{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMANDA K PAITSEL","gend":1,"add":"1935 S STEWART AVE","city":"COVINGTON","state":"VA","zip":"24426-9998","dob":"1984-04-17","age":"","mstatus":"","insh":"20033041*01","cliId":"","pno":5406913743,"cno":5406913743,"email":"","ename":"","eno":"","pphy":"MOUGHRABI, BASSEL MD","ppno":5409666430,"pcpadd":"65 SHENANDOAH AVENUE,","pcpcity":"DALEVILLE","pcpstate":"VA","pcpzip":"24083-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5409661348,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M12.232","G56.22","G56.02","R53.83","J02.9","E03.9","NO DATA","H92.03","J45.30","J45.31","R06.02","J38.3","Z87.09","R10.32","F17.200","R10.9","J45.901","Z20.822","K25.9","Z98.84","K91.2","K28.9","F34.1","R73.03","D50.8","E55.9","I10.","E53.8","E66.9","R10.2","E66.01","Z68.41","J02.0","J06.9","J45.41","H66.93","J44.1","J45.40","J30.89","R07.9","J20.9","R06.2","S46.211A","M25.521","J45.909","Z79.890","M25.511","M25.571","J01.90","B96.89","F17.210","N39.0","R19.7","F41.9","D50.9","R10.84","K57.30","K63.89","K64.2","K21.9","Z83.71","Z79.899","Z80.0","Z88.1","Z91.040","Z01.818","J40.","K27.9","D50.0","D64.9","F43.12","Z62.810","M19.012","R50.9","R79.89","R68.89","R39.9","S80.02XA","M25.562","F60.5","R07.2","M54.6","K52.9","R60.9","F43.10","R10.13","R10.11","K31.89","R05.","B37.9","Z63.4","R10.0","R10.12","T85.898A","M54.2","R51.9","L03.111","Z72.0","R11.0","Z68.43","X58.XXXA","L03.113","M79.631","S76.311A","M23.91","R29.898","H66.91","S90.31XA","A08.4","Z68.42","R05.9","B97.89","K95.89","F43.21","Z48.89","H60.501","R10.31","R63.4","R53.81","R35.0","Z87.19","Z88.4","Z20.828","J01.91","E66.3","J45.998","R42.","N94.9","H69.81","K27.7","M25.512","R30.0","R09.81","J10.1","Z01.419","N76.0","M25.561","J98.4","J45.50"],"date":["2021-01-18","2021-01-18","2021-01-18","2022-07-25","2021-11-30","2023-06-04","2023-04-28","2021-02-17","2021-11-11","2021-06-25","2023-05-10","2021-11-11","2021-08-11","2022-08-15","2023-09-13","2021-11-08","2023-04-28","2023-07-11","2021-12-16","2023-04-18","2021-12-16","2022-02-08","2023-04-18","2023-04-12","2023-02-27","2023-05-30","2023-05-30","2023-03-01","2023-04-12","2022-08-01","2023-05-30","2022-11-02","2023-01-14","2023-06-29","2023-03-15","2023-03-15","2023-04-28","2023-09-13","2023-09-13","2023-05-10","2023-03-22","2023-07-11","2023-06-04","2023-06-04","2023-07-11","2023-06-04","2023-06-04","2021-03-06","2022-05-30","2021-04-20","2023-05-10","2022-09-10","2023-07-12","2022-10-13","2022-09-29","2021-10-06","2021-10-06","2021-10-06","2021-10-06","2021-12-06","2021-12-06","2022-11-08","2021-12-06","2021-12-06","2021-10-06","2021-11-06","2021-11-08","2021-11-08","2021-11-08","2021-11-08","2023-04-18","2022-07-12","2022-07-11","2022-07-13","2022-07-13","2022-09-10","2022-09-10","2023-01-30","2023-02-27","2023-04-18","2023-05-10","2023-05-10","2023-07-11","2022-02-09","2023-02-27","2022-02-08","2021-10-06","2021-12-06","2021-05-07","2021-08-27","2021-06-15","2021-09-14","2021-12-06","2021-12-16","2022-02-04","2022-02-16","2023-03-04","2022-06-29","2022-02-16","2022-02-16","2023-01-30","2023-03-04","2023-03-04","2023-06-04","2023-06-21","2023-06-21","2023-06-29","2021-03-06","2021-04-19","2022-02-09","2022-07-13","2021-11-27","2022-02-08","2023-01-03","2021-03-29","2021-08-27","2021-12-06","2021-12-06","2021-09-29","2021-11-30","2021-12-06","2021-12-06","2022-01-24","2023-05-30","2021-05-03","2021-09-02","2021-11-04","2021-11-04","2021-11-04","2022-02-09","2022-05-09","2022-05-09","2022-05-30","2022-06-29","2022-08-15","2022-08-15","2023-02-27","2023-08-22","2023-08-18"],"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":[["","43547028211","ESCITALOPRAM