{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TRAVIS R CHISHOLM","gend":0,"add":"2801 LAFLIN PL APT 5","city":"HENRICO","state":"VA","zip":"23228-9998","dob":"1946-11-02","age":"","mstatus":"","insh":"20025331*01","cliId":"","pno":8044845729,"cno":8044845729,"email":"","ename":"","eno":"","pphy":"ROSENBERG, MARK J MD","ppno":8049685700,"pcpadd":"SUITE 100 5000 COX ROAD,","pcpcity":"GLEN ALLEN","pcpstate":"VA","pcpzip":"23060-9998","pcpcounty":"","pcpid":"","pcpname":"Community Memorial Hospital ER Physicians","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8049685739,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.13","F41.1","S61.412A","N45.1","N52.9","N40.1","N30.90","N50.812","R22.2","L20.89","R10.9","G47.33","J44.9","K21.9","NO DATA","E78.5","F13.10","G47.00","G25.81","D50.9","F41.9","G47.61","Z01.812","Z20.822","R33.9","D12.2","Z12.11","Z86.010","K63.5","K64.8","R80.9","I12.9","D63.1","E66.9","T83.9XXA","T83.511A","N39.0","R09.89","Z00.00","Z13.6","R64.","Z11.59","I50.32","Z13.31","I70.219","Z86.19","I70.0","Z68.27","K62.5","R06.83","R35.1","R10.84","R19.7","D17.1","J43.9","Z87.891","Z46.6","Z23.","F17.200","Z79.82","M79.642","Z71.9","S00.03XA","E66.3","R53.83","R17.","E86.0","R33.8","R06.02","R91.1","R35.0"],"date":["2021-09-15","2021-09-24","2021-10-15","2023-03-01","2023-03-01","2023-03-30","2021-06-24","2022-04-23","2022-12-14","2022-12-02","2022-12-02","2023-03-30","2023-03-30","2023-03-30","2023-03-30","2023-03-30","2021-06-17","2023-02-13","2022-02-08","2021-11-09","2023-02-13","2023-02-13","2022-03-01","2023-03-07","2022-01-26","2022-03-10","2022-03-10","2022-03-10","2022-03-10","2022-03-10","2022-05-17","2022-05-17","2022-05-17","2023-02-13","2021-03-24","2021-03-24","2021-03-24","2022-09-07","2022-10-19","2022-10-19","2022-10-19","2022-10-19","2022-10-19","2022-10-19","2022-10-19","2022-10-19","2022-10-19","2022-10-19","2023-02-07","2021-06-14","2021-09-15","2021-09-15","2021-10-02","2022-12-14","2022-12-14","2022-12-14","2021-06-24","2023-09-25","2021-10-15","2021-10-15","2021-10-15","2022-02-08","2022-07-27","2022-08-09","2023-03-07","2023-03-07","2021-02-20","2021-03-24","2023-09-21","2021-04-22","2021-07-23"],"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":[["","00172392670","DIAZEPAM","TAB 5MG","45","Select","Select",""],["","49348098053","SM ASPIRIN","TAB 81MG EC","30","Select","Select",""],["","60505024708","MIRTAZAPINE","15 MG","30","Select","Select",""],["","60505016809","PRAVASTATIN","TAB 10MG","30","Select","Select",""],["","00310460012","BEVESPI","AER 9-4.8MCG","11","Select","Select",""],["","16729016917","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","00904675180","ASPIRIN LOW","TAB 81MG EC","30","Select","Select",""],["","80777027310","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","68382080505","TRAZODONE","TAB 50MG","30","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","10135068962","ASPIRIN","TAB 81MG EC","30","Select","Select",""],["","57237009960","CEFDINIR","CAP 300MG","14","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","00173088710","TRELEGY","AER ELLIPTA","60","Select","Select",""],["","52268020101","SUTAB","TAB ","24","Select","Select",""],["","62756016013","TAMSULOSIN","CAP 0.4MG","30","Select","Select",""],["","00172572880","FAMOTIDINE","20 MG","20","Select","Select",""],["","00904699880","DOCUSATE SOD","CAP 