{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CLEMENTINE F WHITE","gend":1,"add":"2319 FORT DR UNIT 101","city":"ALEXANDRIA","state":"VA","zip":"22303-9998","dob":"1960-12-20","age":"","mstatus":"","insh":"20037228*01","cliId":"","pno":4342729524,"cno":4342729524,"email":"","ename":"","eno":"","pphy":"PHAM, NICK MD","ppno":7035337673,"pcpadd":"SUITE F 6408 SEVEN CORNERS PL,","pcpcity":"FALLS CHURCH","pcpstate":"VA","pcpzip":"22044-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7035337675,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H25.12","I10.","E11.9","H26.9","F25.0","F43.12","F10.20","F14.20","E78.5","E11.42","I63.9","Z86.73","Z72.0","H53.132","J45.41","R41.840","Z79.4","I34.0","I36.1","E11.65","R79.89","F31.72","J45.998","F12.10","F15.10","Z65.3","F11.20","F33.3","H57.9","Z74.3","F10.10","E11.69","NO DATA","R07.9","H91.8X3","H54.62","R93.0","G95.9","E11.40","T38.0X5A","I66.9","D49.7","H53.8","F43.10","F63.81","F84.5","Z65.1","F33.8","H25.812","M25.569","G45.3","L20.89","R29.810","H25.811","R06.02","T78.02XA","H53.9","I12.9","I65.22","F32.9","N18.9","F25.1","E03.9","J45.20","R94.31","E11.21","R94.6","E66.3","Z68.35","F17.210","N17.9","R25.1","I65.23","D50.9","R53.1","Z23.","H26.20","E11.22","F10.232","R01.1","K56.1","R10.32","I16.0","C50.812","Z17.0","K63.89","D49.0","R93.3","Z00.01","E02.","E16.2","Z99.89","Z00.8"],"date":["2021-01-04","2023-09-21","2023-04-17","2021-01-25","2023-08-01","2023-08-01","2022-04-25","2022-04-25","2022-04-04","2022-04-04","2023-09-26","2022-02-15","2022-02-15","2022-02-15","2022-02-15","2021-09-22","2021-09-22","2022-09-07","2022-09-07","2023-06-28","2021-01-05","2021-02-03","2021-03-03","2021-03-01","2021-03-01","2021-03-01","2021-03-03","2021-03-03","2021-08-17","2021-08-17","2023-08-01","2023-08-01","2023-08-28","2021-08-17","2021-05-10","2021-08-17","2021-08-17","2021-08-19","2022-02-15","2021-08-18","2021-08-19","2021-08-19","2021-08-19","2022-11-01","2022-11-01","2022-11-01","2022-11-01","2022-11-01","2021-01-04","2021-07-21","2021-08-30","2022-04-19","2023-09-25","2021-01-25","2021-06-26","2021-06-26","2021-08-17","2021-11-30","2021-08-17","2021-08-17","2021-08-17","2021-09-07","2021-09-07","2022-05-06","2023-09-21","2021-04-05","2021-04-05","2021-04-05","2021-04-05","2021-04-05","2022-09-07","2022-09-07","2022-09-07","2022-09-07","2022-09-07","2021-06-30","2021-01-04","2021-11-30","2022-02-08","2023-09-21","2023-09-25","2023-09-25","2023-06-28","2023-09-07","2023-09-07","2023-09-25","2023-09-25","2023-09-25","2023-05-22","2023-09-21","2023-06-28","2023-06-28","2023-09-21"],"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":[["","49884012301","LABETALOL","TAB 200MG","270","Select","Select",""],["","00904678370","ASPIRIN LOW","TAB 81MG EC","30","Select","Select",""],["","69097082607","BENZTROPINE","TAB 0.5MG","30","Select","Select",""],["","24208060203","PROLENSA","SOL 0.0007","3","Select","Select",""],["","60758011905","PREDNISOLONE","SUS 1% OP","5","Select","Select",""],["","31722052101","HYDRALAZINE","TAB 50MG","90","Select","Select",""],["","65862020399","LOSARTAN POT","TAB 100MG","30","Select","Select",""],["","67877043203","ARIPIPRAZOLE","10 MG","30","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","3","Select","Select",""],["","64980056310","FUROSEMIDE","40 MG","90","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA","200","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","45","Select","Select",""],["","65862084003","MOXIFLOXACIN","SOL HCL 