{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LASHAWN WYCHE","gend":1,"add":"811 W WASHINGTON ST APT A","city":"PETERSBURG","state":"VA","zip":"23803-9998","dob":"1976-01-20","age":"","mstatus":"","insh":"20037968*01","cliId":"","pno":8042033176,"cno":8042033176,"email":"","ename":"","eno":"","pphy":"JIN, XIAO HONG MD","ppno":8047320648,"pcpadd":"15 GOODRICH AVE,","pcpcity":"PETERSBURG","pcpstate":"VA","pcpzip":"23805-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8048616846,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I16.1","I10.","NO DATA","F14.10","F17.200","J45.901","G47.33","R60.9","E66.9","F19.10","M17.5","W19.XXXA","I11.0","E66.01","I50.33","E11.9","E87.5","F17.210","I16.0","I25.10","I25.2","I34.0","J45.909","K44.9","M06.9","R09.02","Z20.822","V58.89","J06.9","I50.9","R06.02","M05.9","Z79.899","G56.02","R07.9","S80.02XA","S13.4XXA","M25.562","F31.60","F41.1","S29.019A","S16.1XXA","S80.11XA","I11.9","R19.7","R30.0","M17.0","R94.30","I42.7","T40.5X5A","J44.1","Z91.14","F31.32","M25.50","J44.9","Z72.0","Z71.2","Z71.6","J45.30","M19.90","F14.90","R11.2","Z91.89","E78.5","Z79.84","Z79.82","R11.10","F33.1","R77.8","Z87.09","R10.30","N32.81","F19.20","E78.2","I50.22","M79.605","M54.9","R06.00","R05.1","S29.012A","K21.9","Z04.3","M54.2","J02.9","H66.001","J01.10","J20.9","N30.00","G47.30","R07.81","Z00.01","N39.0"],"date":["2021-03-05","2023-08-25","2022-11-02","2021-06-22","2023-01-27","2021-03-12","2022-02-22","2021-05-27","2021-12-13","2021-03-11","2021-08-20","2021-08-20","2023-06-30","2022-02-12","2022-04-14","2023-06-30","2022-02-12","2023-06-30","2023-06-30","2022-02-12","2022-02-12","2022-02-12","2023-06-30","2022-02-12","2023-06-30","2022-03-18","2023-01-27","2022-10-26","2023-01-27","2023-06-30","2023-01-27","2021-03-03","2023-06-30","2021-03-03","2023-06-30","2021-06-24","2021-06-24","2021-06-24","2023-09-22","2023-09-22","2022-08-25","2022-08-25","2022-08-25","2021-06-22","2021-05-27","2021-05-27","2021-05-27","2021-06-22","2022-04-13","2022-04-13","2022-11-06","2022-11-06","2021-02-01","2021-06-22","2022-02-22","2023-06-30","2023-02-08","2022-07-01","2022-07-01","2021-03-03","2021-03-04","2022-04-06","2022-04-06","2022-04-06","2023-06-30","2023-06-30","2022-04-06","2023-07-17","2021-03-04","2021-03-04","2021-12-13","2021-12-13","2022-02-13","2022-03-16","2022-04-14","2022-09-02","2023-08-25","2022-03-18","2023-05-10","2022-08-25","2023-06-30","2022-08-25","2022-11-02","2023-02-08","2023-02-08","2023-02-08","2023-05-10","2023-06-30","2023-06-30","2023-06-30","2023-08-25","2023-08-25"],"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":[["","00228203196","ALPRAZOLAM","1 MG","48","Select","Select",""],["","13668001005","CITALOPRAM","TAB 20MG","30","Select","Select",""],["","69452015120","VITAMIN D","2 1250 MCG","4","Select","Select",""],["","68001039708","FAMOTIDINE","20 MG","30","Select","Select",""],["","68001018408","QUETIAPINE","TAB 100MG","30","Select","Select",""],["","70010006310","METFORMIN","TAB 500MG","60","Select","Select",""],["","62135021010","FOLIC ACID","TAB 1MG","30","Select","Select",""],["","69315011710","FUROSEMIDE","40 MG","15","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","68001015203","CARVEDILOL","25 MG","60","Select","Select",""],["","51224012230","AZITHROMYCIN","500 MG","5","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","68001036103","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","59746017509","PREDNISONE","20 