN-CAFFE","50-325-40","90","Select","Select",""],["","00002143611","EMGALITY PEN","120 MG\/ML","1","Select","Select",""],["","31722072690","MONTELUKAST SODIUM","10 MG","90","Select","Select",""],["","00832105415","BACLOFEN","10 MG","120","Select","Select",""],["","00078100768","KESIMPTA PEN","20MG\/0.4ML","1.2","Select","Select",""],["","00093030801","CLEMASTINE FUMARATE","2.68 MG","90","Select","Select",""],["","00172572860","FAMOTIDINE","20 MG","180","Select","Select",""],["","67877054360","CEFDINIR","300 MG","14","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","00173069600","ADVAIR DISKUS","250-50 MCG","60","Select","Select",""],["","11877001140","BINAXNOW COVID-","19 AG SELF TEST","2","Select","Select",""],["","82607066026","FLOWFLEX COVID-","19 AG HOME TEST","1","Select","Select",""],["","66993058597","FLUTICASONE-SALMETEROL","250-50 MCG","60","Select","Select",""],["","70010049105","METFORMIN HCL ER","500 MG","360","Select","Select",""],["","49035049858",""," ","60","Select","Select",""],["","49035007021","EQ MUCUS ER TAB","600MG","60","Select","Select",""],["","60432060616","PROMETH\/COD SOL","6.25-10","150","Select","Select",""],["","59746017310","PREDNISONE TAB","10MG","30","Select","Select",""],["","63824005636","MUCINEX DM TAB","30-600ER","60","Select","Select",""],["","00002143611","EMGALITY INJ","120MG\/ML","1","Select","Select",""],["","31722072690","MONTELUKAST TAB","10MG","90","Select","Select",""],["","69452014430","BENZONATATE CAP","200MG","90","Select","Select",""],["","76204010060","IPRATROPIUM SOL","0.02%INH","150","Select","Select",""],["","68645059354","LISINOPRIL TAB","40MG","30","Select","Select",""],["","00173069600","ADVAIR DISKU AER","250\/50","120","Select","Select",""],["","67877041301","METFORMIN TAB","500MG ER","120","Select","Select",""],["","51672129803","KETOCONAZOLE CRE","2%","60","Select","Select",""],["","43598065530","BUPROPN HCL TAB","150MG XL","30","Select","Select",""],["","45802006435","TRIAMCINOLON CRE","0.1%","30","Select","Select",""],["","00185012201","NITROFURANTN CAP","100MG","14","Select","Select",""],["","76204020060","ALBUTEROL NEB","0.083%","180","Select","Select",""],["","00078100768","KESIMPTA INJ","20\/.4ML","1","Select","Select",""],["","69367020301","BUT\/APAP\/CAF TAB","","30","Select","Select",""],["","00378932232","WIXELA INHUB AER","500\/50","60","Select","Select",""],["","57237000430","FLUCONAZOLE TAB","100MG","15","Select","Select",""],["","66993058597","FLUTIC\/SALME AER","250\/50","120","Select","Select",""],["","00069108530","PAXLOVID TAB","300-100","30","Select","Select",""],["","33342008841","RIZATRIPTAN TAB","10MG","18","Select","Select",""],["","57237007710","ONDANSETRON TAB","4MG ODT","10","Select","Select",""],["","50742050504","SCOPOLAMINE DIS","1MG\/3DAY","2","Select","Select",""],["","00781106110","ALPRAZOLAM TAB","0.25MG","3","Select","Select",""],["","59267030401","PFIZER BIVAL INJ BA","4\/BA5","0","Select","Select",""],["","00597015330","JARDIANCE TAB","25MG","90","Select","Select",""],["","00054327099","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","00093030801","CLEMASTINE TAB","2.68MG","90","Select","Select",""],["","00002143380","TRULICITY","0.75MG\/0.5","2","Select","Select",""],["","00002150680","MOUNJARO","2.5 MG\/0.5","2","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":""}]}]}