{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JERICA  A STILTNER","gend":1,"add":"3291 SIX AND TWENTY MILE BRANCH ROAD","city":"GRUNDY","state":"VA","zip":"24614-9998","dob":"1988-04-09","age":"","mstatus":"","insh":"20035671*01","cliId":"","pno":2763122902,"cno":2763122902,"email":"","ename":"","eno":"","pphy":"PATEL, DINKAR N MD","ppno":2769356424,"pcpadd":"1520 SLATE CREEK RD,","pcpcity":"GRUNDY","pcpstate":"VA","pcpzip":"24614-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":2769352494,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R07.89","R42.","Z11.59","R07.9","F41.1","Z72.0","Z11.52","G43.009","M54.5","H66.91","Z95.810","NO DATA","G43.109","I10.","K30.","I50.9","E55.9","J32.1","J20.9","A49.3","R05.9","R05.","J30.89","R05.1","R09.82","K21.9","J30.1","R60.0","M19.90","M54.2","M25.552","J02.9","R09.81","I48.91","I47.2","Z01.411","Z80.3","N95.1","Z11.3","N83.202","R06.02","G90.09","Q20.3","Q24.9","I07.1","N83.209","R10.2","F17.210","Z79.01","Z79.899","F34.1","Z20.822","I51.89","Z95.0","I36.1","I87.8","L03.211","U07.1","R94.31","J15.7","R09.1"],"date":["2023-06-22","2021-01-05","2021-01-05","2021-01-05","2022-12-28","2021-01-06","2023-01-30","2022-11-28","2021-08-23","2021-06-29","2022-08-02","2023-06-20","2023-03-23","2023-06-20","2021-10-21","2022-10-28","2022-12-28","2022-03-14","2023-03-20","2023-03-13","2023-03-20","2021-07-27","2021-12-08","2023-01-30","2021-12-08","2022-12-28","2022-12-28","2022-09-01","2022-10-19","2022-10-19","2022-10-19","2023-01-30","2023-01-30","2022-02-02","2022-02-02","2022-10-20","2022-10-20","2022-10-20","2022-10-20","2022-10-20","2021-01-05","2022-12-15","2022-02-02","2022-02-02","2022-02-02","2022-08-04","2022-08-04","2022-08-04","2022-08-04","2022-08-04","2023-05-24","2023-06-22","2022-02-02","2022-02-02","2022-02-02","2022-02-02","2021-09-23","2022-09-06","2021-01-18","2023-06-22","2023-06-22"],"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":[["","45802091987","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","00527169505","BUT\/APAP\/CAF","TAB ","40","Select","Select",""],["","69315011710","FUROSEMIDE","40 MG","60","Select","Select",""],["","16729013616","CLONAZEPAM","0.5 MG","30","Select","Select",""],["","42806064801","DIPHENHYDRAM","CAP 25MG","60","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","69452015120","VITAMIN D","2 1250 MCG","4","Select","Select",""],["","71093011105","GABAPENTIN","600 MG","90","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","60","Select","Select",""],["","00378459577","METOPROL SUC","TAB 25MG ER","60","Select","Select",""],["","00003089421","ELIQUIS","5 MG","60","Select","Select",""],["","69452013117","DOFETILIDE","125 MCG","60","Select","Select",""],["","68001016208","PROMETHAZINE","TAB 25MG","30","Select","Select",""],["","68462035705","POT CHLORIDE","CAP 10MEQ ER","120","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","00781808926","AZITHROMYCIN","250 MG","6","Select","Select",""],["","53746051105","SPIRONOLACT","TAB 25MG","30","Select","Select",""],["","68180024108","LEVOFLOXACIN","TAB 500MG","7","Select","Select",""],["","42582021618","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","59746017210","PREDNISONE","TAB 5MG","20","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","70000018001","8 HOUR PAIN","TAB 650MG","60","Select","Select",""],["","68001016208","PROMETHAZINE HCL","25 MG","30","Select","Select",""],["","68180096301","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","55505011133","SAFETUSSIN DM","100-10MG\/5","480","Select","Select",""],["","68180012202","CEPHALEXIN","500 MG","30","Select","Select",""],["","00527169505","BUTALBITAL-ACETAMINOPHEN-CAFFE","50-325-40","40","Select","Select",""],["","31722071390","PANTOPRAZOLE SODIUM","40 MG","60","Select","Select",""],["","45802091987","CETIRIZINE HCL","10 MG","30","Select","Select",""],["","42806064801","DIPHENHYDRAMINE HCL","25 MG","60","Select","Select",""],["","00378459577","METOPROLOL SUCCINATE","25 MG","60","Select","Select",""],["","57896073604","GUAIASORB DM","100-10MG\/5","480","Select","Select",""],["","68462035705","POTASSIUM CHLORIDE","10 MEQ","120","Select","Select",""],["","53746051105","SPIRONOLACTONE","25 MG","30","Select","Select",""],["","00378115005","BUSPIRONE HCL","10 MG","60","Select","Select",""],["","67877057505","BENZONATATE","200 MG","30","Select","Select",""],["","31722071390","PANTOPRAZOLE TAB","40MG","60","Select","Select",""],["","45802091987","CETIRIZINE TAB","10MG","30","Select","Select",""],["","69452013117","DOFETILIDE CAP","125MCG","60","Select","Select",""],["","68001016208","PROMETHAZINE TAB","25MG","30","Select","Select",""],["","68462035705","POT CHLORIDE CAP","10MEQ ER","120","Select","Select",""],["","00527169505","BUT\/APAP\/CAF TAB","","40","Select","Select",""],["","42806064801","DIPHENHYDRAM CAP","25MG","60","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","69452015120","VITAMIN D CAP","50000UNT","4","Select","Select",""],["","71093012205","GABAPENTIN CAP","400MG","60","Select","Select",""],["","69315011710","FUROSEMIDE TAB","40MG","60","Select","Select",""],["","00228300311","CLONAZEPAM TAB","0.5MG","30","Select","Select",""],["","00378459577","METOPROL SUC TAB","25MG ER","60","Select","Select",""],["","00003089421","ELIQUIS TAB","5MG","60","Select","Select",""],["","31722099601","HYDROCO\/APAP TAB","5-325MG","12","Select","Select",""],["","71093011105","GABAPENTIN TAB","600MG","90","Select","Select",""],["","68180016013","AZITHROMYCIN TAB","250MG","6","Select","Select",""],["","53746051105","SPIRONOLACT TAB","25MG","30","Select","Select",""],["","65162068090","PROMETHAZINE SOL DM","","480","Select","Select",""],["","68180096301","ALBUTEROL AER HFA","","8","Select","Select",""],["","42582021618","DOXYCYCL HYC CAP","100MG","20","Select","Select",""],["","68180024108","LEVOFLOXACIN TAB","500MG","7","Select","Select",""],["","59746017210","PREDNISONE TAB","5MG","20","Select","Select",""],["","42582021618","DOXYCYCLINE HYCLATE","100 MG","20","Select","Select",""],["","58657050016","CODEINE-GUAIFENESIN","10-100MG\/5","200","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":""}]}]}