{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DAPHNE RAMSEY","gend":1,"add":"PO BOX 124","city":"IRVINGTON","state":"VA","zip":"22480-9998","dob":"1979-03-14","age":"","mstatus":"","insh":"20033747*01","cliId":"","pno":8042964725,"cno":8042964725,"email":"","ename":"","eno":"","pphy":"WALKLEY, SUSAN NP","ppno":7572593258,"pcpadd":"5249 OLDE TOWNE ROAD SUITE D,","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":"23188-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7572201953,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E03.9","Z71.1","K21.9","I10.","M43.6","J45.909","Z85.41","K74.60","F17.210","Z79.899","Z79.1","M54.2","Z71.89","R94.4","R74.01","E87.6","R79.0","D50.9","R73.03","E66.9","F11.20","K80.20","R10.13","R11.2","F14.10","F60.9","R31.9","N39.0","R07.89","D64.9","R94.6","N20.0","I51.7","R79.89","Z79.890","Z68.41","M79.89","R09.02","J96.22","J96.21","B18.2","J44.1","E04.2","G47.33","Z90.5","D63.8","I50.32","I34.0","R31.0","N13.2"],"date":["2023-09-26","2023-01-18","2023-01-18","2023-09-22","2021-09-07","2023-06-07","2023-06-07","2021-09-07","2023-06-07","2023-06-07","2021-09-07","2021-09-07","2022-09-13","2022-09-13","2022-09-13","2023-09-26","2022-09-13","2022-09-13","2023-06-13","2023-06-13","2022-03-15","2022-03-01","2022-03-01","2023-06-11","2021-07-28","2022-08-19","2022-09-01","2022-09-01","2021-10-08","2023-09-22","2023-06-07","2023-06-13","2023-06-11","2023-06-07","2023-06-07","2023-06-07","2023-06-07","2023-09-22","2023-09-26","2023-09-26","2023-09-26","2023-09-26","2023-09-26","2023-09-22","2023-09-22","2023-09-26","2023-09-26","2023-09-23","2023-09-24","2023-06-11"],"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":[["","16729018201","HYDROCHLOROT","TAB 12.5MG","30","Select","Select",""],["","80777027310","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","53746051401","SPIRONOLACT","TAB 50MG","90","Select","Select",""],["","43547040111","FUROSEMIDE","20 MG","30","Select","Select",""],["","00904759080","FEROSUL","325(65) MG","30","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","00093506105","HYDROXYZ HCL","TAB 25MG","30","Select","Select",""],["","69238183801","LEVOTHYROXIN","TAB 150MCG","30","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","55111012305","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","00173060202","FLOVENT DISK","AER 100MCG","60","Select","Select",""],["","68180098003","LISINOPRIL","TAB 10MG","30","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","15","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","57629010020","FERROUS SULF","TAB 325MG","30","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","00172572860","FAMOTIDINE","20 MG","30","Select","Select",""],["","65862044990","VALACYCLOVIR","TAB 1GM","2","Select","Select",""],["","00054032756","FLUTICASONE-SALMETEROL","250-50 MCG","60","Select","Select",""],["","53885004601","ONETOUCH ULTRA","2","1","Select","Select",""],["","50383074120","ALBUTEROL SULFATE","5 MG\/ML","20","Select","Select",""],["","00173069600","ADVAIR DISKUS","250-50 MCG","60","Select","Select",""],["","57629010020","FERROUS SULFATE","325(65) MG","90","Select","Select",""],["","29300039810","AMLODIPINE BESYLATE","10 MG","30","Select","Select",""],["","43598083205","ATORVASTATIN CALCIUM","40 MG","30","Select","Select",""],["","53885024510","ONETOUCH ULTRA TEST STRIP","","100","Select","Select",""],["","00378181777","LEVOTHYROXINE SODIUM","175 MCG","30","Select","Select",""],["","00173060202","FLOVENT DISKUS","100 MCG","60","Select","Select",""],["","00378932132","WIXELA INHUB","250-50 MCG","60","Select","Select",""],["","53885000810","ONETOUCH DELICA PLUS LANCET","33 GAUGE","100","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","90 MCG","18","Select","Select",""],["","56151146304","TRUE METRIX GLUCOSE TEST STRIP","","50","Select","Select",""],["","56151147002","TRUE METRIX BLOOD GLUCOSE MTR","","1","Select","Select",""],["","53746051401","SPIRONOLACT TAB","50MG","30","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","80777027310","MODERNA VAC INJ COVID-","19","0","Select","Select",""],["","55111012305","ATORVASTATIN TAB","40MG","30","Select","Select",""],["","23155050105","HYDROXYZ HCL TAB","25MG","30","Select","Select",""],["","00054429731","FUROSEMIDE TAB","20MG","30","Select","Select",""],["","00173060202","FLOVENT DISK AER","100MCG","60","Select","Select",""],["","68180098003","LISINOPRIL TAB","10MG","30","Select","Select",""],["","00904759080","FEROSUL TAB","325MG","30","Select","Select",""],["","66993001968","ALBUTEROL AER HFA","","18","Select","Select",""],["","16729018201","HYDROCHLOROT TAB","12.5MG","30","Select","Select",""],["","69238183801","LEVOTHYROXIN TAB","150MCG","30","Select","Select",""],["","68462015713","ONDANSETRON TAB","4MG ODT","15","Select","Select",""],["","00143992801","CIPROFLOXACN TAB","500MG","14","Select","Select",""],["","00378427677","VALACYCLOVIR TAB","1GM","2","Select","Select",""],["","00172572860","FAMOTIDINE TAB","20MG","30","Select","Select",""],["","57629010020","FERROUS SULF TAB","325MG","30","Select","Select",""],["","68180072003","AMLODIPINE TAB","5MG","30","Select","Select",""],["","00904672059","ACETAMINOPHEN","500 MG","30","Select","Select",""],["","00363017508","PAIN RELIEVER","500 MG","30","Select","Select",""],["","00406012305","HYDROCODONE-ACETAMINOPHEN","5 MG-325MG","12","Select","Select",""],["","57237007710","ONDANSETRON ODT","4 MG","20","Select","Select",""],["","57237011490","ALFUZOSIN HCL ER","10 MG","30","Select","Select",""],["","53885027025","ONETOUCH VERIO TEST STRIP","","30","Select","Select",""],["","69238110002","DOXYCYCLINE HYCLATE","100 MG","10","Select","Select",""],["","69584085350","SPIRONOLACTONE","50 MG","30","Select","Select",""],["","83490031065","VIOS AEROSOL DELIVERY SYSTEM","","1","Select","Select",""],["","56151014701","TRUEPLUS LANCETS","33 GAUGE","100","Select","Select",""],["","00054981729","PREDNISONE","10 MG","42","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":""}]}]}