{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHIRLEY T GHOLSTON","gend":1,"add":"401 ROBERT AVE APT 701","city":"PETERSBURG","state":"VA","zip":"23805-9998","dob":"1967-08-01","age":"","mstatus":"","insh":"20027808*01","cliId":"","pno":8049265522,"cno":8049265522,"email":"","ename":"","eno":"","pphy":"MCCURRY, CARA DO","ppno":8045262121,"pcpadd":"436 CLAIRMONT CT STE 100,","pcpcity":"COLONIAL HEIGHTS","pcpstate":"VA","pcpzip":"23834-9998","pcpcounty":"","pcpid":"","pcpname":"Bon Secours - Colonial Heights Family Medicine","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8045202617,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.40","E11.65","E78.2","I10.","G62.9","Z68.34","Z79.4","J45.901","E11.9","M89.49","K21.9","Z09.","K43.9","Z68.33","E11.3293","H52.01","H52.223","I51.7","K44.9","J45.902","R06.02","E87.6","R06.2","R05.","R79.89","S80.01XA","M17.11","W19.XXXA","Z01.419","Z12.31","K59.00","E66.09","Z79.84","G47.00","Z68.32","S83.241A","S83.281A","M22.41","R11.0","R10.9","Z79.51","R10.84","R10.819","W19.XXXD","V58.89","M94.261","H52.4","E10.40","G89.29","Z20.822","Z79.899","D22.9","E78.5","J45.909","Z79.82","M72.2","M77.8","R07.9","R94.31","M19.041","M19.042","M77.31","M77.32","R53.82","K59.09","E10.3593","H25.13","H35.033","Z11.4","Z11.59"],"date":["2023-09-15","2022-08-19","2022-07-28","2023-07-11","2021-08-24","2021-05-24","2023-09-15","2021-02-10","2022-08-20","2021-08-24","2022-08-17","2021-03-17","2022-10-04","2022-09-07","2022-12-09","2022-12-09","2022-12-09","2021-01-25","2023-09-15","2021-02-08","2021-02-08","2021-02-08","2021-02-08","2021-02-08","2021-02-08","2021-08-10","2021-11-12","2021-08-10","2022-08-17","2023-09-15","2023-09-15","2022-08-17","2022-08-19","2021-09-14","2021-09-14","2021-11-12","2021-11-12","2021-11-12","2022-08-20","2022-08-20","2022-08-20","2023-09-15","2022-08-20","2021-10-01","2021-10-26","2021-11-12","2022-09-07","2021-02-08","2021-02-08","2021-02-08","2021-02-08","2021-05-24","2021-11-12","2021-11-12","2021-11-12","2022-03-09","2022-03-09","2022-07-28","2022-07-28","2021-08-24","2021-08-24","2021-08-24","2021-08-24","2021-08-24","2022-08-24","2023-07-11","2023-07-11","2023-07-11","2023-09-15","2023-09-15"],"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":[["","00378247401","DICLOFEN POT","TAB 50MG","12","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","14","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA","300","Select","Select",""],["","00603188016","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","50111056101","TRAZODONE","TAB 100MG","90","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","69097084507","CYCLOBENZAPR","TAB 5MG","15","Select","Select",""],["","65862052305","GABAPENTIN","TAB 600MG","90","Select","Select",""],["","69097083305","SERTRALINE","TAB 25MG","30","Select","Select",""],["","67877057505","BENZONATATE","CAP 200MG","21","Select","Select",""],["","65862053820","LEVOFLOXACIN","TAB 750MG","5","Select","Select",""],["","00002822259","INSULIN LISP","INJ 100\/ML","15","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","15","Select","Select",""],["","53885039310","ONETOUCH US","MIS LANCETS","100","Select","Select",""],["","68180097903","LISINOPRIL","TAB 40MG","180","Select","Select",""],["","00527193206","CLARITHROMYC","TAB 500MG","28","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","69097096507","NABUMETONE","TAB 500MG","60","Select","Select",""],["","67877056110","METFORMIN","TAB 500MG","120","Select","Select",""],["","00093005805","TRAMADOL HCL","TAB 50MG","12","Select","Select",""],["","00378699252","ALBUTEROL","NEB 1.25MG\/3","75","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","15","Select","Select",""],["","67618010160","COLACE","CAP 