{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JENNIFER SCHOOLS","gend":1,"add":"314 ARBOR OAK DR RM 409MASSADHOTEL","city":"ASHLAND","state":"VA","zip":"23005-9998","dob":"1975-12-19","age":"","mstatus":"","insh":"20034606*01","cliId":"","pno":8043472472,"cno":8043472472,"email":"","ename":"","eno":"","pphy":"SIMMONS, CAMERON PA","ppno":8047989208,"pcpadd":"306 ASHCAKE RD STE C,","pcpcity":"ASHLAND","pcpstate":"VA","pcpzip":"23005-9998","pcpcounty":"","pcpid":"","pcpname":"Bon Secours Internal Medicine Of Ashland","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8047988108,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E88.89","M17.12","Z68.24","J45.909","Z91.09","Z71.9","M79.89","M79.669","M25.662","M25.562","M62.81","Z96.652","Z47.1","F20.3","M25.512","R29.3","M54.12","N39.0","R30.0","Z47.89","M50.90","M06.9","J45.20","F20.0","F33.41","F41.9","F42.9","M79.7","M19.90","D82.3","R10.9","Z91.81","Z79.51","Z79.891","Z98.1","Z23.","Z00.00","F25.0","J44.1","F20.9","F25.9","J45.901","R11.2","R53.81","T81.9XXA","M24.662","R20.2","Z87.440","R39.15","R35.0","N76.6","Z79.2","Z79.899","R82.998","Z79.890","J45.50","M50.20","M50.30","Z20.822","M47.812","M17.0","F41.8","J06.0","R52.","R53.83","V54.19","K57.90","W19.XXXA","NO DATA","M54.2","M62.838","Z12.4","M25.561","Z12.11","Z68.30","M50.321","Z01.812","G89.18","K52.9","M17.11","K59.00","Z79.01","Z86.19","G89.29","K59.03","R31.9","M48.02","Z01.818","E66.3","E78.00","R73.9","Z01.419"],"date":["2021-01-14","2021-06-21","2021-01-14","2023-04-12","2023-04-12","2023-04-12","2021-06-27","2021-06-27","2021-09-21","2021-09-21","2021-09-21","2022-11-15","2021-10-19","2022-03-07","2021-11-27","2022-01-14","2023-09-06","2023-05-15","2022-05-04","2022-06-02","2022-06-02","2022-06-02","2022-06-02","2023-05-15","2022-11-15","2023-05-15","2022-06-02","2023-05-15","2022-06-02","2022-06-02","2022-06-02","2022-06-02","2022-06-02","2022-06-02","2023-05-08","2022-10-24","2022-11-15","2023-09-05","2023-05-15","2021-06-28","2021-01-06","2023-05-15","2021-06-27","2021-06-27","2021-06-27","2022-12-20","2021-11-27","2021-11-04","2021-11-04","2021-06-02","2021-06-02","2021-11-04","2021-11-04","2021-08-04","2021-08-04","2021-09-15","2022-04-07","2022-10-12","2022-10-17","2023-08-16","2021-04-15","2021-09-07","2022-06-28","2022-06-28","2022-06-28","2022-07-15","2022-07-15","2022-07-15","2023-08-16","2023-08-16","2023-02-09","2023-05-15","2022-12-20","2023-05-15","2022-12-20","2023-02-09","2021-09-03","2021-06-21","2021-06-28","2021-06-28","2021-06-28","2021-06-28","2021-06-28","2022-12-20","2021-04-21","2021-04-21","2023-09-06","2021-09-03","2023-04-12","2023-05-15","2023-05-15","2023-09-18"],"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":[["","71093011105","GABAPENTIN","600 MG","120","Select","Select",""],["","42806016105","HYDROXYZ HCL","TAB 50MG","60","Select","Select",""],["","33342006807","OLANZAPINE","5 MG","60","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","7","Select","Select",""],["","00378932232","WIXELA INHUB","500-50 MCG","60","Select","Select",""],["","68180012101","CEPHALEXIN","CAP 250MG","30","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","59148007280","ABILIFY MAIN","INJ 400MG","1","Select","Select",""],["","27241009903","DULOXETINE","CAP 60MG","60","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","60","Select","Select",""],["","00574011830","TROSPIUM CHL","CAP 60MG ER","30","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","30","Select","Select",""],["","00173069700","ADVAIR DISKU","AER 500\/50","60","Select","Select",""],["","13668018930","TOLTERODINE","CAP 2MG ER","30","Select","Select",""],["","59267100001","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","40","Select","Select",""],["","50428029464","CVS SENNA PL","TAB 8.6-50MG","30","Select","Select",""],["","00378877035","ESTRADIOL","CRE 0.0001","42","Select","Select",""],["","00093598627","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","69842019958","ANTIBIOTIC","OIN ","14","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","30","Select","Select",""],["","69097015807","MELOXICAM","TAB 7.5MG","30","Select","Select",""],["","00003089321","ELIQUIS","TAB 2.5MG","28","Select","Select",""],["","50428317857","GENTLE LAXAT","TAB 5MG EC","10","Select","Select",""],["","00093342210","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","00069024230","TOVIAZ","TAB 4MG","30","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","67877054360","CEFDINIR","CAP 300MG","20","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","30","Select","Select",""],["","60505025103","TIZANIDINE","TAB 2MG","30","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","90","Select","Select",""],["","00093005805","TRAMADOL HCL","TAB 50MG","20","Select","Select",""],["","00378064110","PREDNISONE","TAB 10MG","29","Select","Select",""],["","76385012350","METHOCARBAMOL","500 MG","28","Select","Select",""],["","00173069700","ADVAIR DISKUS","500-50 MCG","60","Select","Select",""],["","65862057490","MONTELUKAST SODIUM","10 MG","15","Select","Select",""],["","65862042005","SULFAMETHOXAZOLE-TRIMETHOPRIM","800-160 MG","30","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","42806016005","HYDROXYZINE HCL","25 MG","60","Select","Select",""],["","59267030401","PFIZER COVID BIVAL (","12Y UP)EUA 30 MCG\/0.3","0.3","Select","Select",""],["","60505025103","TIZANIDINE HCL","2 MG","30","Select","Select",""],["","27241009903","DULOXETINE HCL","60 MG","60","Select","Select",""],["","69097084507","CYCLOBENZAPRINE HCL","5 MG","10","Select","Select",""],["","59148007280","ABILIFY MAINTENA","400 MG","1","Select","Select",""],["","00597010061","SPIRIVA RESPIMAT","2.5 MCG","4","Select","Select",""],["","16571040250","CETIRIZINE HCL","10 MG","30","Select","Select",""],["","59267100001","PFIZER VACC INJ COVID-","19","0","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","69097014260","ALBUTEROL AER HFA","","7","Select","Select",""],["","71093011105","GABAPENTIN TAB","600MG","120","Select","Select",""],["","65862042005","SMZ\/TMP DS TAB","800-160","30","Select","Select",""],["","65862057490","MONTELUKAST TAB","10MG","30","Select","Select",""],["","27241009903","DULOXETINE CAP","60MG","60","Select","Select",""],["","33342006807","OLANZAPINE TAB","5MG","60","Select","Select",""],["","42806016105","HYDROXYZ HCL TAB","50MG","60","Select","Select",""],["","59148007280","ABILIFY MAIN INJ","400MG","1","Select","Select",""],["","65162019050","NAPROXEN TAB","500MG","60","Select","Select",""],["","00378932232","WIXELA INHUB AER","500\/50","60","Select","Select",""],["","67877054360","CEFDINIR CAP","300MG","20","Select","Select",""],["","00487990130","ALBUTEROL NEB","0.5%","360","Select","Select",""],["","00173069700","ADVAIR DISKU AER","500\/50","60","Select","Select",""],["","65862039010","ONDANSETRON TAB","4MG ODT","12","Select","Select",""],["","53746010901","HYDROCO\/APAP TAB","5-325MG","12","Select","Select",""],["","60505025103","TIZANIDINE TAB","2MG","30","Select","Select",""],["","69097015807","MELOXICAM TAB","7.5MG","30","Select","Select",""],["","42858010201","OXYCOD\/APAP TAB","5-325MG","30","Select","Select",""],["","00093310905","AMOXICILLIN CAP","500MG","30","Select","Select",""],["","00093342210","CYCLOBENZAPR TAB","10MG","30","Select","Select",""],["","49483060450","IBUPROFEN TAB","800MG","90","Select","Select",""],["","00093005805","TRAMADOL HCL TAB","50MG","20","Select","Select",""],["","65862050320","AMOX\/K CLAV TAB","875-125","20","Select","Select",""],["","00378064110","PREDNISONE TAB","10MG","29","Select","Select",""],["","16571020106","DICLOFENAC TAB","75MG DR","60","Select","Select",""],["","47781030301","NITROFURANTOIN MONO-MACRO","100 MG","10","Select","Select",""],["","59267030401","PFIZER COVID BIVAL (12Y UP)","EUA","0.3","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":""}]}]}