{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ERMA  E SCOTT","gend":1,"add":"1946 RAVEN ST","city":"RICHMOND","state":"VA","zip":"23223-9998","dob":"1945-07-14","age":"","mstatus":"","insh":"20038855*01","cliId":"","pno":8047803053,"cno":8047803053,"email":"","ename":"","eno":"","pphy":"MARZOUK, CAROLIN NP","ppno":8046284327,"pcpadd":"417 N 11TH STREET,","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":"23298-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8048284670,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G92.","R93.0","R94.4","I13.2","N18.5","I50.20","E87.2","E21.3","R00.1","I25.10","I21.A1","Z91.14","I12.0","I50.32","N18.6","D63.1","M32.9","I21.4","E78.5","J98.4","Z99.2","Z79.82","R51.9","NO DATA","I25.2","Z86.73","Z95.5","E11.21","V58.89","H04.123","E11.9","R60.9","I50.22","E11.22","H35.032","H52.13","H25.813","H52.203","H52.4","U07.1","I48.91","I49.9","I50.9","E87.70","J96.01","N17.9","I50.43","M32.14","D64.9","Z66.","R41.82","I12.9","E08.22","N18.4","I50.33","I08.3","R10.9","Z49.01","E87.1","J84.9","M79.672","G89.29","I49.1","Z79.899","L29.9","Z01.818","I11.0","Z79.811","I48.92","I13.0","J41.0","I10.","I50.40","N18.9","E66.01","R53.1","I50.23","N25.81","I16.1","K56.7","E66.2","I49.5","J44.9","R94.31","I16.0","M85.9","M25.572","T82.858A","L85.3","Z74.09","R06.09","I50.42","E78.00","Z68.33","E66.9","K21.9","Z79.51","E87.5","Z91.19","Z68.39","R06.02","R10.84","Z20.828","M81.0","Z68.36","F03.90","Z20.822","F32.9","G93.40","Z87.891","E21.2","I27.20","E83.52","J81.0","R09.02","R09.89","I87.8","Z68.35","I25.5","I49.3","I47.2","R41.0","N28.9","I51.7","I08.0","J81.1","I45.9","T82.838A","R03.0"],"date":["2021-06-07","2021-06-05","2021-06-05","2023-03-21","2022-04-28","2022-02-01","2021-06-21","2023-05-16","2022-09-13","2022-12-06","2021-06-08","2021-06-06","2023-04-25","2021-11-04","2023-05-31","2023-05-16","2023-05-16","2021-11-04","2021-11-04","2021-11-04","2023-05-16","2021-11-04","2021-11-02","2023-04-27","2022-09-13","2021-11-02","2022-02-01","2022-09-27","2022-09-27","2022-03-22","2022-09-27","2022-07-29","2023-04-20","2022-12-06","2022-09-27","2022-09-27","2022-09-27","2022-09-27","2022-09-27","2022-12-09","2023-04-26","2022-07-29","2023-03-21","2022-12-06","2023-04-25","2021-10-12","2021-10-12","2021-10-12","2023-04-25","2021-10-07","2021-06-09","2021-06-04","2021-06-04","2021-10-28","2021-10-01","2022-07-29","2021-10-05","2022-08-16","2021-10-10","2021-10-10","2021-10-12","2021-10-12","2022-02-01","2022-02-01","2022-03-08","2022-03-23","2022-08-09","2022-08-09","2023-05-16","2023-05-16","2022-12-22","2023-04-26","2021-01-13","2021-01-13","2022-11-08","2021-06-04","2023-04-25","2022-12-06","2021-09-27","2021-09-27","2021-09-27","2021-09-27","2023-05-16","2021-09-27","2021-09-29","2021-10-05","2021-10-10","2023-03-21","2022-10-06","2022-11-08","2022-11-08","2023-05-16","2023-05-16","2022-12-06","2022-12-06","2023-04-27","2022-12-06","2023-04-27","2022-04-28","2021-10-28","2023-04-27","2021-09-27","2021-09-27","2023-05-16","2021-02-09","2021-06-04","2022-07-29","2021-06-04","2021-06-06","2021-06-06","2021-06-08","2021-06-09","2021-09-15","2023-04-25","2022-07-31","2022-07-28","2022-07-29","2022-07-29","2022-07-29","2022-09-17","2022-09-17","2021-06-04","2021-06-04","2021-06-04","2021-06-08","2021-09-27","2022-07-31","2023-03-21","2023-04-25"],"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":[["","29300013505","CLONIDINE","TAB 0.1MG","270","Select","Select",""],["","67877019905","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","51660093901","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","29300022019","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","50111032701","HYDRALAZINE","TAB 25MG","270","Select","Select",""],["","50111091701","TORSEMIDE","TAB 20MG","120","Select","Select",""],["","00904645760","DOK","CAP 100MG","60","Select","Select",""],["","70677005801","SM SENNA LAX","TAB 8.6MG","30","Select","Select",""],["","00143177101","ISOSORB DIN","TAB 10MG","90","Select","Select",""],["","16729000515","SIMVASTATIN","TAB 20MG","90","Select","Select",""],["","00054430125","FUROSEMIDE","80 MG","16","Select","Select",""],["","31722070190","LOSARTAN POT","TAB 50MG","90","Select","Select",""],["","00904699860","DOCUSATE SOD","CAP 100MG","20","Select","Select",""],["","31722010430","CINACALCET","TAB 