{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANGELA WILLIS","gend":1,"add":"5780 PONY FARM DR APT 302","city":"RICHMOND","state":"VA","zip":"23227-9998","dob":"1976-09-30","age":"","mstatus":"","insh":"1745597*01","cliId":"","pno":8042441572,"cno":8042441572,"email":"","ename":"","eno":"","pphy":"LATHAM, RUTH MD","ppno":8047641253,"pcpadd":"8200 MEADOWBRIDGE RD STE 306","pcpcity":"MECHANICSVILLE","pcpstate":"VA","pcpzip":"23116-9998","pcpcounty":"","pcpid":"","pcpname":"Memorial Medical Center","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8047641259,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R07.9","R06.02","M79.89","F33.1","F31.4","F41.1","J20.9","E11.65","Z12.11","S83.232A","E78.00","E03.9","L03.116","G43.909","E11.9","F17.200","I10.","J45.909","Z20.822","R11.0","J06.9","J40.","L02.429","R07.89","R60.0","M79.7","Z01.812","V58.89","G43.009","F17.210","G47.00","E66.01","Z79.4","Z79.899","Z88.6","R94.31","Z88.5","Z68.43","M25.562"],"date":["2021-12-21","2021-12-15","2021-12-21","2023-03-30","2023-02-22","2023-02-22","2021-12-13","2022-08-26","2021-12-13","2022-03-22","2022-08-26","2022-08-26","2022-11-03","2022-11-03","2021-10-05","2021-10-05","2022-08-26","2021-10-05","2022-03-18","2021-10-05","2021-10-12","2021-11-26","2022-08-26","2021-12-29","2021-12-29","2021-12-29","2022-03-18","2022-03-22","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2022-03-07"],"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":[["","53885004401","ONE TOUCH","KIT VERIO FL","1","Select","Select",""],["","65702072910","ACCU-CHEK","KIT GUIDE","1","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","120","Select","Select",""],["","69238117309","DOXEPIN HCL","100 MG","30","Select","Select",""],["","43598013901","KETOROLAC","TAB 10MG","20","Select","Select",""],["","00172208380","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","100","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","100","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","18","Select","Select",""],["","21922000909","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","42806008405","BUSPIRONE","TAB 10MG","90","Select","Select",""],["","13668000805","ZOLPIDEM","TAB 10MG","30","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","31722071310","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","00781107710","ALPRAZOLAM","0.5 MG","60","Select","Select",""],["","00472022041","CLOTRIMAZOLE","CRE 0.01","45","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","15","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","42","Select","Select",""],["","68645055954","CITALOPRAM","TAB 40MG","30","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","55111029398","SUMATRIPTAN","TAB 100MG","9","Select","Select",""],["","00603533815","PREDNISONE","PAK 10MG","21","Select","Select",""],["","45963055650","GABAPENTIN","300 MG","270","Select","Select",""],["","45802010901","TRIAMCINOLON","AER 55MCG\/AC","17","Select","Select",""],["","00054429931","FUROSEMIDE","40 MG","90","Select","Select",""],["","00115180301","HYDROXYZ PAM","CAP 25MG","90","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","70010049105","METFORMIN","TAB 500MG ER","120","Select","Select",""],["","23155013525","DOXYCYC MONO","TAB 100MG","14","Select","Select",""],["","00527169501","BUT\/APAP\/CAF","TAB ","30","Select","Select",""],["","08214054080","PEN NEEDLES","MIS 32GX5\/32","100","Select","Select",""],["","69238207807","PROPRANOLOL","TAB 20MG","90","Select","Select",""],["","58160088752","FLUARIX QUAD","INJ 2021-22","0","Select","Select",""],["","70710122801","AMITRIPTYLIN","TAB 75MG","30","Select","Select",""],["","08496080910","KROGER BLOOD","TES GLUCOSE","100","Select","Select",""],["","69238110005","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","00591352530","LIDOCAINE","5 %","20","Select","Select",""],["","00093101042","MUPIROCIN","2 %","22","Select","Select",""],["","65862042001","SMZ\/TMP DS","TAB 800-160","20","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","65862090901","CELECOXIB","200 MG","180","Select","Select",""],["","50228046501","NABUMETONE","500 MG","60","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","42","Select","Select",""],["","00536123201","ASPIRIN","TAB 325MG EC","60","Select","Select",""],["","42571025201","CLINDAMYCIN","CAP 300MG","30","Select","Select",""],["","00143122710","DICYCLOMINE","TAB 20MG","120","Select","Select",""],["","76329146905","NALOXONE","INJ 1MG\/ML","2","Select","Select",""],["","68382005101","MELOXICAM","TAB 15MG","30","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","00093216568","NALOXONE HCL","4 MG","2","Select","Select",""],["","72618300002","NURTEC","TAB 75MG ODT","15","Select","Select",""],["","29300035505","TRAMADOL HCL","TAB 50MG","15","Select","Select",""],["","00955172805","INSULIN GLARGINE SOLOSTAR","100\/ML (3)","30","Select","Select",""],["","69097052444","DICLOFENAC SODIUM","1 %","100","Select","Select",""],["","65862016001","ZOLPIDEM TARTRATE","10 MG","30","Select","Select",""],["","69238207801","PROPRANOLOL HCL","20 MG","90","Select","Select",""],["","00115180301","HYDROXYZINE PAMOATE","25 MG","90","Select","Select",""],["","29300042201","AMITRIPTYLINE HCL","75 MG","30","Select","Select",""],["","55111029398","SUMATRIPTAN SUCCINATE","100 MG","9","Select","Select",""],["","29300012810","HYDROCHLOROTHIAZIDE","25 MG","30","Select","Select",""],["","00378113401","KETOROLAC TROMETHAMINE","10 MG","20","Select","Select",""],["","55111018015","TIZANIDINE HCL","4 MG","120","Select","Select",""],["","72618300002","NURTEC ODT","75 MG","16","Select","Select",""],["","00093005401","BUSPIRONE HCL","10 MG","90","Select","Select",""],["","00378623301","CITALOPRAM HBR","40 MG","30","Select","Select",""],["","53885027210","ONETOUCH VERIO TEST STRIP","","100","Select","Select",""],["","10702025350","BUTALBITAL-ACETAMINOPHEN-CAFFE","50-325-40","30","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","90 MCG","18","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","52817033200","CYCLOBENZAPRINE HCL","10 MG","30","Select","Select",""],["","00378668977","PANTOPRAZOLE SODIUM","40 MG","30","Select","Select",""],["","00591079501","DICYCLOMINE HCL","20 MG","120","Select","Select",""],["","43598081115","CETIRIZINE HCL","10 MG","90","Select","Select",""],["","00363022714","ASPIRIN EC","325 MG","60","Select","Select",""],["","70010049105","METFORMIN HCL ER","500 MG","360","Select","Select",""],["","08290320122","ULTRA-FINE NANO PEN NEEDLE","32GX 5\/32\"","100","Select","Select",""],["","08290320550","NANO","2ND GEN PEN NEEDLE 32GX 5\/32\"","100","Select","Select",""],["","00832712211","DIVALPROEX SODIUM","125 MG","270","Select","Select",""],["","53885004401","ONETOUCH VERIO FLEX METER","","1","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":""}]}]}