{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LORETTA L BLANKENSHIP","gend":1,"add":"PO BOX 489","city":"OAKWOOD","state":"VA","zip":"24631-9998","dob":"1973-06-26","age":"","mstatus":"","insh":"20023994*01","cliId":"","pno":2764984104,"cno":2764984104,"email":"","ename":"","eno":"","pphy":"STAPLETON, KRISTEN L NP","ppno":2769646771,"pcpadd":"1 CLINIC DR,","pcpcity":"RICHLANDS","pcpstate":"VA","pcpzip":"24641-9998","pcpcounty":"","pcpid":"","pcpname":"Family Care Center","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":2769355775,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.3593","Z79.4","H43.392","S72.361A","L97.821","T81.32XA","L97.822","I65.22","E11.9","R60.9","I10.","E03.9","L03.116","R79.89","E11.65","M79.604","Z74.09","S72.141A","S82.251A","L97.511","I89.0","Z13.6","R06.00","J44.9","J30.1","S72.91XA","S82.91XA","G89.11","V89.2XXD","Z74.3","T14.90XA","V47.6XXA","S70.01XA","S86.111A","R06.02","W19.XXXA","I95.9","L97.823","M79.89","I70.293","I50.9","E10.40","Z88.1","Z88.0","Z88.2","Z79.82","Z79.51","Z79.899","Z30.42","Z01.411","Z30.09","F41.9","Z12.4","Z76.89","Z68.41","I87.393","E11.628","I87.399","F33.1","F41.1","Z63.4","R07.9","R26.89","S89.91XS","V48.6XXA","Z47.89","R26.2","M25.561","M25.551","R53.1","E10.622","NO DATA","Z86.79","S82.251K","V54.13","V54.15","V54.16","Z11.59","R09.82","R06.09","E78.2","B37.3","S89.91XA","J01.90","R05.3","M79.672","M86.172","I34.0","R10.9","R00.0","V89.2XXA","L03.115","T81.9XXA","R69.","Z79.890","M79.662","E13.621","M86.171","M25.475","R93.89","E66.01","I87.309","Z96.641","S82.431A","R77.8","I11.0","J30.2","E11.42","E66.9","K21.9","F41.0","E10.9","E78.5","I87.2","I73.9","G47.36","Z71.2","G47.33","Z45.2","N93.9","N85.2","D25.9","Z87.42","M14.672","N91.2","R92.2","Z79.52","E28.2","I87.392","I87.092","Z98.890"],"date":["2021-03-16","2023-02-27","2021-03-31","2021-04-30","2021-10-07","2021-10-26","2021-10-07","2022-02-03","2023-07-06","2022-02-16","2023-07-06","2023-07-06","2022-12-21","2021-05-17","2021-05-06","2021-08-02","2021-05-27","2021-05-07","2021-05-07","2022-02-03","2023-07-13","2023-07-13","2023-01-31","2023-04-10","2023-04-10","2021-04-29","2021-04-28","2021-05-13","2021-05-13","2021-04-28","2021-04-28","2021-05-06","2021-05-27","2021-05-27","2021-05-27","2021-05-27","2021-06-23","2021-10-26","2022-12-21","2021-10-26","2021-10-07","2021-10-07","2023-02-27","2023-02-27","2023-02-27","2021-10-07","2021-10-07","2023-02-27","2023-07-06","2023-01-16","2023-01-16","2023-07-06","2023-01-16","2023-01-16","2023-02-27","2023-02-28","2023-02-28","2023-07-13","2023-03-27","2023-03-27","2023-03-27","2023-03-03","2021-05-13","2021-05-13","2021-05-13","2021-08-02","2021-08-02","2021-08-02","2021-08-02","2021-08-02","2021-09-10","2023-07-06","2021-09-10","2021-10-22","2022-03-28","2021-10-22","2021-12-27","2022-11-22","2022-11-22","2023-03-09","2023-03-09","2021-03-15","2021-04-28","2022-04-04","2022-04-04","2023-03-01","2023-03-01","2023-03-03","2021-02-01","2021-05-03","2021-05-03","2021-05-13","2021-05-13","2021-05-15","2022-12-21","2022-12-21","2023-02-27","2023-02-27","2023-02-27","2023-02-27","2023-03-09","2023-02-27","2023-02-27","2021-04-29","2021-04-29","2021-04-29","2021-04-29","2021-04-29","2021-04-29","2021-04-29","2021-04-29","2021-08-25","2021-08-25","2021-10-26","2021-11-11","2023-03-09","2023-03-09","2023-05-17","2023-02-28","2023-04-10","2023-07-06","2023-04-10","2023-07-06","2023-06-12","2023-07-06","2023-07-06","2023-07-06","2023-07-06","2023-07-11","2023-07-11","2023-07-13"],"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":[["","08290324912","INSULIN SYRG","MIS 1ML\/31G","150","Select","Select",""],["","69452015120","VITAMIN D","2 1250 MCG","4","Select","Select",""],["","0","COMPOUND"," ","300","Select","Select",""],["","68001043897","LORATADINE","10 MG","30","Select","Select",""],["","00173069600","ADVAIR DISKU","AER 250\/50","60","Select","Select",""],["","66993058597","FLUTIC\/SALME","AER 250\/50","60","Select","Select",""],["","60505267108","ATORVASTATIN","TAB 80MG","30","Select","Select",""],["","00173087310","INCRUSE ELPT","INH 62.5MCG","30","Select","Select",""],["","00002871501","HUMULIN","70-30 70-30\/ML","30","Select","Select",""],["","69315011610","FUROSEMIDE","20 MG","60","Select","Select",""],["","68001033408","LISINOPRIL","10 MG","30","Select","Select",""],["","33342010215","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00169750111","NOVOLOG","100\/ML","20","Select","Select",""],["","46122041660","GNP