{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARY M BEVERLY","gend":1,"add":"1675 FOREST AVE APT 4","city":"BUENA VISTA","state":"VA","zip":"24416-9998","dob":"1966-11-25","age":"","mstatus":"","insh":"20038125*01","cliId":"","pno":5403198230,"cno":5403198230,"email":"","ename":"","eno":"","pphy":"ARNOLD, COLLEEN MD","ppno":5404633381,"pcpadd":"STE 1 55 COMFORT WAY,","pcpcity":"LEXINGTON","pcpstate":"VA","pcpzip":"24450-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5404633477,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F43.23","Z20.822","E11.9","H04.123","H40.013","H52.4","R29.6","M25.512","M25.552","S39.92XA","B37.0","H57.12","H10.45","Z12.31","Z00.00","G89.4","E11.42","E53.8","T14.8XXA","Z23.","I10.","F17.200","E78.2","S22.32XA","S20.212A","R32.","N39.46","N39.41","R39.12","R39.14","K21.9","K59.09","K92.1","R14.0","M79.7","R10.13","K44.9","K58.1","K63.89","K64.0","E11.40","E78.5","Q60.0","N32.81","J45.909","G89.29","F43.10","R11.0","R39.81","N81.84","F33.41","H25.812","H25.811","M62.9","D49.2","H25.813","M70.61","M75.51","V54.19","U07.1","F11.20","Z01.818","Z63.4","G60.9","R25.2","G43.909","R05.9","Z91.030","R51.9","Z79.891","I95.9","F43.8","Z96.1","Z98.41","Z98.42","Z72.0","NO DATA","M19.011","S46.011A","M70.62","H25.043","M54.5","S20.219A","M75.101","R21.","M25.511","M75.111","R68.89","J10.1","L98.9","R53.83","E87.6","E61.1"],"date":["2023-09-19","2022-08-24","2023-07-12","2021-03-03","2021-03-03","2021-03-03","2021-11-01","2021-05-28","2021-05-28","2021-05-28","2021-05-28","2021-12-16","2021-09-13","2021-11-02","2021-11-02","2023-02-02","2023-06-13","2023-02-02","2021-11-02","2021-11-02","2023-02-02","2023-02-02","2022-05-10","2022-04-17","2022-04-17","2022-05-16","2023-09-06","2022-04-26","2022-04-26","2022-04-26","2023-02-15","2022-05-05","2022-05-16","2022-05-16","2023-01-06","2022-05-16","2022-05-16","2023-02-15","2022-05-16","2022-05-16","2022-05-16","2022-05-16","2022-05-16","2022-05-16","2023-02-02","2023-01-18","2023-09-13","2023-08-10","2023-03-20","2023-09-06","2022-04-28","2021-08-18","2021-09-01","2022-05-10","2022-05-29","2021-07-29","2021-10-18","2023-01-18","2022-04-28","2022-08-24","2021-02-24","2021-08-27","2021-09-17","2023-05-17","2023-05-17","2023-05-17","2022-07-26","2022-07-26","2023-05-17","2021-02-24","2021-07-26","2021-07-26","2023-07-12","2023-07-12","2023-07-12","2022-04-12","2023-09-01","2022-10-12","2022-10-12","2021-05-14","2021-07-13","2021-03-25","2022-04-17","2023-03-10","2022-01-29","2023-09-01","2023-04-05","2023-05-12","2023-05-12","2023-06-13","2023-06-13","2023-06-13","2023-06-13"],"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":[["","16729017317","AMITRIPTYLIN","TAB 50MG","150","Select","Select",""],["","68462047205","POT CL MICRO","TAB 20MEQ ER","120","Select","Select",""],["","55111018010","TIZANIDINE","TAB 4MG","270","Select","Select",""],["","68382014005","TOPIRAMATE","100 MG","60","Select","Select",""],["","08290236712","LACTINEX","GRA ","72","Select","Select",""],["","11523723404","MIRALAX","17 G\/DOSE","1530","Select","Select",""],["","00761035920","SENNA-S","TAB 8.6-50MG","30","Select","Select",""],["","64980033912","MAGNESIUM-OX","TAB 400MG","30","Select","Select",""],["","78206012701","DULERA","100-5 MCG","13","Select","Select",""],["","53885027150","ONETOUCH","TES VERIO","50","Select","Select",""],["","00904548689","CERTAVITE","TAB SENIOR","30","Select","Select",""],["","13107008405","LORAZEPAM","1 MG","90","Select","Select",""],["","23155080901","VITAMIN