{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CAROLYN W HILL","gend":1,"add":"PO BOX 3143","city":"LEBANON","state":"VA","zip":"24266-9998","dob":"1964-09-14","age":"","mstatus":"","insh":"20029159*01","cliId":"","pno":2767017887,"cno":2767017887,"email":"","ename":"","eno":"","pphy":"YOUSUF, SAMINA MD","ppno":2768890433,"pcpadd":"142 HIGHLANDS DR,","pcpcity":"LEBANON","pcpstate":"VA","pcpzip":"24266-9998","pcpcounty":"","pcpid":"","pcpname":"Community Medical Care","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4234311457,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R55.","I49.1","I10.","E78.2","M54.2","M43.22","F41.1","E66.01","Z68.41","Z13.83","Z23.","H55.00","I67.9","J01.90","Z20.822","R07.9","F41.0","R01.1","M47.812","F33.0","E11.65","R13.12","R60.1","M79.671","M79.672","R42.","M47.12","M47.816","M54.81","G47.33","R06.83","R06.81","J45.20","F43.10","F11.90","R56.9","K21.9","G47.19","Z79.84","Z79.899","F33.42","G47.61","N39.3","Z71.3","NO DATA","M79.621","R59.1","E78.5","F41.9","M15.0","M65.311","R53.83","R11.10","C18.9","K57.90","K63.5","K57.30","J45.909","M54.9","M62.838","Z85.038","M54.12","H65.01","J30.1","E55.9","Z13.89","R06.02","R60.0","Z98.890","Z90.49","Z87.19","R09.89","I47.1","Z71.82","E11.9","H25.13","H43.813","H02.831","H02.834","N39.0","R31.9","R00.0","H25.811","H25.812","H04.123","Z99.89"],"date":["2022-03-22","2022-03-22","2023-09-18","2023-09-18","2023-01-31","2021-05-05","2023-01-31","2023-09-18","2023-09-18","2022-03-31","2022-10-11","2021-10-08","2021-10-08","2021-10-25","2021-10-25","2022-03-31","2022-03-22","2022-03-22","2022-11-08","2023-01-31","2022-11-08","2022-07-21","2022-09-23","2022-09-15","2022-09-15","2022-03-22","2021-08-12","2021-08-12","2021-06-25","2023-09-18","2021-11-09","2021-11-29","2021-11-09","2021-11-09","2023-09-18","2023-09-18","2023-09-18","2021-11-09","2021-11-29","2023-01-03","2022-02-03","2021-12-17","2022-06-23","2021-04-01","2023-09-17","2021-11-10","2021-11-10","2022-06-15","2023-09-18","2021-08-03","2021-08-03","2022-03-22","2021-12-02","2022-06-13","2022-06-13","2022-06-13","2022-06-13","2023-08-28","2022-06-15","2021-08-12","2022-06-13","2021-04-14","2021-05-12","2021-05-12","2021-05-12","2022-03-03","2022-03-22","2022-03-22","2023-09-12","2021-02-08","2021-02-08","2021-10-25","2022-04-06","2022-05-26","2023-08-28","2023-05-16","2023-05-09","2023-05-09","2023-05-09","2023-09-17","2023-09-17","2023-09-17","2023-08-29","2023-08-29","2023-08-29","2023-08-28"],"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":[["","31722099701","HYDROCO\/APAP","TAB 10-325MG","28","Select","Select",""],["","00093083201","CLONAZEPAM","0.5 MG","90","Select","Select",""],["","00143924920","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","65162047810","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","42806054701","VITAMIN D","2 1250 MCG","4","Select","Select",""],["","00904788980","DOK","100 MG","60","Select","Select",""],["","68645055354","LISINOPRIL","20 MG","30","Select","Select",""],["","49035046708","ASPIRIN 81MG","CHE WABLE TABLETS","108","Select","Select",""],["","00310737220","BUDES\/FORMOT","AER 80-4.5","10","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","65862062405","GEMFIBROZIL","TAB 600MG","30","Select","Select",""],["","49035007860","EQ STOOL","CAP SOFTENER","60","Select","Select",""],["","29300012910","HYDROCHLOROT","TAB 