TAB","20MG","30","Select","Select",""],["","59746017509","PREDNISONE TAB","20MG","20","Select","Select",""],["","42806031250","DOXYCYCL HYC TAB","100MG","20","Select","Select",""],["","00006505506","MOLNUPIRAVIR CAP","200MG","40","Select","Select",""],["","50228017910","GABAPENTIN CAP","100MG","90","Select","Select",""],["","63736012301","VITRON-C TAB","65-125","30","Select","Select",""],["","51267089099","CONTRAVE TAB","8-90MG","30","Select","Select",""],["","00378181377","LEVOTHYROXIN TAB","125MCG","90","Select","Select",""],["","29300016915","TIZANIDINE TAB","4MG","30","Select","Select",""],["","69452015120","VITAMIN D","CAP 50000UNT","12","Select","Select",""],["","55111014512","FLUCONAZOLE TAB","150MG","2","Select","Select",""],["","29300041319","CYCLOBENZAPR TAB","5MG","15","Select","Select",""],["","65162019011","NAPROXEN TAB","500MG","14","Select","Select",""],["","00074706890","SYNTHROID TAB","125MCG","90","Select","Select",""],["","31722071390","PANTOPRAZOLE TAB","40MG","60","Select","Select",""],["","65862017160","TOPIRAMATE TAB","25MG","60","Select","Select",""],["","10702002501","PHENTERMINE TAB","37.5MG","30","Select","Select",""],["","16714008210","HYDROXYZ HCL TAB","25MG","90","Select","Select",""],["","68645052254","SERTRALINE TAB","50MG","90","Select","Select",""],["","00186037020","SYMBICORT AER","160-4.5","10","Select","Select",""],["","00054327099","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","69452015120","VITAMIN D CAP","50000UNT","12","Select","Select",""],["","72305017530","EUTHYROX TAB","175MCG","30","Select","Select",""],["","69097014260","ALBUTEROL AER HFA","","7","Select","Select",""],["","00143924920","AMOX\/K CLAV TAB","875-125","20","Select","Select",""],["","69238110002","DOXYCYCL HYC CAP","100MG","14","Select","Select",""],["","00121077516","GG\/CODEINE SOL","100-10\/5","400","Select","Select",""],["","68645055254","LISINOPRIL TAB","10MG","30","Select","Select",""],["","42192060716","BROM\/PSE\/DM SYP","2\/30\/10","400","Select","Select",""],["","00169280015","SAXENDA INJ","18MG\/3ML","15","Select","Select",""],["","00487020103","IPRATROPIUM\/ SOL ALBUTER","","90","Select","Select",""],["","65162027250","SMZ\/TMP DS TAB","800-160","10","Select","Select",""],["","65162047810","NITROFURANTN CAP","100MG","14","Select","Select",""],["","00603533815","PREDNISONE PAK","10MG","21","Select","Select",""],["","50111033402","METRONIDAZOL TAB","500MG","14","Select","Select",""],["","00143928501","AMOXICILLIN TAB","875MG","20","Select","Select",""],["","10702002501","PHENTERMINE HCL","37.5 MG","30","Select","Select",""],["","68645055254","LISINOPRIL","10 MG","30","Select","Select",""],["","43547040111","FUROSEMIDE","20 MG","30","Select","Select",""],["","00591292754","LEVALBUTEROL TARTRATE HFA","45 MCG","15","Select","Select",""],["","00169280015","SAXENDA","3 MG\/0.5ML","15","Select","Select",""],["","31722071390","PANTOPRAZOLE SODIUM","40 MG","60","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE","50 