{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHELBY L HENSLEY","gend":1,"add":"344 SOURWOOD DR","city":"DUFFIELD","state":"VA","zip":"24244-9998","dob":"1974-09-05","age":"","mstatus":"","insh":"20014617*01","cliId":"","pno":2765964254,"cno":2765964254,"email":"","ename":"","eno":"","pphy":"SERGENT, BERNIE N DO","ppno":2766798890,"pcpadd":"1490 PARK AVE NW SUITE 3,","pcpcity":"NORTON","pcpstate":"VA","pcpzip":"24273-9998","pcpcounty":"","pcpid":"","pcpname":"Residency Clinic","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":2764391485,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","F10.20","E03.9","C50.919","R60.9","F33.2","F43.10","R20.2","R06.00","C50.511","K21.9","Z79.811","Z85.3","R25.2","N95.1","R23.2","Z17.0","F10.10","S01.81XA","M25.551","M25.651","R26.2","M62.81","R79.1","Z20.822","R06.02","S73.034A","T07.XXXA","I07.1","NO DATA","H31.22","R32.","F33.9","F17.200","Z23.","G47.00","R09.81","F41.9","S73.034D","S32.461A","S42.201D","D62.","V54.11","V54.13","V54.16","V58.89","V47.5XXD","D63.0","G47.01","D69.6","M54.5","G89.29","F10.21","S42.241A","V87.7XXA","S32.401A","S92.121A","D64.9","Z72.0","M17.0","R20.0","R60.0","J45.909","G62.9","F17.210","F17.290","Z79.52","Z79.899","M79.605","S72.001A","V89.2XXA","G89.21","Z00.00","N12.","F33.1","Z87.81","E55.9","R53.1","R94.131","Z03.818","M25.511","M22.41","M22.42","L91.0","S42.201A","S32.421A","S72.051A","S32.019A","S32.029A","S73.004A","E87.1","S92.513A","R40.2411","E83.39","E87.6","M25.561","M25.562","D50.9","G44.1","M25.652","J32.8","J20.9","D75.89","S32.453A","S42.211A","R53.81","F32.9","Z92.21","Z90.13","M53.3"],"date":["2022-10-31","2023-08-02","2021-10-04","2021-05-10","2022-08-15","2023-08-02","2023-08-02","2022-07-22","2022-08-15","2023-05-17","2022-11-17","2022-11-17","2022-11-17","2022-11-17","2022-11-17","2022-11-17","2023-05-17","2021-08-02","2021-07-13","2022-07-29","2022-07-29","2022-07-29","2022-07-29","2022-08-15","2022-08-15","2022-08-15","2023-01-24","2023-01-24","2022-10-25","2022-10-31","2022-10-31","2023-09-11","2021-05-26","2021-03-10","2021-03-10","2021-03-10","2021-03-10","2021-07-13","2021-07-19","2021-10-25","2021-07-19","2021-07-19","2021-09-01","2022-10-10","2022-02-14","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2022-08-30","2022-08-31","2021-07-06","2021-07-06","2021-07-06","2021-10-25","2021-07-06","2021-07-06","2022-08-30","2022-07-22","2022-10-25","2022-07-01","2022-07-01","2022-07-01","2022-07-01","2022-07-01","2022-07-01","2022-07-01","2021-07-13","2021-07-13","2022-02-10","2021-11-10","2021-11-10","2022-02-10","2021-11-10","2022-02-10","2022-07-22","2022-07-22","2021-08-02","2022-08-30","2022-06-03","2022-06-03","2022-08-30","2021-07-03","2021-07-03","2021-07-03","2021-07-13","2021-07-13","2021-07-03","2021-07-13","2021-07-03","2021-07-03","2021-07-03","2021-07-13","2021-09-02","2021-09-02","2021-10-04","2022-05-19","2022-05-20","2021-03-31","2021-03-31","2021-03-31","2021-07-03","2021-07-13","2021-07-13","2021-07-13","2022-04-04","2022-04-04","2023-04-11"],"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":[["","10370010150","BUPROPN HCL","TAB 150MG XL","30","Select","Select",""],["","00536109808","MELATONIN","TAB 5MG","60","Select","Select",""],["","00378623305","CITALOPRAM","TAB 40MG","30","Select","Select",""],["","42806054701","VITAMIN D","2 1250 MCG","4","Select","Select",""],["","00378182310","LEVOTHYROXIN","TAB 