100MG","30","Select","Select",""],["","55111015810","OMEPRAZOLE","CAP 20MG","90","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","5","Select","Select",""],["","00002879959","HUMALOG KWIK","INJ 100\/ML","30","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","75826011510","PHENAZOPYRID","TAB 200MG","6","Select","Select",""],["","80777027398","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","28","Select","Select",""],["","00173071920","FLOVENT HFA","110 MCG","12","Select","Select",""],["","59779060016","CVS ASPIRIN","TAB 81MG EC","90","Select","Select",""],["","64980028001","GLIPIZIDE ER","TAB 5MG","30","Select","Select",""],["","43547042409","LOSARTAN\/HCT","TAB 100-25","90","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","70377002811","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","00955172805","INSULIN GLAR","INJ 100U\/ML","15","Select","Select",""],["","57599080300","FREESTY LIBR","MIS 2 READER","1","Select","Select",""],["","00121087316","LACTULOSE","10 G\/15 ML","1892","Select","Select",""],["","66993007996","FLUTICAS HFA","AER 110MCG","12","Select","Select",""],["","45802065078","LORATADINE","10 MG","60","Select","Select",""],["","43547042409","LOSARTAN-HYDROCHLOROTHIAZIDE","100MG-25MG","90","Select","Select",""],["","49502025175","SEMGLEE (YFGN) PEN","100\/ML (3)","30","Select","Select",""],["","50111056101","TRAZODONE HCL","100 MG","90","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","100\/ML (3)","15","Select","Select",""],["","67877056110","METFORMIN HCL","500 MG","120","Select","Select",""],["","00002822259","INSULIN LISPRO KWIKPEN U-","100 100\/ML","30","Select","Select",""],["","70377002811","ATORVASTATIN CALCIUM","20 MG","90","Select","Select",""],["","56151146001","TRUE METRIX GLUCOSE TEST STRIP","","400","Select","Select",""],["","49483048112","ASPIRIN EC","81 MG","30","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","00002879959","HUMALOG KWIK INJ","100\/ML","30","Select","Select",""],["","00088221905","LANTUS SOLOS INJ","100\/ML","15","Select","Select",""],["","69097096507","NABUMETONE TAB","500MG","60","Select","Select",""],["","53885024510","ONETOUCH TES ULTRA","","300","Select","Select",""],["","68180097903","LISINOPRIL TAB","40MG","180","Select","Select",""],["","59779060027","CVS ASPIRIN TAB","81MG EC","90","Select","Select",""],["","43547042409","LOSARTAN\/HCT TAB","100-25","90","Select","Select",""],["","67877056110","METFORMIN TAB","500MG","120","Select","Select",""],["","70377002811","ATORVASTATIN TAB","20MG","30","Select","Select",""],["","64980028001","GLIPIZIDE ER TAB","5MG","30","Select","Select",""],["","00955172805","INSULIN GLAR INJ","100U\/ML","15","Select","Select",""],["","65862085901","FAMOTIDINE TAB","20MG","90","Select","Select",""],["","57599080000","FREESTY LIBR KIT","2 SENSOR","3","Select","Select",""],["","00121087316","LACTULOSE SOL","10GM\/15","210","Select","Select",""],["","57599080300","FREESTY LIBR MIS","2 READER","1","Select","Select",""],["","66993007996","FLUTICAS HFA AER","110MCG","12","Select","Select",""],["","45802065078","LORATADINE TAB","10MG","90","Select","Select",""],["","00173071920","FLOVENT HFA AER","110MCG","12","Select","Select",""],["","50111056101","TRAZODONE TAB","100MG","90","Select","Select",""],["","49502039475","INSULIN GLARGINE-YFGN","100\/ML (3)","15","Select","Select",""],["","66993007996","FLUTICASONE PROPIONATE HFA","110 MCG","12","Select","Select",""],["","53885024510","ONETOUCH ULTRA TEST STRIP","","100","Select","Select",""],["","53885027210","ONETOUCH VERIO TEST STRIP","","100","Select","Select",""],["","43386006019","GAVILYTE-C","240-22.72G","4000","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":""}]}]}