MG","18","Select","Select",""],["","00363007120","MUCUS RELIEF","TAB 600MG ER","30","Select","Select",""],["","68001023803","CLONIDINE","TAB 0.2MG","60","Select","Select",""],["","00536110788","NICOTINE TD","DIS 14MG\/24H","30","Select","Select",""],["","00135014502","NICODERM CQ","DIS 21MG\/24H","30","Select","Select",""],["","70010077005","METHOCARBAM","TAB 750MG","40","Select","Select",""],["","57237007530","ONDANSETRON","TAB 4MG","20","Select","Select",""],["","69367016304","PHENAZOPYRID","TAB 200MG","6","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","00173068220","VENTOLIN HFA","AER ","18","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","65162010250","GABAPENTIN","CAP 300MG","30","Select","Select",""],["","00173089310","TRELEGY","AER 200MCG","60","Select","Select",""],["","00904576960","ARTHRTS PAIN","TAB 650MG","90","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","24385038689","ANTI-DIARRHE","TAB 2MG","20","Select","Select",""],["","21922000909","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","00527128210","DICYCLOMINE","TAB 20MG","30","Select","Select",""],["","63304072005","DILTIAZEM","24HR ER (CD) 240 MG","30","Select","Select",""],["","70756060915","OFLOXACIN","0.3 %","5","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","120","Select","Select",""],["","68462039610","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","68462018022","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","68001025317","FLUCONAZOLE","150 MG","2","Select","Select",""],["","00574200830","NYSTOP","POW 100000","30","Select","Select",""],["","50742017505","ISOSORB MONO","TAB 30MG ER","30","Select","Select",""],["","68001044503","POT CHLORIDE","TAB 20MEQ ER","10","Select","Select",""],["","68001033508","LISINOPRIL","20 MG","30","Select","Select",""],["","59267102501","PFIZER VACC","INJ ADLT RTU","0","Select","Select",""],["","65162062711","TRAMADOL HCL","TAB 50MG","12","Select","Select",""],["","55111018010","TIZANIDINE","TAB 4MG","40","Select","Select",""],["","00378363705","CETIRIZINE HCL","10 MG","30","Select","Select",""],["","00173089310","TRELEGY ELLIPTA","200-62.5","60","Select","Select",""],["","13668001005","CITALOPRAM HBR","20 MG","30","Select","Select",""],["","00904515460","GUAIFENESIN","200 MG","15","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","90 MCG","18","Select","Select",""],["","68001018408","QUETIAPINE FUMARATE","100 MG","30","Select","Select",""],["","00378827093","ALBUTEROL SULFATE","2.5 MG\/3ML","225","Select","Select",""],["","00904688365","ACETAMINOPHEN ER","650 MG","60","Select","Select",""],["","51660052605","ALLERGY RELIEF","10 MG","15","Select","Select",""],["","00781185220","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","20","Select","Select",""],["","59267030401","PFIZER COVID BIVAL (","12Y UP)EUA 30 MCG\/0.3","0.3","Select","Select",""],["","69452014320","BENZONATATE","100 MG","20","Select","Select",""],["","63304072005","DILTIAZEM CAP","240MG ER","30","Select","Select",""],["","68001018408","QUETIAPINE TAB","100MG","30","Select","Select",""],["","68462039610","OMEPRAZOLE CAP","20MG","30","Select","Select",""],["","13668001005","CITALOPRAM TAB","20MG","30","Select","Select",""],["","00228203196","ALPRAZOLAM TAB","1MG","120","Select","Select",""],["","68001023803","CLONIDINE