MUCUS ER","TAB 600MG","60","Select","Select",""],["","00378181710","LEVOTHYROXIN","TAB 175MCG","30","Select","Select",""],["","59267100001","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","00703680101","MEDROXYPR AC","INJ 150MG\/ML","1","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","24208083060","NEO\/POLY\/DEX","SUS 0.1% OP","5","Select","Select",""],["","00781313363","ENOXAPARIN","INJ 30\/0.3ML","2","Select","Select",""],["","00406012405","HYDROCO\/APAP","TAB 7.5-325","45","Select","Select",""],["","53885024450","ONETOUCH","TES ULTRA","100","Select","Select",""],["","53885039310","ONETOUCH US","MIS LANCETS","100","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","40","Select","Select",""],["","60432060816","PROMETHAZINE","SYP 6.25\/5ML","180","Select","Select",""],["","00002831501","HUMULIN N","INJ U-100","30","Select","Select",""],["","60505003306","PENTOXIFYLLI","TAB 400MG ER","60","Select","Select",""],["","16571041250","CIPROFLOXACN","TAB 500MG","20","Select","Select",""],["","51660052601","ALLERGY RELF","TAB 10MG","30","Select","Select",""],["","50383070016","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00310461612","BREZTRI AERO","AER SPHERE","11","Select","Select",""],["","65862064169","AZITHROMYCIN","250 MG","6","Select","Select",""],["","59746017310","PREDNISONE","TAB 10MG","10","Select","Select",""],["","76204020025","ALBUTEROL SULFATE","2.5 MG\/3ML","360","Select","Select",""],["","33342010215","MONTELUKAST SODIUM","10 MG","30","Select","Select",""],["","68180096301","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","45802049878","GUAIFENESIN ER","600 MG","60","Select","Select",""],["","00173069600","ADVAIR DISKUS","250-50 MCG","60","Select","Select",""],["","00703680101","MEDROXYPROGESTERONE ACETATE","150 MG\/ML","1","Select","Select",""],["","63304069301","CLINDAMYCIN HCL","300 MG","20","Select","Select",""],["","08290324912","VEO INSULIN SYRINGE","31GX15\/64\"","150","Select","Select",""],["","60505267108","ATORVASTATIN CALCIUM","80 MG","30","Select","Select",""],["","55111032105","GLIMEPIRIDE","2 MG","60","Select","Select",""],["","00378181710","LEVOTHYROXINE SODIUM","175 MCG","30","Select","Select",""],["","46122041660","MUCUS ER","600 MG","60","Select","Select",""],["","53885024450","ONETOUCH ULTRA TEST STRIP","","50","Select","Select",""],["","68462018022","MUPIROCIN","2 %","22","Select","Select",""],["","64380080707","IBUPROFEN","800 MG","60","Select","Select",""],["","00378181710","LEVOTHYROXIN TAB","175MCG","30","Select","Select",""],["","33342010215","MONTELUKAST TAB","10MG","30","Select","Select",""],["","08290324912","INSULIN SYRG MIS","1ML\/31G","150","Select","Select",""],["","53885024450","ONETOUCH TES ULTRA","","100","Select","Select",""],["","68001033408","LISINOPRIL TAB","10MG","30","Select","Select",""],["","00002871501","HUMULIN INJ","70\/30","30","Select","Select",""],["","60505267108","ATORVASTATIN TAB","80MG","30","Select","Select",""],["","51660052601","ALLERGY RELF TAB","10MG","30","Select","Select",""],["","53885039310","ONETOUCH US MIS LANCETS","","100","Select","Select",""],["","00169750111","NOVOLOG INJ","100\/ML","20","Select","Select",""],["","00173069600","ADVAIR DISKU AER","250\/50","60","Select","Select",""],["","69452015120","VITAMIN D CAP","50000UNT","4","Select","Select",""],["","69315011610","FUROSEMIDE TAB","20MG","60","Select","Select",""],["","00703680101","MEDROXYPR AC INJ","150MG\/ML","1","Select","Select",""],["","16571041250","CIPROFLOXACN TAB","500MG","20","Select","Select",""],["","68180096301","ALBUTEROL AER HFA","","8","Select","Select",""],["","50383070016","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","68001043897","LORATADINE TAB","10MG","30","Select","Select",""],["","68180016013","AZITHROMYCIN TAB","250MG","6","Select","Select",""],["","00310461612","BREZTRI AERO AER SPHERE","","11","Select","Select",""],["","59746017310","PREDNISONE TAB","10MG","10","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","76204020025","ALBUTEROL NEB","0.083%","360","Select","Select",""],["","46122041660","GNP MUCUS ER TAB","600MG","60","Select","Select",""],["","63304069301","CLINDAMYCIN CAP","300MG","40","Select","Select",""],["","00121092716","PROMETHAZINE HCL","6.25MG\/5ML","180","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":""}]}]}