MCG","48","Select","Select",""],["","00169452514","WEGOVY","0.25MG\/0.5","2","Select","Select",""],["","69315091001","DIPHENOXYLATE-ATROPINE","2.5-.025MG","28","Select","Select",""],["","00143924920","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","20","Select","Select",""],["","00781261305","AMOXICILLIN","500 MG","60","Select","Select",""],["","00378967130","IPRATROPIUM-ALBUTEROL","0.5-3MG\/3","90","Select","Select",""],["","55111014512","FLUCONAZOLE","150 MG","2","Select","Select",""],["","00143122701","DICYCLOMINE HCL","20 MG","30","Select","Select",""],["","16714008210","HYDROXYZINE HCL","25 MG","120","Select","Select",""],["","29300022019","MONTELUKAST SODIUM","10 MG","30","Select","Select",""],["","72578005518","DOXYCYCLINE HYCLATE","100 MG","20","Select","Select",""],["","00406012405","HYDROCODONE-ACETAMINOPHEN","7.5-325 MG","15","Select","Select",""],["","00378827052","ALBUTEROL SULFATE","2.5 MG\/3ML","75","Select","Select",""],["","50228017910","GABAPENTIN","100 MG","90","Select","Select",""],["","63304061650","DOXYCYCLINE MONOHYDRATE","100 MG","20","Select","Select",""],["","65162019011","NAPROXEN","500 MG","14","Select","Select",""],["","59746017509","PREDNISONE","20 MG","15","Select","Select",""],["","70954040110","DEXAMETHASONE","1.5 MG","35","Select","Select",""],["","42806040021","METHYLPREDNISOLONE","4 MG","21","Select","Select",""],["","68462015713","ONDANSETRON ODT","4 MG","10","Select","Select",""],["","68645052254","SERTRALINE HCL","50 MG","90","Select","Select",""],["","65862017160","TOPIRAMATE","25 MG","60","Select","Select",""],["","29300022705","METRONIDAZOLE","500 MG","30","Select","Select",""],["","70010016305","CETIRIZINE HCL","10 MG","30","Select","Select",""],["","00074706890","SYNTHROID","125 MCG","90","Select","Select",""],["","43547028211","ESCITALOPRAM","TAB 20MG","30","Select","Select",""],["","69238110002","DOXYCYCL HYC","CAP 100MG","28","Select","Select",""],["","00006505506","MOLNUPIRAVIR","CAP 200MG","40","Select","Select",""],["","51267089099","CONTRAVE","TAB 8-90MG","30","Select","Select",""],["","63736012301","VITRON-C","TAB 65-125","90","Select","Select",""],["","80681017401","VITAMIN D3","CAP 1.25MG","4","Select","Select",""],["","29300041319","CYCLOBENZAPR","TAB 5MG","15","Select","Select",""],["","00378182377","LEVOTHYROXIN","TAB 137MCG","30","Select","Select",""],["","29300016915","TIZANIDINE","TAB 4MG","30","Select","Select",""],["","16714008310","HYDROXYZ HCL","TAB 50MG","60","Select","Select",""],["","68645052254","SERTRALINE","TAB 50MG","30","Select","Select",""],["","00186037020","SYMBICORT","160-4.5MCG","10.2","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","60","Select","Select",""],["","72305017530","EUTHYROX","TAB 175MCG","30","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","7","Select","Select",""],["","47335075649","IPRATROPIUM\/","SOL ALBUTER","90","Select","Select",""],["","00143924920","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","42192060716","BROM\/PSE\/DM","SYP 2\/30\/10","400","Select","Select",""],["","10702002501","PHENTERMINE","TAB 37.5MG","30","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","00121077516","GG\/CODEINE","SOL 100-10\/5","400","Select","Select",""],["","65162027250","SMZ\/TMP DS","TAB 800-160","10","Select","Select",""],["","65162047810","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","00310737020","BUDESONIDE-FORMOTEROL FUMARATE","160-4.5MCG","10.2","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":""}]}]}