{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WANDA A HAWKINS","gend":1,"add":"423 BRUNSWICK AVE","city":"EMPORIA","state":"VA","zip":"23847-9998","dob":"1972-09-05","age":"","mstatus":"","insh":"1988029*01","cliId":"","pno":4345949569,"cno":4345949569,"email":"","ename":"","eno":"","pphy":"WATSON, JENNIFER NP","ppno":4346346101,"pcpadd":"6 DOCTORS DR,","pcpcity":"EMPORIA","pcpstate":"VA","pcpzip":"23847-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4346348611,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z20.828","A60.9","M54.9","Z20.822","R06.02","T50.905A","J45.909","E66.9","Z79.52","Z79.899","Z82.49","Z87.891","Z98.84","Z79.51","R22.0","R05.9","R22.9","M79.604","Z12.11","Z86.010","K63.5","K57.30","G89.29","NO DATA","Z48.816","D25.9","N93.9","D64.9","Z01.419","A59.01","Z90.710","H10.45","H52.03","H52.223","H52.4","G89.4","M54.16","M51.36","M51.37","D12.2","D12.3","D12.4","K21.9","E66.01","Z68.42","E03.9","B34.9","R51.9","E89.0","Z68.33","S86.911A","M54.17","Z23.","N39.0","K59.00","D50.9","Z68.36","Z20.2","M43.16","E05.00","M54.2","K74.60","E87.6","E83.51","N17.9","M17.11","M25.561","R60.0","M70.72","M25.552","R82.90","Z12.31","Z68.41","Z86.718"],"date":["2021-02-19","2021-07-27","2021-09-28","2022-11-06","2021-12-06","2021-12-06","2022-12-03","2022-12-03","2021-12-06","2022-12-03","2022-03-24","2022-12-03","2022-12-03","2021-12-06","2021-12-06","2021-12-06","2021-12-06","2022-03-23","2022-10-17","2022-10-17","2022-10-17","2022-10-17","2022-12-03","2022-12-03","2021-01-13","2021-01-13","2021-01-13","2021-01-13","2022-08-12","2021-08-04","2022-03-24","2021-12-29","2021-12-29","2021-12-29","2021-12-29","2022-05-27","2022-05-27","2022-05-27","2022-02-08","2022-10-17","2022-10-17","2022-10-17","2022-10-17","2022-10-17","2022-10-17","2022-10-17","2022-11-06","2022-11-06","2022-12-03","2021-01-12","2022-03-24","2022-05-27","2022-11-08","2023-03-06","2021-04-16","2021-04-16","2022-12-03","2021-07-26","2022-01-12","2022-12-03","2022-12-03","2021-07-26","2021-07-26","2021-07-26","2021-07-26","2021-08-04","2022-03-24","2021-08-04","2021-08-04","2021-08-04","2022-08-12","2022-08-12","2022-03-24","2022-03-24"],"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":[["","59651000305","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","00378181377","LEVOTHYROXIN","TAB 125MCG","90","Select","Select",""],["","00115165903","PROPRANOLOL","TAB 10MG","90","Select","Select",""],["","69680011225","CYANOCOBALAM","INJ 1000MCG","1","Select","Select",""],["","00536100901","FERROUS SULF","TAB 325MG","90","Select","Select",""],["","00555901658","SPRINTEC 28","TAB 28 DAY","84","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","10","Select","Select",""],["","80777027399","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","50428166363","BISACODYL","TAB 5MG EC","4","Select","Select",""],["","65162019011","NAPROXEN","500 MG","20","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","68180065208","DOXYCYC MONO","CAP 100MG","20","Select","Select",""],["","13668000905","CITALOPRAM","TAB 10MG","90","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","4","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","20","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","08290329651","INSULIN SYRG","MIS 1ML\/25G","100","Select","Select",""],["","59779030602","CVS PURELAX","POW ","238","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","23155022801","ACYCLOVIR","TAB 800MG","50","Select","Select",""],["","10702002901","PHENTERMINE","CAP 37.5MG","30","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","00169452514","WEGOVY","INJ 0.25MG","2","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","59779067613","CVS C-LAX","TAB 5MG","30","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","76385012450","METHOCARBAM","TAB 750MG","30","Select","Select",""],["","59746017509","PREDNISONE","20 