50MG","30","Select","Select",""],["","45802065078","LORATADINE","TAB 10MG","90","Select","Select",""],["","29300022019","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","42571035707","POT CHLORIDE","SOL 0.1","300","Select","Select",""],["","00186037220","SYMBICORT","AER 80-4.5","10","Select","Select",""],["","64380076921","PEG-3350\/KCL","SOL \/SODIUM","4000","Select","Select",""],["","60687043198","HEALTHYLAX","POW ","30","Select","Select",""],["","76204020030","ALBUTEROL","NEB 0.00083","90","Select","Select",""],["","45802086866","POLYETH GLYC","POW 3350 NF","20","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","60","Select","Select",""],["","70677003401","STOOL SOFTNR","CAP 100MG","60","Select","Select",""],["","80777027399","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","00904699880","DOCUSATE SOD","CAP 100MG","60","Select","Select",""],["","70010016305","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","53885024450","ONETOUCH","TES ULTRA","50","Select","Select",""],["","68645058259","METFORMIN","TAB 500MG","60","Select","Select",""],["","00904675180","ASPIRIN LOW","TAB 81MG EC","30","Select","Select",""],["","56151149403","TRUE METRIX","KIT AIR","1","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","100","Select","Select",""],["","49035045875","ALLERGY REL","TAB 10MG","90","Select","Select",""],["","65702072910","ACCU-CHEK","KIT GUIDE","1","Select","Select",""],["","08290326895","BD SWAB REG","PAD SNGL USE","100","Select","Select",""],["","55111014512","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","00002143480","TRULICITY","1.5 MG\/0.5","2","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","55111015330","ONDANSETRON","TAB 4MG","40","Select","Select",""],["","69238110002","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","00904693126","PEG 3350","POW ","28","Select","Select",""],["","00456120130","LINZESS","CAP 145MCG","90","Select","Select",""],["","70010077001","METHOCARBAM","TAB 750MG","30","Select","Select",""],["","00054418425","DEXAMETHASON","TAB 4MG","6","Select","Select",""],["","16714068202","SIMVASTATIN","10 MG","90","Select","Select",""],["","00093216568","NALOXONE HCL","4 MG","2","Select","Select",""],["","49035041690","EQ ASPIRIN","TAB 325MG","90","Select","Select",""],["","43547040211","FUROSEMIDE","TAB 40MG","90","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","29300041519","CYCLOBENZAPRINE HCL","10 MG","60","Select","Select",""],["","67877069601","CHLORTHALIDONE","25 MG","90","Select","Select",""],["","49035056314","ASPIRIN EC","81 MG","90","Select","Select",""],["","00121168016","POTASSIUM CHLORIDE","20MEQ\/15ML","300","Select","Select",""],["","00406012501","HYDROCODONE-ACETAMINOPHEN","10MG-325MG","28","Select","Select",""],["","16714079904","CETIRIZINE HCL","10 MG","90","Select","Select",""],["","29300022019","MONTELUKAST SODIUM","10 MG","30","Select","Select",""],["","31722071390","PANTOPRAZOLE SODIUM","40 MG","90","Select","Select",""],["","68180096301","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","49035045875","ALLERGY RELIEF","10 MG","90","Select","Select",""],["","00904728080","DOCUSATE SODIUM","100 MG","60","Select","Select",""],["","12843010105","BAYER CHEWABLE ASPIRIN","81 MG","30","Select","Select",""],["","45802086866","POLYETHYLENE GLYCOL","3350 17 G","20","Select","Select",""],["","55111015330","ONDANSETRON