0.5%","3","Select","Select",""],["","00006011231","JANUVIA","50 MG","90","Select","Select",""],["","68462012605","GABAPENTIN","TAB 600MG","90","Select","Select",""],["","00173060102","FLOVENT DISK","AER 250MCG","180","Select","Select",""],["","55111012205","ATORVASTATIN","TAB 20MG","90","Select","Select",""],["","00378668977","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","65862076990","FENOFIBRATE","TAB 145MG","90","Select","Select",""],["","45963067611","METOPROLOL","TAB 50MG ER","90","Select","Select",""],["","42806054701","VITAMIN D","2 1250 MCG","4","Select","Select",""],["","73070010315","INSULIN ASPA","INJ FLEXPEN","12","Select","Select",""],["","23155050105","HYDROXYZ HCL","TAB 25MG","120","Select","Select",""],["","00363058714","ASPIRIN 81","TAB 81MG EC","30","Select","Select",""],["","00009540001","NICOTROL","INH ","168","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","10","Select","Select",""],["","00363042405","NICOTINE","LOZ 4MG CINN","216","Select","Select",""],["","11917015398","NICOTINE POL","LOZ 2MG CHRY","144","Select","Select",""],["","11917017229","NICOTINE TD","DIS 14MG\/24H","28","Select","Select",""],["","00135051007","NICORETTE","LOZ 2MG MINT","288","Select","Select",""],["","00904530660","BANOPHEN","CAP 25MG","30","Select","Select",""],["","00054001925","PREDNISONE","TAB 50MG","4","Select","Select",""],["","49502010202","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","65862035705","CLOPIDOGREL","75 MG","90","Select","Select",""],["","08290320119","BD PEN NEEDL","MIS 31GX5MM","300","Select","Select",""],["","50742061601","METOPROL SUC","TAB 50MG ER","90","Select","Select",""],["","69238183007","LEVOTHYROXIN","TAB 25MCG","90","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","7","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","00045044902","TYLENOL","TAB 500MG","30","Select","Select",""],["","00472037915","CLOTRIM\/BETA","CRE DIPROP","30","Select","Select",""],["","64380080807","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","60258009901","IRON 100\/C","TAB 100-250","30","Select","Select",""],["","11877001140","BINAXNOW COV","KIT HOME TES","8","Select","Select",""],["","73070010315","INSULIN ASPART FLEXPEN","100\/ML (3)","27","Select","Select",""],["","31722052101","HYDRALAZINE HCL","50 MG","90","Select","Select",""],["","69097082607","BENZTROPINE MESYLATE","0.5 MG","30","Select","Select",""],["","53885001110","ONETOUCH DELICA PLUS LANCET","30 GAUGE","100","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","100\/ML (3)","45","Select","Select",""],["","53885024510","ONETOUCH ULTRA TEST STRIP","","100","Select","Select",""],["","53885013610","ONETOUCH DELICA","33 GAUGE","100","Select","Select",""],["","65862020399","LOSARTAN POTASSIUM","100 MG","30","Select","Select",""],["","63323058282","GLUCAGON EMERGENCY KIT","1 MG","1","Select","Select",""],["","00378668977","PANTOPRAZOLE SODIUM","40 MG","90","Select","Select",""],["","45963067611","METOPROLOL SUCCINATE","50 MG","90","Select","Select",""],["","69238183007","LEVOTHYROXINE SODIUM","25 MCG","90","Select","Select",""],["","43598083105","ATORVASTATIN CALCIUM","20 MG","90","Select","Select",""],["","49884012301","LABETALOL HCL","200 MG","15","Select","Select",""],["","51672201002","HYDROCORTISONE","0.5 %","56.8","Select","Select",""],["","41167000396","CORTIZONE-","10 WITH ALOE 1 %","56","Select","Select",""],["","66685100100","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","20","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":""}]}]}