137MCG","30","Select","Select",""],["","29300022010","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","69543021712","MAG OXIDE","TAB 400MG","30","Select","Select",""],["","16729032210","OLMESA MEDOX","TAB 40MG","90","Select","Select",""],["","47781010830","EXEMESTANE","25 MG","30","Select","Select",""],["","16571040250","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","13668015590","ESOMEPRA MAG","CAP 40MG DR","30","Select","Select",""],["","68180016011","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","53746027205","SMZ\/TMP DS","TAB 800-160","20","Select","Select",""],["","00781322464","ENOXAPARIN","INJ 40\/0.4ML","12","Select","Select",""],["","47781019605","OXYCOD\/APAP","TAB 5-325MG","60","Select","Select",""],["","96295013892","VITAMIN B1","TAB 100MG","30","Select","Select",""],["","00536106210","STOOL SOFTNR","CAP 100MG","30","Select","Select",""],["","00378615010","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","11917005022","CALCIUM","500-VIT D3 500MG-5MCG","60","Select","Select",""],["","53746010905","HYDROCO\/APAP","TAB 5-325MG","30","Select","Select",""],["","00378773293","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","00185067405","HYDROXYZ PAM","CAP 25MG","30","Select","Select",""],["","67877032105","IBUPROFEN","800 MG","90","Select","Select",""],["","31722022205","GABAPENTIN","300 MG","180","Select","Select",""],["","00378351510","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","40","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","20","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","20","Select","Select",""],["","65862053820","LEVOFLOXACIN","TAB 750MG","7","Select","Select",""],["","50228011410","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","50580072651","ZYRTEC ALLGY","TAB 10MG","30","Select","Select",""],["","00378700110","PAROXETINE","TAB 10MG","7","Select","Select",""],["","69097042207","CELECOXIB","CAP 100MG","30","Select","Select",""],["","00904546052","OYST SHELL\/D","TAB 500MG","30","Select","Select",""],["","43598016630","OLANZAPINE","TAB 10MG","30","Select","Select",""],["","00591565801","CYCLOBENZAPR","TAB 10MG","90","Select","Select",""],["","50111043302","TRAZODONE","TAB 50MG","30","Select","Select",""],["","45802049858","GUAIFENESIN","TAB 600MG ER","60","Select","Select",""],["","65862017760","CEFDINIR","CAP 300MG","14","Select","Select",""],["","00378668910","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","00904698640","MUCUS RELIEF","TAB 600MG ER","60","Select","Select",""],["","00002411730","ZYPREXA","TAB 10MG","30","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","7","Select","Select",""],["","59779065034","TUSSIN ADULT","LIQ 100\/5ML","120","Select","Select",""],["","54838011740","SILTUSSIN SA","SYP 100\/5ML","118","Select","Select",""],["","00054429725","FUROSEMIDE","20 MG","30","Select","Select",""],["","00054418425","DEXAMETHASON","TAB 4MG","15","Select","Select",""],["","31722021205","SERTRALINE","TAB 25MG","7","Select","Select",""],["","47781030801","NITROFUR MAC","CAP 100MG","10","Select","Select",""],["","00574041202","POLYETH GLYC","POW 3350 NF","255","Select","Select",""],["","00093005305","BUSPIRONE","TAB 5MG","60","Select","Select",""],["","66424002010","DIPHENHYDRAM","CAP 25MG","30","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","66424002010","DIPHENHYDRAMINE HCL","25 MG","30","Select","Select",""],["","67877024210","QUETIAPINE FUMARATE","25 