{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TIJUANA GIST","gend":1,"add":"6302 EDGEWOOD DR","city":"DISPUTANTA","state":"VA","zip":"23842-9998","dob":"1973-12-02","age":"","mstatus":"","insh":"1655410*01","cliId":"","pno":8044794508,"cno":8044794508,"email":"","ename":"","eno":"","pphy":"HEDIAN, KATHERINE DO","ppno":4342863602,"pcpadd":"2256 IRISH ROAD,","pcpcity":"ESMONT","pcpstate":"VA","pcpzip":"22937-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4342863819,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G43.019","R11.2","M54.5","I10.","J45.909","F32.9","Z68.41","M17.12","E66.01","Z68.42","J30.9","J30.1","J45.40","J45.901","H10.45","H25.13","H44.23","H25.12","Z20.828","J18.9","S40.012A","J01.00","G47.00","M25.561","Z30.46","J45.51","D72.829","J98.11","E87.6","G43.909","T38.0X5A","Z79.51","Z79.899","Z90.49","Z88.8","Z91.040","Z79.52","Z87.01","R06.02","J45.50","J45.41","J06.9","Z01.419","Z32.02","N83.201","Z30.09","H25.11","R03.0","Z71.3","Z71.89","L20.89","R07.9","T21.35XA","T31.0","G47.13","F31.81","F39.","G47.10","R45.89","E55.9","G43.709","F41.8","D50.8","S83.92XA","W22.8XXA","S83.411A","S62.662A","J01.10","F33.1","M25.562","R05.1","NO DATA","J02.9","Z12.11","R10.13","R12.","J04.0","J45.20","Z20.822","V54.12","R10.816","E66.09","Z68.35","Z01.818","J45.30","Z12.31","R07.89","D12.0","K29.70","K21.9","Z53.8","Z30.017","J30.2","N76.0","B96.89","B37.3","L73.9","V58.89","S50.361A","R19.7"],"date":["2022-09-12","2023-05-07","2021-09-08","2022-09-12","2023-05-26","2023-01-09","2023-04-18","2022-01-04","2023-05-12","2023-05-12","2023-05-22","2023-05-22","2023-03-02","2023-04-18","2023-05-22","2021-04-16","2021-04-16","2021-06-24","2022-05-19","2021-09-05","2021-09-22","2023-03-02","2023-01-09","2023-01-23","2023-02-02","2023-04-18","2023-04-18","2023-04-18","2023-04-18","2023-04-18","2023-04-18","2023-05-26","2023-04-18","2023-04-18","2023-04-18","2023-04-18","2023-04-18","2023-04-18","2023-04-18","2023-05-22","2023-04-24","2023-04-24","2023-05-12","2023-05-12","2023-05-12","2023-05-12","2021-07-01","2022-02-08","2022-02-08","2022-02-08","2022-09-19","2023-05-08","2023-09-11","2023-09-11","2021-01-13","2021-01-13","2021-01-13","2021-01-13","2021-01-13","2022-01-18","2022-01-18","2022-01-18","2022-01-18","2021-11-23","2021-11-23","2022-09-17","2023-02-17","2021-01-23","2021-05-19","2022-02-10","2022-06-07","2022-09-12","2023-01-30","2023-05-26","2023-05-09","2023-05-09","2022-05-28","2022-05-28","2023-02-28","2023-02-28","2023-05-07","2021-04-23","2021-01-20","2021-06-21","2022-01-18","2022-01-18","2023-05-07","2023-05-26","2023-05-26","2023-05-26","2021-03-19","2021-03-23","2021-04-23","2022-01-06","2022-01-06","2022-01-06","2022-01-06","2022-11-24","2022-12-08","2023-05-07"],"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":[["","68462011944","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","70436001004","BUPROPN HCL","TAB 150MG XL","30","Select","Select",""],["","16571066401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","63402030430","LATUDA","40 MG","90","Select","Select",""],["","00904759080","FEROSUL","325(65) MG","30","Select","Select",""],["","73796071002","OMRON 3 SERI","MIS BP MONIT","1","Select","Select",""],["","00173072020","FLOVENT HFA","AER 220MCG","12","Select","Select",""],["","51660093901","CETIRIZINE","TAB 10MG","90","Select","Select",""],["","69097012203","TOPIRAMATE","25 MG","180","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","30","Select","Select",""],["","29300022019","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","59267102503","PFIZER VACC","INJ ADLT RTU","0","Select","Select",""],["","66993008096","FLUTICAS HFA","AER 220MCG","12","Select","Select",""],["","62135098505","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","00121077504","GG\/CODEINE","SOL 100-10\/5","118","Select","Select",""],["","59746017506","PREDNISONE","20 MG","10","Select","Select",""],["","76204020025","ALBUTEROL","NEB 0.00083","150","Select","Select",""],["","27808008601","HYD POL\/CPM","SUS 10-8\/5ML","100","Select","Select",""],["","62332025118","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00173071720","ADVAIR HFA","230-21MCG","12","Select","Select",""],["","67877021560","CEFUROXIME","TAB 250MG","20","Select","Select",""],["","64764072030","TRINTELLIX","5 MG","30","Select","Select",""],["","00093310953","AMOXICILLIN","CAP 500MG","20","Select","Select",""],["","00093598627","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","65862062690","RIZATRIPTAN","10 MG","9","Select","Select",""],["","42806071401","BENZONATATE","100 MG","60","Select","Select",""],["","29300041510","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","45802006435","TRIAMCINOLON","CRE 0.001","15","Select","Select",""],["","72647033104","METHYLPRED","TAB 4MG","21","Select","Select",""],["","61442010210","DICLOFENAC","TAB 50MG DR","14","Select","Select",""],["","70010077001","METHOCARBAM","TAB 750MG","60","Select","Select",""],["","00115180301","HYDROXYZ PAM","CAP 25MG","30","Select","Select",""],["","65862007701","CIPROFLOXACN","TAB 500MG","20","Select","Select",""],["","45802086802","POLYETHYLENE GLYCOL","3350 17 G\/DOSE","714","Select","Select",""],["","00527512570","LACTULOSE","10 G\/15 ML","90","Select","Select",""],["","50383070016","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","69097084087","IPRATROPIUM-ALBUTEROL","0.5-3MG\/3","90","Select","Select",""],["","50111056001","TRAZODONE HCL","50 MG","60","Select","Select",""],["","29300022019","MONTELUKAST SODIUM","10 MG","30","Select","Select",""],["","65862007701","CIPROFLOXACIN HCL","500 MG","20","Select","Select",""],["","16571020211","DICLOFENAC SODIUM","50 MG","14","Select","Select",""],["","65862039010","ONDANSETRON ODT","4 MG","21","Select","Select",""],["","67877084201","FAMOTIDINE","20 MG","30","Select","Select",""],["","29033000301","SUCRALFATE","1 G","60","Select","Select",""],["","00173089310","TRELEGY ELLIPTA","200-62.5","60","Select","Select",""],["","69584061150","METHOCARBAMOL","500 MG","40","Select","Select",""],["","00310737020","BUDESONIDE-FORMOTEROL FUMARATE","160-4.5MCG","10.2","Select","Select",""],["","00186037020","SYMBICORT","160-4.5MCG","10.2","Select","Select",""],["","51660093901","CETIRIZINE HCL","10 MG","30","Select","Select",""],["","70436001104","BUPROPION XL","300 MG","90","Select","Select",""],["","41167432007","ALLEGRA-D","24 HOUR 180-240MG","30","Select","Select",""],["","42806054701","VITAMIN D","2 1250 MCG","4","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":""}]}]}