MG","10","Select","Select",""],["","50111078751","AZITHROMYCIN","250 MG","6","Select","Select",""],["","00031873912","ROBITUSSIN","LIQ 20-400","118","Select","Select",""],["","60505025203","TIZANIDINE","TAB 4MG","60","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","15","Select","Select",""],["","43547040211","FUROSEMIDE","40 MG","30","Select","Select",""],["","71930005552","APAP\/CODEINE","TAB 300-30MG","20","Select","Select",""],["","31722070530","VALACYCLOVIR","TAB 1GM","90","Select","Select",""],["","43598029290","PREGABALIN","CAP 50MG","60","Select","Select",""],["","69097084507","CYCLOBENZAPR","TAB 5MG","30","Select","Select",""],["","50428029673","CVS ANTACID\/","SUS ANTI-GAS","150","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","67877021660","CEFUROXIME","TAB 500MG","20","Select","Select",""],["","50428009256","GENTLE LAXAT","TAB 5MG EC","4","Select","Select",""],["","43386009019","GAVILYTE-G","SOL ","4000","Select","Select",""],["","00378668910","PANTOPRAZOLE","TAB 40MG","20","Select","Select",""],["","00245010810","FERROUS SULFATE","325(65) MG","60","Select","Select",""],["","42806054701","VITAMIN D","2 1250 MCG","12","Select","Select",""],["","00378181377","LEVOTHYROXINE SODIUM","125 MCG","90","Select","Select",""],["","65162047810","NITROFURANTOIN MONO-MACRO","100 MG","14","Select","Select",""],["","08290305269","INTEGRA SYRINGE","25GX5\/8\"","1","Select","Select",""],["","70069000510","CYANOCOBALAMIN INJECTION","1000MCG\/ML","1","Select","Select",""],["","75826011510","PHENAZOPYRIDINE HCL","200 MG","6","Select","Select",""],["","68180096301","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","16571020106","DICLOFENAC TAB","75MG DR","60","Select","Select",""],["","76385012450","METHOCARBAM TAB","750MG","30","Select","Select",""],["","60505025203","TIZANIDINE TAB","4MG","60","Select","Select",""],["","59651000305","OMEPRAZOLE CAP","40MG","30","Select","Select",""],["","69097084507","CYCLOBENZAPR TAB","5MG","30","Select","Select",""],["","59746000103","METHYLPRED TAB","4MG","21","Select","Select",""],["","00378181377","LEVOTHYROXIN TAB","125MCG","90","Select","Select",""],["","00093031401","KETOROLAC TAB","10MG","15","Select","Select",""],["","71930005552","APAP\/CODEINE TAB","300-30MG","20","Select","Select",""],["","31722070530","VALACYCLOVIR TAB","1GM","90","Select","Select",""],["","00093310905","AMOXICILLIN CAP","500MG","21","Select","Select",""],["","43547040211","FUROSEMIDE TAB","40MG","30","Select","Select",""],["","69680011225","CYANOCOBALAM INJ","1000MCG","1","Select","Select",""],["","00536100901","FERROUS SULF TAB","325MG","90","Select","Select",""],["","43598029290","PREGABALIN CAP","50MG","60","Select","Select",""],["","65162019050","NAPROXEN TAB","500MG","20","Select","Select",""],["","68180016011","AZITHROMYCIN TAB","250MG","6","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","47781030301","NITROFURANTN CAP","100MG","10","Select","Select",""],["","00378064110","PREDNISONE TAB","10MG","18","Select","Select",""],["","65862042005","SMZ\/TMP DS TAB","800-160","10","Select","Select",""],["","50428029673","CVS ANTACID\/ SUS ANTI-GAS","","150","Select","Select",""],["","50428009256","GENTLE LAXAT TAB","5MG EC","4","Select","Select",""],["","00378668910","PANTOPRAZOLE TAB","40MG","20","Select","Select",""],["","65862039010","ONDANSETRON TAB","4MG ODT","12","Select","Select",""],["","67877021660","CEFUROXIME TAB","500MG","20","Select","Select",""],["","13668000905","CITALOPRAM TAB","10MG","30","Select","Select",""],["","00093317431","ALBUTEROL AER HFA","","8","Select","Select",""],["","43386009019","GAVILYTE-G SOL","","4000","Select","Select",""],["","42806040021","METHYLPREDNISOLONE","4 MG","21","Select","Select",""],["","31722053401","METHOCARBAMOL","750 MG","28","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":""}]}]}