{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TRACY ROCHE","gend":1,"add":"2519 ALDRIDGE AVE","city":"COLONIAL HEIGHTS","state":"VA","zip":"23834-9998","dob":"1971-12-12","age":"","mstatus":"","insh":"1441029*01","cliId":"","pno":8042953500,"cno":8042953500,"email":"","ename":"","eno":"","pphy":"SMITH, ANGELICA NP","ppno":"","pcpadd":"436 CLAIRMONT COURT SUITE 100","pcpcity":"COLONIAL HEIGHTS","pcpstate":"VA","pcpzip":"23834-9998","pcpcounty":"","pcpid":"","pcpname":"Bon Secours - Colonial Heights Family Medicine","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R05.","U07.1","J96.01","I10.","J45.909","K12.2","J43.9","Z09.","R06.02","M79.672","M72.2","M77.52","J06.9","K21.9","M19.90","Z79.899","Z79.51","Z90.49","R09.89","T81.41XA","N73.9","N73.2","Z87.442","Z90.711","Z79.1","J44.1","J44.9","J45.41","F41.8","G47.00","N39.0","R19.7","Z12.11","R73.9","Z29.9","Z99.81","L50.9","R00.0","R55.","I95.9","Z79.52","T81.49XA","R10.30","R10.2","K04.7","Z20.822","R06.2","Z13.6","Z13.89","Z13.83","E87.6","N61.1","Z86.16","J18.9","NO DATA","F41.9","G89.29","M79.673","J10.1","R06.00","F90.9","J45.51","Z68.38","Z01.419","Z11.51","Z11.3","N92.6","N94.6","Z68.34","N83.202","N92.0","N73.0","M71.342","M19.042","S69.92XA","W23.0XXA","A41.89","Z88.6","Z88.1","Z88.8","J44.0","Z91.018","Z87.441","Z98.51","B37.2","R22.31","R50.9","R68.83","J12.89","J20.9","N92.1","J11.00","Z20.828","Z00.00","M54.2","Z68.33","T81.40XA","N13.30","E66.9","E04.1","H90.5","J98.11","Z87.01","Z90.710","F32.9","Z88.5","Z79.3","R21.","J45.901","S59.912A","B37.0","J02.9","U09.9","Z68.36"],"date":["2021-04-02","2021-04-25","2023-02-22","2023-02-24","2023-02-24","2021-04-02","2023-03-03","2023-03-03","2023-02-23","2022-06-13","2022-09-28","2022-09-28","2022-07-13","2023-02-22","2022-07-13","2023-02-22","2023-02-22","2023-02-22","2022-07-13","2022-09-21","2022-09-21","2022-09-21","2023-02-22","2022-09-21","2022-09-21","2023-02-24","2022-10-17","2023-01-03","2023-01-03","2023-01-03","2023-01-03","2023-01-03","2023-01-03","2023-02-23","2023-02-23","2021-03-24","2021-06-04","2021-11-16","2022-05-04","2022-05-04","2022-05-04","2022-09-22","2022-09-21","2022-09-21","2023-01-27","2022-12-03","2021-01-15","2021-03-08","2021-03-08","2021-03-08","2021-03-16","2021-08-06","2023-02-22","2022-05-15","2022-08-04","2023-02-23","2022-07-01","2022-06-13","2022-11-13","2022-11-13","2021-06-04","2021-06-04","2021-09-14","2022-08-04","2022-08-04","2022-08-04","2022-08-04","2022-08-19","2023-03-03","2022-09-15","2022-09-15","2022-09-21","2021-01-27","2021-01-27","2021-01-27","2021-01-27","2021-03-13","2021-03-13","2021-03-13","2021-03-13","2021-03-13","2021-03-13","2021-03-13","2021-03-13","2021-03-03","2021-03-03","2021-03-08","2021-03-08","2021-03-22","2022-05-15","2022-08-19","2022-11-29","2021-04-14","2022-07-01","2022-07-01","2022-07-01","2022-09-21","2023-02-22","2023-02-22","2023-02-22","2023-02-22","2023-02-22","2023-02-22","2023-02-22","2021-02-19","2021-02-19","2021-02-19","2021-02-19","2022-05-19","2022-07-05","2023-01-12","2023-01-12","2021-11-16","2021-11-16"],"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":[["","42806071405","BENZONATATE","100 MG","30","Select","Select",""],["","60432060616","PROMETH\/COD","SOL 6.25-10","120","Select","Select",""],["","60219170801","PREDNISONE","20 MG","20","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","17","Select","Select",""],["","51991070610","ALPRAZOLAM","1 MG","60","Select","Select",""],["","59310057922","PROAIR HFA","AER ","17","Select","Select",""],["","00173088710","TRELEGY","AER ELLIPTA","60","Select","Select",""],["","00904671839","MUCUS RELIEF","TAB 600MG ER","16","Select","Select",""],["","00487020160","IPRATROPIUM\/","SOL ALBUTER","360","Select","Select",""],["","00173068220","VENTOLIN HFA","AER ","18","Select","Select",""],["","43547035311","LISINOPRIL","10 MG","90","Select","Select",""],["","16714049602","CLOTRIM\/BETA","CRE 1-0.05%","45","Select","Select",""],["","00316022360","NYSTAT\/TRIAM","CRE ","60","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","60432027516","BROM\/PSE\/DM","SYP ","118","Select","Select",""],["","72578005505","DOXYCYCL HYC","CAP 100MG","6","Select","Select",""],["","16571040250","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","80681013100","VITAMIN D","3 125 MCG","30","Select","Select",""],["","13668042905","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","00121086816","NYSTATIN","100000\/ML","280","Select","Select",""],["","00116200116","CHLORHEX GLU","SOL 0.0012","473","Select","Select",""],["","00472040492","CLOBETASOL","LOT 0.0005","59","Select","Select",""],["","00310737220","BUDES\/FORMOT","AER 80-4.5","10","Select","Select",""],["","49483060450","IBUPROFEN","800 MG","90","Select","Select",""],["","55111072510","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","62332011291","METOPROL TAR","TAB 25MG","180","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","00054429731","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","00093506001","HYDROXYZ HCL","TAB 10MG","60","Select","Select",""],["","00186037020","SYMBICORT","160-4.5MCG","10.2","Select","Select",""],["","59267100003","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","00093031101","LOPERAMIDE","2 MG","40","Select","Select",""],["","00603548232","PROPRANOLOL","TAB 10MG","60","Select","Select",""],["","69367016304","PHENAZOPYRID","TAB 200MG","4","Select","Select",""],["","00093598627","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","14","Select","Select",""],["","43547040011","CYCLOBENZAPR","TAB 10MG","10","Select","Select",""],["","00527143501","METAXALONE","TAB 800MG","20","Select","Select",""],["","62756024064","ONDANSETRON","TAB 4MG ODT","30","Select","Select",""],["","00527128201","DICYCLOMINE","TAB 20MG","20","Select","Select",""],["","57237004199","PENICILLN VK","TAB 500MG","40","Select","Select",""],["","27808003503","HYDROCO\/APAP","TAB 5-325MG","3","Select","Select",""],["","42858000101","OXYCODONE","TAB 5MG","20","Select","Select",""],["","31722094905","OXYCOD\/APAP","TAB 5-325MG","25","Select","Select",""],["","65862053820","LEVOFLOXACIN","750 MG","5","Select","Select",""],["","70710112307","DOXYCYC MONO","TAB 100MG","10","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","29300022701","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","70436015542","PROMETHAZINE","SOL DM","140","Select","Select",""],["","68180067711","OSELTAMIVIR","CAP 75MG","6","Select","Select",""],["","04142000007","FLORASTOR","CAP 250MG","8","Select","Select",""],["","00121077508","GG\/CODEINE","SOL 100-10\/5","30","Select","Select",""],["","00781717612","NALOXONE","SPR 4MG","2","Select","Select",""],["","00069108530","PAXLOVID","TAB 300-100","30","Select","Select",""],["","55111072510","MONTELUKAST SODIUM","10 MG","90","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","90 MCG","18","Select","Select",""],["","00116200116","CHLORHEXIDINE GLUCONATE","0.12 %","473","Select","Select",""],["","00172392670","DIAZEPAM","5 MG","2","Select","Select",""],["","75834050005","METFORMIN HCL ER","500 MG","90","Select","Select",""],["","65862050320","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","28","Select","Select",""],["","00310737020","BUDESONIDE-FORMOTEROL FUMARATE","160-4.5MCG","30.6","Select","Select",""],["","47781030301","NITROFURANTOIN MONO-MACRO","100 MG","20","Select","Select",""],["","23155050001","HYDROXYZINE HCL","10 MG","60","Select","Select",""],["","57664050658","METOPROLOL TARTRATE","25 MG","90","Select","Select",""],["","65162003310","ACETAMINOPHEN-CODEINE","300MG-30MG","12","Select","Select",""],["","00904671760","CETIRIZINE HCL","10 MG","30","Select","Select",""],["","65862001401","AMOXICILLIN","500 MG","21","Select","Select",""],["","68382005105","MELOXICAM","15 MG","30","Select","Select",""],["","55111046601","METOPROLOL SUCCINATE","25 MG","90","Select","Select",""],["","13668042905","PANTOPRAZOLE SODIUM","40 MG","90","Select","Select",""],["","60008040780","INDICAID COVID-","19 AG HOME TEST","8","Select","Select",""],["","56362000589","IHEALTH COVID-","19 AG HOME TEST","8","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":""}]}]}