TAB","0.2MG","60","Select","Select",""],["","69452015120","VITAMIN D CAP","50000UNT","4","Select","Select",""],["","70010006310","METFORMIN TAB","500MG","60","Select","Select",""],["","69315011710","FUROSEMIDE TAB","40MG","10","Select","Select",""],["","68001015103","CARVEDILOL TAB","12.5MG","60","Select","Select",""],["","66993001968","ALBUTEROL AER HFA","","18","Select","Select",""],["","00310737020","BUDES\/FORMOT AER","160-4.5","10","Select","Select",""],["","00173068220","VENTOLIN HFA AER","","18","Select","Select",""],["","68001044503","POT CHLORIDE TAB","20MEQ ER","10","Select","Select",""],["","00186037020","SYMBICORT AER","160-4.5","10","Select","Select",""],["","00574200830","NYSTOP POW","100000","30","Select","Select",""],["","68462018022","MUPIROCIN OIN","2%","22","Select","Select",""],["","24385038689","ANTI-DIARRHE TAB","2MG","20","Select","Select",""],["","68001025320","FLUCONAZOLE TAB","150MG","1","Select","Select",""],["","00527128210","DICYCLOMINE TAB","20MG","30","Select","Select",""],["","65862050320","AMOX\/K CLAV TAB","875-125","20","Select","Select",""],["","50742017505","ISOSORB MONO TAB","30MG ER","30","Select","Select",""],["","51224002230","AZITHROMYCIN TAB","250MG","5","Select","Select",""],["","68001033508","LISINOPRIL TAB","20MG","30","Select","Select",""],["","76204020025","ALBUTEROL NEB","0.083%","300","Select","Select",""],["","68001036103","MONTELUKAST TAB","10MG","30","Select","Select",""],["","65162062711","TRAMADOL HCL TAB","50MG","12","Select","Select",""],["","00173089310","TRELEGY AER ELLIPTA","","60","Select","Select",""],["","00536110788","NICOTINE TD DIS","14MG\/24H","30","Select","Select",""],["","59267102501","PFIZER VACC INJ ADLT RTU","","0","Select","Select",""],["","67877032105","IBUPROFEN TAB","800MG","90","Select","Select",""],["","55111018010","TIZANIDINE TAB","4MG","40","Select","Select",""],["","21922000909","DICLOFENAC GEL","1%","100","Select","Select",""],["","00054001925","PREDNISONE TAB","50MG","3","Select","Select",""],["","52817033200","CYCLOBENZAPR TAB","10MG","15","Select","Select",""],["","00173089310","TRELEGY AER","200MCG","60","Select","Select",""],["","65862042005","SULFAMETHOXAZOLE-TRIMETHOPRIM","800-160 MG","20","Select","Select",""],["","68001024604","ONDANSETRON ODT","4 MG","21","Select","Select",""],["","68001039603","POTASSIUM CHLORIDE","10 MEQ","30","Select","Select",""],["","69784018014","POLYETHYLENE GLYCOL","3350 17 G","30","Select","Select",""],["","29300042110","AMITRIPTYLINE HCL","50 MG","30","Select","Select",""],["","68001042300","NITROFURANTOIN MONO-MACRO","100 MG","14","Select","Select",""],["","45802095301","DICLOFENAC SODIUM","1 %","100","Select","Select",""],["","69315030630","NYSTATIN","100000\/G","30","Select","Select",""],["","00536589688","NICOTINE PATCH","21 MG\/24HR","30","Select","Select",""],["","70010006510","METFORMIN HCL","1000 MG","30","Select","Select",""],["","50111056003","TRAZODONE HCL","50 MG","60","Select","Select",""],["","72578000105","DOXYCYCLINE HYCLATE","100 MG","28","Select","Select",""],["","27808005701","PROMETHAZINE-DM","6.25-15\/5","118","Select","Select",""],["","68382013905","TOPIRAMATE","50 MG","60","Select","Select",""],["","59267030401","PFIZER COVID BIVAL (12Y UP)","EUA","0.3","Select","Select",""],["","00904673080","ACETAMINOPHEN","500 MG","120","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":""}]}]}