{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WILLIAM D HARRIS","gend":0,"add":"156 OPAL LN PO BOX 190","city":"MONTROSS","state":"VA","zip":"22520-9998","dob":"1976-07-25","age":"","mstatus":"","insh":"20028785*01","cliId":"","pno":8044930605,"cno":8044930605,"email":"","ename":"","eno":"","pphy":"ERNST, ANGELA N MD","ppno":8044939999,"pcpadd":"18849 KINGS HIGHWAY,","pcpcity":"MONTROSS","pcpstate":"VA","pcpzip":"22520-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4345811704,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F20.9","R07.9","Z20.822","E11.9","E78.5","I10.","F17.210","Z86.73","E66.9","Z68.41","M25.572","Z53.29","M79.672","F25.0","F10.20","R41.82","F22.","V62.85","R44.0","Z91.14","R00.2","K57.32","K59.00","R60.9","B35.1","E11.51","L85.1","E11.40","I45.9","G47.33","F10.251","R05.9","I44.30","E66.01","Z68.42","I20.9","E78.2","Z79.84","D23.71","Q82.8","Z45.018","F10.99","Z89.9","Z04.89","R10.0","I44.1","N52.9","F20.0","Z79.82","Z79.899","F41.9","F41.1","R00.0","Z53.21","R07.2","D23.72","J40.","E11.42","R25.2","K04.7","R10.9","Z00.6","K21.9","E83.52","R06.83","Z88.0","Z89.022","F10.10","R51.9","K02.9","R29.898","R20.0"],"date":["2023-07-18","2023-08-15","2022-01-13","2022-12-18","2022-03-04","2023-08-15","2022-12-18","2022-12-18","2022-03-04","2022-01-13","2022-01-13","2022-01-13","2022-01-13","2023-09-15","2023-04-14","2022-03-14","2022-03-14","2022-03-14","2022-03-14","2022-03-14","2023-01-11","2022-11-26","2023-05-22","2023-08-15","2022-11-21","2022-11-21","2021-10-12","2022-11-21","2023-08-15","2022-12-18","2022-03-04","2022-09-27","2022-12-19","2022-12-19","2022-12-19","2022-09-19","2022-07-14","2022-12-18","2022-11-21","2022-11-21","2022-12-27","2022-03-04","2022-03-04","2022-03-04","2022-11-26","2022-12-18","2021-09-16","2022-12-18","2022-01-13","2022-01-13","2022-01-13","2022-01-13","2022-01-13","2022-01-13","2022-01-12","2022-08-17","2022-07-14","2022-07-14","2022-07-14","2022-07-14","2022-11-26","2022-12-18","2022-12-18","2022-12-18","2022-12-18","2022-12-18","2022-12-18","2023-04-27","2023-05-22","2023-06-11","2023-09-14","2023-09-14"],"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":[["","53885065701","ONETOUCH","KIT VERIO","1","Select","Select",""],["","00597003134","CATAPRES-TTS","DIS 0.1\/24HR","3","Select","Select",""],["","00832154011","HALOPERIDOL","5 MG","60","Select","Select",""],["","65862056090","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","51224000760","METFORMIN","TAB 500MG ER","30","Select","Select",""],["","16729018317","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","60505258009","ATORVASTATIN","TAB 40MG","31","Select","Select",""],["","59148007280","ABILIFY MAIN","INJ 400MG","1","Select","Select",""],["","51672130104","AMMONIUM LAC","CRE 0.12","140","Select","Select",""],["","00555073302","TRAZODONE","TAB 300MG","31","Select","Select",""],["","51672129803","KETOCONAZOLE","CRE 0.02","60","Select","Select",""],["","53885039310","ONETOUCH US","MIS LANCETS","100","Select","Select",""],["","00121087316","LACTULOSE","10 G\/15 ML","473","Select","Select",""],["","00591350804","CLONIDINE","DIS 0.1\/24HR","4","Select","Select",""],["","59267100001","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","100","Select","Select",""],["","00406048410","APAP\/CODEINE","TAB 300-30MG","6","Select","Select",""],["","63304069201","CLINDAMYCIN","CAP 150MG","11","Select","Select",""],["","00832712315","DIVALPROEX","TAB 250MG DR","30","Select","Select",""],["","00363048044","NICOTINE","GUM 2MGFRUIT","100","Select","Select",""],["","50458056401","INVEGA SUST","INJ 234\/1.5","2","Select","Select",""],["","67877022001","CEPHALEXIN","CAP 250MG","28","Select","Select",""],["","68462086201","CHLORPROMAZ","TAB 25MG","120","Select","Select",""],["","55111015330","ONDANSETRON","TAB 4MG","1","Select","Select",""],["","69315090505","LORAZEPAM","1 MG","2","Select","Select",""],["","68462039710","OMEPRAZOLE","40 MG","90","Select","Select",""],["","54629005701","VITAMIN B-1","TAB 100MG","30","Select","Select",""],["","31604001281","B1","TAB 100MG","30","Select","Select",""],["","29300039710","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","68462012605","GABAPENTIN","600 MG","1","Select","Select",""],["","27808023302","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","53885004401","ONE TOUCH","KIT VERIO FL","1","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","70710128501","BACLOFEN","TAB 10MG","30","Select","Select",""],["","64380071206","BENZONATATE","CAP 100MG","30","Select","Select",""],["","00054074287","ALBUTEROL","AER HFA","7","Select","Select",""],["","11917020159","MAG CITRATE","SOL GRAPE","296","Select","Select",""],["","43547035211","LISINOPRIL","TAB 