60MG","30","Select","Select",""],["","53436008430","VELTASSA","POW 8.4GM","30","Select","Select",""],["","50742062201","NIFEDIPINE","TAB 90MG ER","90","Select","Select",""],["","49884025601","MINOXIDIL","2.5 MG","60","Select","Select",""],["","00904652261","SENNA-LAX","TAB 8.6MG","90","Select","Select",""],["","11822331100","RA SENNA","TAB 8.6MG","30","Select","Select",""],["","57896045401","GERI-KOT","TAB 8.6MG","30","Select","Select",""],["","00173085910","BREO ELLIPTA","INH 100-25","180","Select","Select",""],["","00536104710","SODIUM BICAR","TAB 650MG","180","Select","Select",""],["","00310111030","LOKELMA","PAK 10GM","300","Select","Select",""],["","69618006401","SENNA","TAB 8.6MG","30","Select","Select",""],["","68180063709","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","31722058901","METOPROL SUC","TAB 25MG ER","30","Select","Select",""],["","65162005827","SEVELAMER","TAB 800MG","90","Select","Select",""],["","11534016501","FOLIC ACID","1 MG","30","Select","Select",""],["","60258016001","RENA-VITE","TAB ","30","Select","Select",""],["","00093506101","HYDROXYZ HCL","TAB 25MG","15","Select","Select",""],["","57664037708","TRAMADOL HCL","TAB 50MG","20","Select","Select",""],["","50383066730","LIDO\/PRILOCN","CRE 2.5-2.5%","90","Select","Select",""],["","66993013597","FLUTIC\/VILAN","INH 100-25","180","Select","Select",""],["","69367021501","WEST-VITE","TAB W\/FA","30","Select","Select",""],["","50228018001","GABAPENTIN","CAP 300MG","60","Select","Select",""],["","00003089421","ELIQUIS","5 MG","60","Select","Select",""],["","00536730001","NEPHRO-VITE","TAB ","30","Select","Select",""],["","63304072090","DILTIAZEM","24HR ER (CD) 240 MG","60","Select","Select",""],["","10135031401","SENNA LAXATI","TAB 8.6MG","30","Select","Select",""],["","00143177101","ISOSORBIDE DINITRATE","10 MG","90","Select","Select",""],["","00168035730","LIDOCAINE-PRILOCAINE","2.5 %-2.5%","90","Select","Select",""],["","50111032701","HYDRALAZINE HCL","25 MG","270","Select","Select",""],["","60505258009","ATORVASTATIN CALCIUM","40 MG","90","Select","Select",""],["","65162083366","DICLOFENAC SODIUM","1 %","100","Select","Select",""],["","31722010530","CINACALCET HCL","90 MG","30","Select","Select",""],["","29300022019","MONTELUKAST SODIUM","10 MG","90","Select","Select",""],["","00173085910","BREO ELLIPTA INH","100-25","60","Select","Select",""],["","00054430125","FUROSEMIDE TAB","80MG","16","Select","Select",""],["","00143177101","ISOSORB DIN TAB","10MG","90","Select","Select",""],["","50111091701","TORSEMIDE TAB","20MG","120","Select","Select",""],["","11822331100","RA SENNA TAB","8.6MG","30","Select","Select",""],["","31722070190","LOSARTAN POT TAB","50MG","90","Select","Select",""],["","68180063709","ATORVASTATIN TAB","40MG","90","Select","Select",""],["","65162005827","SEVELAMER TAB","800MG","90","Select","Select",""],["","31722058901","METOPROL SUC TAB","25MG ER","30","Select","Select",""],["","11534016501","FOLIC ACID TAB","1MG","30","Select","Select",""],["","31722010430","CINACALCET TAB","60MG","30","Select","Select",""],["","49884025601","MINOXIDIL TAB","2.5MG","60","Select","Select",""],["","29300022019","MONTELUKAST TAB","10MG","90","Select","Select",""],["","50742062201","NIFEDIPINE TAB","90MG ER","90","Select","Select",""],["","57896045401","GERI-KOT TAB","8.6MG","30","Select","Select",""],["","00093506101","HYDROXYZ HCL TAB","25MG","15","Select","Select",""],["","50383066730","LIDO\/PRILOCN CRE","2.5-2.5%","90","Select","Select",""],["","69618006401","SENNA TAB","8.6MG","30","Select","Select",""],["","50111032701","HYDRALAZINE TAB","25MG","270","Select","Select",""],["","00904699860","DOCUSATE SOD CAP","100MG","20","Select","Select",""],["","57664037708","TRAMADOL HCL TAB","50MG","20","Select","Select",""],["","50228018001","GABAPENTIN CAP","300MG","60","Select","Select",""],["","00536730001","NEPHRO-VITE TAB","","30","Select","Select",""],["","60258016001","RENA-VITE TAB","","30","Select","Select",""],["","66993013597","FLUTIC\/VILAN INH","100-25","180","Select","Select",""],["","69367021501","WEST-VITE TAB W\/FA","","30","Select","Select",""],["","00003089421","ELIQUIS TAB","5MG","60","Select","Select",""],["","63304071990","DILTIAZEM CAP","180MG ER","30","Select","Select",""],["","10135031401","SENNA LAXATI TAB","8.6MG","30","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":""}]}]}