{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LISA R JACKSON","gend":1,"add":"2869 OLD WILDERNESS ROAD","city":"CERES","state":"VA","zip":"24318-9998","dob":"1973-10-30","age":"","mstatus":"","insh":"20029734*01","cliId":"","pno":2766823801,"cno":2766823801,"email":"","ename":"","eno":"","pphy":"TITHA, RAVI K MD","ppno":2769646711,"pcpadd":"3150 CLINCH ST,","pcpcity":"RICHLANDS","pcpstate":"VA","pcpzip":"24641-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8443312990,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.5","N30.00","M05.40","G43.909","R39.81","N39.490","N31.9","M25.569","M51.36","J45.998","R33.9","F11.20","N30.10","E78.2","E55.9","E53.9","M25.561","M79.606","R73.9","NO DATA","E87.6","G89.4","E80.6","D69.6","K85.90","N39.0","R74.8","K74.60","I85.00","I86.4","J45.909","S13.4XXA","S43.491A","M25.511","M50.320","R51.0","N30.20","R10.84","J20.9","M50.30","M15.0","J01.80","Z02.89","Z20.822","R05.9"],"date":["2021-08-10","2022-11-15","2022-12-15","2022-12-15","2023-08-30","2023-08-30","2023-08-30","2021-11-04","2023-09-06","2022-07-06","2023-07-12","2023-03-16","2022-08-09","2023-01-16","2023-01-16","2023-01-16","2021-10-07","2022-07-06","2022-07-06","2023-09-06","2023-09-06","2023-09-06","2023-09-05","2023-09-06","2023-09-06","2023-09-06","2023-09-05","2023-09-06","2023-09-06","2023-09-06","2021-03-17","2021-03-22","2021-03-22","2022-10-20","2022-01-05","2021-05-13","2022-12-15","2022-02-03","2022-04-06","2021-06-10","2022-10-20","2021-02-16","2022-03-21","2022-03-21","2022-03-21"],"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":[["","69367020305","BUT\/APAP\/CAF","TAB ","120","Select","Select",""],["","68001041203","GABAPENTIN","800 MG","90","Select","Select",""],["","62756097083","BUPREN\/NALOX","SUB 8-2MG","56","Select","Select",""],["","72578010092","LEVOFLOXACIN","750 MG","30","Select","Select",""],["","61442017230","CEFACLOR","500 MG","90","Select","Select",""],["","69315011710","FUROSEMIDE","40 MG","60","Select","Select",""],["","00093321205","CLONAZEPAM","1 MG","14","Select","Select",""],["","76385013601","METOLAZONE","2.5 MG","30","Select","Select",""],["","68462010630","ONDANSETRON","TAB 8MG","30","Select","Select",""],["","00186037020","SYMBICORT","160-4.5MCG","10.2","Select","Select",""],["","69367016304","PHENAZOPYRID","TAB 200MG","6","Select","Select",""],["","68001025204","FLUCONAZOLE","100 MG","3","Select","Select",""],["","46672005350","BAC","TAB ","120","Select","Select",""],["","00713067815","NYSTATIN","100000\/G","15","Select","Select",""],["","00093220405","METOCLOPRAM","TAB 5MG","15","Select","Select",""],["","65862007705","CIPROFLOXACN","TAB 500MG","60","Select","Select",""],["","68001036103","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","21922000909","DICLOFENAC","GEL 0.01","200","Select","Select",""],["","41167432005","ALLEGRA-D","TAB 24 HOUR","30","Select","Select",""],["","00904645780","DOK","CAP 100MG","30","Select","Select",""],["","27241014501","SILODOSIN","CAP 8MG","30","Select","Select",""],["","67877032105","IBUPROFEN","800 MG","90","Select","Select",""],["","00527128210","DICYCLOMINE","TAB 20MG","90","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","68180096503","LEVOTHYROXIN","TAB 25MCG","30","Select","Select",""],["","00781261305","AMOXICILLIN","500 MG","15","Select","Select",""],["","68001040307","LEVETIRACETA","TAB 500MG","60","Select","Select",""],["","70954002120","PRAZOSIN HCL","5 MG","30","Select","Select",""],["","68001044503","POT CHLORIDE","TAB 20MEQ ER","60","Select","Select",""],["","00904699880","DOCUSATE SOD","CAP 100MG","30","Select","Select",""],["","68180096503","LEVOTHYROXINE SODIUM","25 MCG","30","Select","Select",""],["","00054018913","BUPRENORPHINE-NALOXONE","8 MG-2 MG","30","Select","Select",""],["","00527169505","BUTALBITAL-ACETAMINOPHEN-CAFFE","50-325-40","120","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","90 MCG","18","Select","Select",""],["","68462039610","OMEPRAZOLE","20 MG","30","Select","Select",""],["","65862064169","AZITHROMYCIN","250 MG","6","Select","Select",""],["","68001036103","MONTELUKAST SODIUM","10 MG","30","Select","Select",""],["","21922000909","DICLOFENAC SODIUM","1 %","200","Select","Select",""],["","68001056703","POTASSIUM CHLORIDE","20 MEQ","60","Select","Select",""],["","00121115400","LACTULOSE","20 G\/30 ML","30","Select","Select",""],["","00527128210","DICYCLOMINE HCL","20 MG","90","Select","Select",""],["","68001024717","ONDANSETRON ODT","8 MG","20","Select","Select",""],["","00904699880","DOCUSATE SODIUM","100 MG","30","Select","Select",""],["","24385057826","TUSSIN DM CLEAR","100-10MG\/5","280","Select","Select",""],["","69367016304","PHENAZOPYRIDINE HCL","200 MG","21","Select","Select",""],["","80681002000","MULTIVITAMIN","","30","Select","Select",""],["","00310737020","BUDESONIDE-FORMOTEROL FUMARATE","160-4.5MCG","10.2","Select","Select",""],["","00378013710","ALLOPURINOL","100 MG","30","Select","Select",""],["","00093216568","NALOXONE HCL","4 MG","2","Select","Select",""],["","00037682210","PROCTOFOAM-HC","1 %-1 %","10","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":""}]}]}