HCL","4 MG","40","Select","Select",""],["","60505100301","KETOROLAC TROMETHAMINE","0.5 %","5","Select","Select",""],["","60758011905","PREDNISOLONE ACETATE","1 %","5","Select","Select",""],["","70010016305",""," ","30","Select","Select",""],["","49035011522","STOOL SOFTENER","100 MG","60","Select","Select",""],["","70756060730","OFLOXACIN","0.3 %","5","Select","Select",""],["","29300012910","HYDROCHLOROT TAB","50MG","30","Select","Select",""],["","68645055354","LISINOPRIL TAB","20MG","30","Select","Select",""],["","49035056314","ASPIRIN LOW TAB","81MG EC","90","Select","Select",""],["","00002143480","TRULICITY INJ","1.5\/0.5","2","Select","Select",""],["","70010016305","CETIRIZINE TAB","10MG","30","Select","Select",""],["","42806054701","VITAMIN D CAP","1.25MG","4","Select","Select",""],["","31722099701","HYDROCO\/APAP TAB","10-325MG","28","Select","Select",""],["","68180096301","ALBUTEROL AER HFA","","8","Select","Select",""],["","49035046708","ASPIRIN","81MG CHEWABLE TABLETS","30","Select","Select",""],["","00487950103","ALBUTEROL NEB","0.083%","90","Select","Select",""],["","31722071390","PANTOPRAZOLE TAB","40MG","90","Select","Select",""],["","00054327099","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","00093083201","CLONAZEPAM TAB","0.5MG","60","Select","Select",""],["","70010014805","POT CHLORIDE CAP","10MEQ ER","45","Select","Select",""],["","55111015330","ONDANSETRON TAB","4MG","40","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","00904699880","DOCUSATE SOD CAP","100MG","60","Select","Select",""],["","49035007860","EQ STOOL CAP SOFTENER","","60","Select","Select",""],["","29300022019","MONTELUKAST TAB","10MG","30","Select","Select",""],["","65862062405","GEMFIBROZIL TAB","600MG","30","Select","Select",""],["","45802086866","POLYETH GLYC POW","3350 NF","20","Select","Select",""],["","00591352530","LIDOCAINE PAD","5%","60","Select","Select",""],["","53885000810","ONETOUCH DEL MIS PLUS","33G","100","Select","Select",""],["","53885024450","ONETOUCH TES ULTRA","","50","Select","Select",""],["","69238110002","DOXYCYCL HYC CAP","100MG","20","Select","Select",""],["","49035046768","ASPIRIN LOW CHW","81MG","30","Select","Select",""],["","49035045875","ALLERGY REL TAB","10MG","30","Select","Select",""],["","00904645561","DOK CAP","100MG","60","Select","Select",""],["","63739019861","PEG","3350 POW","2","Select","Select",""],["","64380076921","PEG-","3350\/KCL SOL \/SODIUM","4000","Select","Select",""],["","00093216568","NALOXONE HCL SPR","","2","Select","Select",""],["","00054418425","DEXAMETHASON TAB","4MG","6","Select","Select",""],["","00456120130","LINZESS CAP","145MCG","30","Select","Select",""],["","70010077001","METHOCARBAM TAB","750MG","30","Select","Select",""],["","16729000417","SIMVASTATIN TAB","10MG","90","Select","Select",""],["","42571035707","POT CHLORIDE SOL","10%","300","Select","Select",""],["","43547040111","FUROSEMIDE TAB","20MG","90","Select","Select",""],["","49035041690","EQ ASPIRIN TAB","325MG","90","Select","Select",""],["","00046087221","PREMARIN","0.625 MG\/G","30","Select","Select",""],["","00487950101","ALBUTEROL SULFATE","2.5 MG\/3ML","90","Select","Select",""],["","67877021905","CEPHALEXIN","500 MG","21","Select","Select",""],["","49281040020","ADACEL TDAP","2-2.5-5\/.5","0.5","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":""}]}]}