D","2 1250 MCG","4","Select","Select",""],["","00904759080","FEROSUL","325(65) MG","60","Select","Select",""],["","60432003816","GENERLAC","SOL 10GM\/15","946","Select","Select",""],["","00093201412","SUMATRIPTAN","INJ 6MG\/0.5","9","Select","Select",""],["","64980034214","ALENDRONATE","TAB 70MG","4","Select","Select",""],["","16571040250","CETIRIZINE","TAB 10MG","90","Select","Select",""],["","70756080790","LANSOPRAZOLE","30 MG","30","Select","Select",""],["","64764024060","AMITIZA","CAP 24MCG","60","Select","Select",""],["","29300041010","ATENOLOL","25 MG","90","Select","Select",""],["","00904699880","DOCUSATE SOD","CAP 100MG","300","Select","Select",""],["","00904699446","GAS RELIEF","125 MG","240","Select","Select",""],["","33342015915","TAMSULOSIN","CAP 0.4MG","18","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","00603188016","LIDOCAINE","5 %","30","Select","Select",""],["","50228014605","HYDROCHLOROT","CAP 12.5MG","30","Select","Select",""],["","71093012105","GABAPENTIN","300 MG","300","Select","Select",""],["","50228013690","LEVOCETIRIZI","TAB 5MG","30","Select","Select",""],["","51525590101","CARISOPRODOL","250 MG","21","Select","Select",""],["","43598016860","LUBIPROSTONE","24MCG","60","Select","Select",""],["","42192061801","BENZONATATE","200 MG","60","Select","Select",""],["","57237008834","RIZATRIPTAN","TAB 10MG","12","Select","Select",""],["","57896045501","SENNA PLUS","TAB 8.6-50MG","30","Select","Select",""],["","60758077305","KETOROLAC","SOL 0.004","5","Select","Select",""],["","00065030355","ISOPTO ATROP","SOL 1% OP","5","Select","Select",""],["","17478021505","ATROPINE SUL","SOL 1% OP","5","Select","Select",""],["","17478007035","ERYTHROMYCIN","OIN 5MG\/GM","4","Select","Select",""],["","00121086816","NYSTATIN","SUS 100000","473","Select","Select",""],["","27808003503","HYDROCO\/APAP","TAB 5-325MG","20","Select","Select",""],["","60432026415","FLUTICASONE","SPR 50MCG","48","Select","Select",""],["","60758011910","PREDNISOLONE","SUS 1% OP","10","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00536589688","NICOTINE TD","DIS 21MG\/24H","14","Select","Select",""],["","21922000909","DICLOFENAC","GEL 0.01","300","Select","Select",""],["","57896063412","MAG OXIDE","TAB 400MG","30","Select","Select",""],["","00904759183","FERROUS SULF","TAB 325MG","30","Select","Select",""],["","00067013472","GAS-X","125 MG","240","Select","Select",""],["","49483008110","SENNA-TIME S","TAB 8.6-50MG","30","Select","Select",""],["","90166001334","LANCETS","MIS 33G","100","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","100","Select","Select",""],["","70010013505","POT CHLORIDE","TAB 20MEQ ER","120","Select","Select",""],["","80681014202","CERTAVITE\/","TAB ANTIOXID","30","Select","Select",""],["","65862044930","VALACYCLOVIR","TAB 1GM","21","Select","Select",""],["","57896055501","SENNA-PLUS","TAB 8.6-50MG","30","Select","Select",""],["","67877021905","CEPHALEXIN","500 MG","20","Select","Select",""],["","00074709630","QULIPTA","TAB 30MG","30","Select","Select",""],["","52268010101","GOLYTELY","SOL PINEAPPL","4000","Select","Select",""],["","10572010001","PEG-3350","SOL ELECTROL","4000","Select","Select",""],["","51759020210","AJOVY","INJ 225\/1.5","2","Select","Select",""],["","00005446381","CENTRUM","TAB SILVER","30","Select","Select",""],["","71930001752","ONDANSETRON","TAB 4MG","15","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","18","Select","Select",""],["","00536344508","CEROVITE","TAB