100MG","30","Select","Select",""],["","62135062605","DOXYCYCL HYC","TAB 100MG","28","Select","Select",""],["","52268001201","SUPREP BOWEL","SOL PREP KIT","354","Select","Select",""],["","68462018905","NAPROXEN","TAB 375MG","20","Select","Select",""],["","10572010001","PEG-3350","SOL ELECTROL","4000","Select","Select",""],["","52268010001","GOLYTELY","SOL ","4000","Select","Select",""],["","23155002405","BUSPIRONE","TAB 10MG","60","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","13668056630","TADALAFIL","TAB 5MG","27","Select","Select",""],["","55111015810","OMEPRAZOLE","20 MG","30","Select","Select",""],["","70461012203","FLUAD QUADRI","INJ 2022-23","0","Select","Select",""],["","45802006435","TRIAMCINOLON","CRE 0.001","15","Select","Select",""],["","72888008000","TRAMADOL HCL","TAB 50MG","12","Select","Select",""],["","00121176030","MAG-AL","200-200\/5","150","Select","Select",""],["","00536129383","ANTACID-ANTIGAS","200-200-20","150","Select","Select",""],["","67877045005","TAMSULOSIN HCL","0.4 MG","30","Select","Select",""],["","00597007541","SPIRIVA HANDIHALER","18 MCG","30","Select","Select",""],["","68382080505","TRAZODONE HCL","50 MG","30","Select","Select",""],["","49348015339","ADVANCED ANTACID-ANTIGAS","200-200-20","150","Select","Select",""],["","00904675180","ASPIRIN EC","81 MG","30","Select","Select",""],["","16729000816","PRAVASTATIN SODIUM","10 MG","30","Select","Select",""],["","62135098505","DOXYCYCLINE HYCLATE","100 MG","20","Select","Select",""],["","00121176130","MAG-AL PLUS","200-200-20","150","Select","Select",""],["","76282067942","ALBUTEROL SULFATE HFA","90 MCG","6.7","Select","Select",""],["","67877022005","CEPHALEXIN","250 MG","40","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","00597007541","SPIRIVA CAP HANDIHLR","","30","Select","Select",""],["","68382080505","TRAZODONE TAB","50MG","30","Select","Select",""],["","16729016917","ESCITALOPRAM TAB","10MG","30","Select","Select",""],["","60505016809","PRAVASTATIN TAB","10MG","30","Select","Select",""],["","62756016013","TAMSULOSIN CAP","0.4MG","30","Select","Select",""],["","60505024708","MIRTAZAPINE TAB","15MG","30","Select","Select",""],["","00904675180","ASPIRIN LOW TAB","81MG EC","30","Select","Select",""],["","10572010001","PEG-","3350 SOL ELECTROL","4000","Select","Select",""],["","62135062605","DOXYCYCL HYC TAB","100MG","28","Select","Select",""],["","23155002405","BUSPIRONE TAB","10MG","60","Select","Select",""],["","66993001968","ALBUTEROL AER HFA","","18","Select","Select",""],["","50383070016","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","13668056630","TADALAFIL TAB","5MG","27","Select","Select",""],["","70461012203","FLUAD QUADRI INJ","2022-23","0","Select","Select",""],["","45802006435","TRIAMCINOLON CRE","0.1%","15","Select","Select",""],["","72888008000","TRAMADOL HCL TAB","50MG","12","Select","Select",""],["","51991064310","OMEPRAZOLE CAP","20MG","30","Select","Select",""],["","00536132271","OMEPRAZOLE TAB","20MG DR","30","Select","Select",""],["","00536118297","MUCUS-CHEST CONGESTION","100 MG\/5ML","118","Select","Select",""],["","70461012303","FLUAD QUAD","2023-2024 60MCG\/.5ML","0.5","Select","Select",""],["","59746017506","PREDNISONE","20 MG","8","Select","Select",""],["","00168009915","KETOCONAZOLE","2 %","15","Select","Select",""],["","51224012230","AZITHROMYCIN","500 MG","5","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":""}]}]}