MG","30","Select","Select",""],["","16571040250","CETIRIZINE HCL","10 MG","30","Select","Select",""],["","00378182310","LEVOTHYROXINE SODIUM","137 MCG","30","Select","Select",""],["","29300022010","MONTELUKAST SODIUM","10 MG","30","Select","Select",""],["","00378668910","PANTOPRAZOLE SODIUM","40 MG","30","Select","Select",""],["","59746000103","METHYLPREDNISOLONE","4 MG","21","Select","Select",""],["","51079098620","BUSPIRONE HCL","10 MG","60","Select","Select",""],["","68180035302","SERTRALINE HCL","100 MG","45","Select","Select",""],["","69543021712","MAGNESIUM OXIDE","400 MG","30","Select","Select",""],["","65162083366","DICLOFENAC SODIUM","1 %","100","Select","Select",""],["","00536110888","NICOTINE PATCH","21 MG\/24HR","28","Select","Select",""],["","69543021712","MAG OXIDE TAB","400MG","30","Select","Select",""],["","00378182310","LEVOTHYROXIN TAB","137MCG","30","Select","Select",""],["","16571040250","CETIRIZINE TAB","10MG","30","Select","Select",""],["","60505006507","OMEPRAZOLE CAP","20MG","30","Select","Select",""],["","50228011410","FLUOXETINE CAP","20MG","30","Select","Select",""],["","42806054701","VITAMIN D CAP","1.25MG","4","Select","Select",""],["","60505082901","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","69097042207","CELECOXIB CAP","100MG","30","Select","Select",""],["","00591565801","CYCLOBENZAPR TAB","10MG","90","Select","Select",""],["","00378700110","PAROXETINE TAB","10MG","7","Select","Select",""],["","00904546052","OYST SHELL\/D TAB","500MG","30","Select","Select",""],["","50111043302","TRAZODONE TAB","50MG","30","Select","Select",""],["","47781010830","EXEMESTANE TAB","25MG","30","Select","Select",""],["","29300022010","MONTELUKAST TAB","10MG","30","Select","Select",""],["","65862017760","CEFDINIR CAP","300MG","14","Select","Select",""],["","43598016405","OLANZAPINE TAB","5MG","7","Select","Select",""],["","00904698640","MUCUS RELIEF TAB","600MG ER","60","Select","Select",""],["","67877029605","IBUPROFEN TAB","800MG","90","Select","Select",""],["","45802049858","GUAIFENESIN TAB","600MG ER","60","Select","Select",""],["","00008060701","PANTOPRAZOLE TAB","40MG","30","Select","Select",""],["","67877022310","GABAPENTIN CAP","300MG","60","Select","Select",""],["","00054418425","DEXAMETHASON TAB","4MG","15","Select","Select",""],["","59779065034","TUSSIN ADULT LIQ","100\/5ML","120","Select","Select",""],["","54838011740","SILTUSSIN SA SYP","100\/5ML","118","Select","Select",""],["","69097014260","ALBUTEROL AER HFA","","7","Select","Select",""],["","00002411730","ZYPREXA TAB","10MG","30","Select","Select",""],["","00054429725","FUROSEMIDE TAB","20MG","30","Select","Select",""],["","59762490001","SERTRALINE TAB","50MG","30","Select","Select",""],["","65162083366","DICLOFENAC GEL","1%","100","Select","Select",""],["","66424002010","DIPHENHYDRAM CAP","25MG","30","Select","Select",""],["","00093005305","BUSPIRONE TAB","5MG","60","Select","Select",""],["","00574041202","POLYETH GLYC POW","3350 NF","255","Select","Select",""],["","47781030801","NITROFUR MAC CAP","100MG","10","Select","Select",""],["","00536137223","NICOTINE GUM","4 MG","110","Select","Select",""],["","10702001110","HYDROXYZINE HCL","25 MG","60","Select","Select",""],["","65162011511","HYDROCODONE-ACETAMINOPHEN","7.5-325 MG","16","Select","Select",""],["","45802086802","POLYETHYLENE GLYCOL","3350 17 G\/DOSE","238","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":""}]}]}