SENIOR","30","Select","Select",""],["","63739031110","SENNA\/DSS","TAB 8.6-50MG","30","Select","Select",""],["","00093598619","EPINEPHRINE","0.3MG\/0.3","2","Select","Select",""],["","40985022390","SENTRY","TAB SENIOR","30","Select","Select",""],["","00069034530","PAXLOVID","TAB 300-100","30","Select","Select",""],["","68382004101","PROMETHAZINE","TAB 25MG","60","Select","Select",""],["","57237000511","FLUCONAZOLE","150 MG","2","Select","Select",""],["","49502050002","EPIPEN 2-PAK","INJ 0.3MG","2","Select","Select",""],["","69315024848","CODEINE\/GG","SOL 10-100\/5","118","Select","Select",""],["","00121077516","GG\/CODEINE","SOL 100-10\/5","118","Select","Select",""],["","00143980305","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","00093770198","LEVOCETIRIZINE DIHYDROCHLORIDE","5 MG","30","Select","Select",""],["","69097022416","ALENDRONATE SODIUM","70 MG","4","Select","Select",""],["","16729017317","AMITRIPTYLINE HCL","50 MG","180","Select","Select",""],["","57896063412","MAGNESIUM OXIDE","400 MG","30","Select","Select",""],["","68382004101","PROMETHAZINE HCL","25 MG","60","Select","Select",""],["","57896040110","DOCUSATE SODIUM","100 MG","300","Select","Select",""],["","50228014605","HYDROCHLOROTHIAZIDE","12.5 MG","60","Select","Select",""],["","65862059805","TAMSULOSIN HCL","0.4 MG","30","Select","Select",""],["","00406048401","ACETAMINOPHEN-CODEINE","300MG-30MG","15","Select","Select",""],["","70010013505","POTASSIUM CHLORIDE","20 MEQ","120","Select","Select",""],["","57896048930","POLYETHYLENE GLYCOL","3350 17 G\/DOSE","1530","Select","Select",""],["","68462039710","OMEPRAZOLE","40 MG","180","Select","Select",""],["","80681014202","CERTAVITE-ANTIOXIDANT","18MG-0.4MG","30","Select","Select",""],["","00182864300","SIMETHICONE","80 MG","240","Select","Select",""],["","55111018010","TIZANIDINE HCL","4 MG","270","Select","Select",""],["","21922000909","DICLOFENAC SODIUM","1 %","300","Select","Select",""],["","70000041503","CLEARLAX","17 G\/DOSE","1530","Select","Select",""],["","00093101042","MUPIROCIN","2 %","22","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","10888277409",""," ","1","Select","Select",""],["","00121077504","GUAIFENESIN-CODEINE","10-100MG\/5","118","Select","Select",""],["","62332041510","OSELTAMIVIR PHOSPHATE","75 MG","10","Select","Select",""],["","27808005701","PROMETHAZINE-DM","6.25-15\/5","118","Select","Select",""],["","00054350049","LIDOCAINE HCL VISCOUS","2 %","100","Select","Select",""],["","00254302902","LUBIPROSTONE CAP","24MCG","60","Select","Select",""],["","64980043710","ATENOLOL TAB","25MG","90","Select","Select",""],["","69618002302","MAG OXIDE TAB","400MG","30","Select","Select",""],["","42806054701","VITAMIN D CAP","1.25MG","4","Select","Select",""],["","64980034214","ALENDRONATE TAB","70MG","4","Select","Select",""],["","80681014202","CERTAVITE\/ TAB ANTIOXID","","30","Select","Select",""],["","00904699446","GAS RELIEF CAP","125MG","240","Select","Select",""],["","00904759180","FEROSUL TAB","325MG","60","Select","Select",""],["","68382013805","TOPIRAMATE TAB","25MG","120","Select","Select",""],["","00085720601","DULERA AER","100-5MCG","13","Select","Select",""],["","21922000909","DICLOFENAC GEL","1%","300","Select","Select",""],["","13107008405","LORAZEPAM TAB","1MG","90","Select","Select",""],["","55111018010","TIZANIDINE TAB","4MG","270","Select","Select",""],["","70010013505","POT CHLORIDE TAB","20MEQ ER","120","Select","Select",""],["","64679051603","TAMSULOSIN