5MG","60","Select","Select",""],["","45802086802","POLYETH GLYC","POW 3350 NF","476","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","28","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","30","Select","Select",""],["","60505265401","TRAZODONE HCL","100 MG","30","Select","Select",""],["","50458056401","INVEGA SUSTENNA","234MG\/1.5","1.5","Select","Select",""],["","53489014301","SPIRONOLACTONE","25 MG","30","Select","Select",""],["","70010049105","METFORMIN HCL ER","500 MG","30","Select","Select",""],["","53885027025","ONETOUCH VERIO TEST STRIP","","50","Select","Select",""],["","69097014260","ALBUTEROL SULFATE HFA","90 MCG","6.7","Select","Select",""],["","00832712415","DIVALPROEX SODIUM","500 MG","30","Select","Select",""],["","55111046601","METOPROLOL SUCCINATE","25 MG","30","Select","Select",""],["","29300039710","AMLODIPINE BESYLATE","5 MG","30","Select","Select",""],["","82891038801","BLOOD PRESSURE MONITOR","","1","Select","Select",""],["","53885013610","ONETOUCH DELICA","33 GAUGE","100","Select","Select",""],["","67877056105","METFORMIN HCL","500 MG","90","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","62332011291","METOPROLOL TARTRATE","25 MG","60","Select","Select",""],["","00093506001","HYDROXYZINE HCL","10 MG","60","Select","Select",""],["","51672130104","AMMONIUM LACTATE","12 %","280","Select","Select",""],["","31604001281","VITAMIN B-","1 100 MG","30","Select","Select",""],["","00228212750","CLONIDINE HCL","0.1 MG","10","Select","Select",""],["","00378032701","HALOPERIDOL TAB","5MG","60","Select","Select",""],["","59148007280","ABILIFY MAIN INJ","400MG","1","Select","Select",""],["","00597003134","CATAPRES-TTS DIS","0.1\/24HR","3","Select","Select",""],["","00832712315","DIVALPROEX TAB","250MG DR","30","Select","Select",""],["","53885000810","ONETOUCH DEL MIS PLUS","33G","100","Select","Select",""],["","65862056090","PANTOPRAZOLE TAB","40MG","30","Select","Select",""],["","60505258009","ATORVASTATIN TAB","40MG","31","Select","Select",""],["","16729018317","HYDROCHLOROT TAB","25MG","30","Select","Select",""],["","62756014202","METFORMIN TAB","500MG ER","30","Select","Select",""],["","13668033005","TRAZODONE TAB","50MG","30","Select","Select",""],["","53885027210","ONETOUCH TES VERIO","","100","Select","Select",""],["","00363048044","NICOTINE GUM","2MGFRUIT","100","Select","Select",""],["","00591350804","CLONIDINE DIS","0.1\/24HR","12","Select","Select",""],["","67877022001","CEPHALEXIN CAP","250MG","28","Select","Select",""],["","50458056401","INVEGA SUST INJ","234\/1.5","2","Select","Select",""],["","68462086201","CHLORPROMAZ TAB","25MG","120","Select","Select",""],["","68462039610","OMEPRAZOLE CAP","20MG","30","Select","Select",""],["","31604001281","B","1 TAB 100MG","30","Select","Select",""],["","63304069301","CLINDAMYCIN CAP","300MG","21","Select","Select",""],["","00228212810","CLONIDINE TAB","0.2MG","30","Select","Select",""],["","29300039710","AMLODIPINE TAB","5MG","30","Select","Select",""],["","00121087316","LACTULOSE SOL","10GM\/15","946","Select","Select",""],["","55111015330","ONDANSETRON TAB","4MG","10","Select","Select",""],["","00406048410","APAP\/CODEINE TAB","300-30MG","6","Select","Select",""],["","69315090505","LORAZEPAM TAB","1MG","10","Select","Select",""],["","68462012605","GABAPENTIN TAB","600MG","8","Select","Select",""],["","53885065701","ONETOUCH KIT VERIO","","1","Select","Select",""],["","53885013610","ONETOUCH MIS LANCETS","","100","Select","Select",""],["","27808023302","DOXYCYCL HYC CAP","100MG","20","Select","Select",""],["","53885004401","ONE TOUCH KIT VERIO FL","","1","Select","Select",""],["","00781808926","AZITHROMYCIN TAB","250MG","6","Select","Select",""],["","64380071206","BENZONATATE CAP","100MG","30","Select","Select",""],["","00054074287","ALBUTEROL AER HFA","","7","Select","Select",""],["","45802086802","POLYETH GLYC POW","3350 NF","238","Select","Select",""],["","11917020159","MAG CITRATE SOL GRAPE","","296","Select","Select",""],["","43547035211","LISINOPRIL TAB","5MG","60","Select","Select",""],["","00143992801","CIPROFLOXACN TAB","500MG","28","Select","Select",""],["","50111033402","METRONIDAZOL TAB","500MG","30","Select","Select",""],["","70710128501","BACLOFEN TAB","10MG","30","Select","Select",""],["","53885000810","ONETOUCH DELICA PLUS LANCET","33 GAUGE","100","Select","Select",""],["","53885004401","ONETOUCH VERIO FLEX METER","","1","Select","Select",""],["","68462016305","CARVEDILOL","6.25 MG","180","Select","Select",""],["","65862018601","CLINDAMYCIN HCL","300 MG","21","Select","Select",""],["","00132070336","BISACODYL","10MG\/30ML","37","Select","Select",""],["","00406051205","OXYCODONE-ACETAMINOPHEN","5 MG-325MG","8","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":""}]}]}