CAP","0.4MG","90","Select","Select",""],["","37205025172","SENNA PLUS TAB","8.6-50MG","30","Select","Select",""],["","00603188016","LIDOCAINE PAD","5%","30","Select","Select",""],["","50228014605","HYDROCHLOROT CAP","12.5MG","60","Select","Select",""],["","70756080790","LANSOPRAZOLE CAP","30MG DR","30","Select","Select",""],["","71093012105","GABAPENTIN CAP","300MG","300","Select","Select",""],["","41100082071","MIRALAX POW","3350 NF","1530","Select","Select",""],["","16729017317","AMITRIPTYLIN TAB","50MG","180","Select","Select",""],["","51525590101","CARISOPRODOL TAB","250MG","21","Select","Select",""],["","65862044930","VALACYCLOVIR TAB","1GM","21","Select","Select",""],["","62037099905","POT CL MICRO TAB","20MEQ ER","120","Select","Select",""],["","57896055501","SENNA-PLUS TAB","8.6-50MG","30","Select","Select",""],["","50228013690","LEVOCETIRIZI TAB","5MG","30","Select","Select",""],["","52268010101","GOLYTELY SOL PINEAPPL","","4000","Select","Select",""],["","10572010001","PEG-","3350 SOL ELECTROL","4000","Select","Select",""],["","68180012202","CEPHALEXIN CAP","500MG","40","Select","Select",""],["","27808003502","HYDROCO\/APAP TAB","5-325MG","20","Select","Select",""],["","10702001801","OXYCODONE TAB","5MG","18","Select","Select",""],["","51759020210","AJOVY INJ","225\/1.5","2","Select","Select",""],["","00074709630","QULIPTA TAB","30MG","30","Select","Select",""],["","49483008110","SENNA-TIME S TAB","8.6-50MG","30","Select","Select",""],["","63739031110","SENNA\/DSS TAB","8.6-50MG","30","Select","Select",""],["","71930001752","ONDANSETRON TAB","4MG","20","Select","Select",""],["","00904548689","CERTAVITE TAB SENIOR","","30","Select","Select",""],["","00005446381","CENTRUM TAB SILVER","","30","Select","Select",""],["","31722095801","BENZONATATE CAP","200MG","60","Select","Select",""],["","40985022390","SENTRY TAB SENIOR","","30","Select","Select",""],["","00536344508","CEROVITE TAB SENIOR","","30","Select","Select",""],["","57896040110","DOCUSATE SOD CAP","100MG","300","Select","Select",""],["","58657050016","CODEINE\/GG SOL","10-100\/5","237","Select","Select",""],["","00536589688","NICOTINE TD DIS","21MG\/24H","14","Select","Select",""],["","64380078932","LIDOCAINE OIN","5%","35","Select","Select",""],["","00143980305","DOXYCYCL HYC CAP","100MG","20","Select","Select",""],["","68462011944","FLUCONAZOLE TAB","150MG","2","Select","Select",""],["","00115169449","EPINEPHRINE INJ","0.3MG","2","Select","Select",""],["","49502050002","EPIPEN","2-PAK INJ 0.3MG","2","Select","Select",""],["","57237008834","RIZATRIPTAN TAB","10MG","12","Select","Select",""],["","00069034530","PAXLOVID TAB","300-100","30","Select","Select",""],["","68382004101","PROMETHAZINE TAB","25MG","60","Select","Select",""],["","00121077516","GG\/CODEINE SOL","100-10\/5","118","Select","Select",""],["","53885027150","ONETOUCH VERIO TEST STRIP","","2500","Select","Select",""],["","57896070310","IRON","325(65) MG","60","Select","Select",""],["","00023050601","REFRESH CLASSIC","1.4 %-0.6%","30","Select","Select",""],["","00781729685","ALBUTEROL SULFATE HFA","90 MCG","6.7","Select","Select",""],["","00378827052","ALBUTEROL SULFATE","2.5 MG\/3ML","90","Select","Select",""],["","00121057616","METOCLOPRAMIDE HCL","5 MG\/5 ML","473","Select","Select",""],["","50111078766","AZITHROMYCIN","250 MG","6","Select","Select",""],["","00173071920","FLOVENT HFA","110 MCG","12","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":""}]}]}