{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MELINDA SUTTON","gend":1,"add":"18492 GOSPEL TEMPLE","city":"MELFA","state":"VA","zip":"23410-9998","dob":"1973-05-11","age":"","mstatus":"","insh":"20039721*01","cliId":"","pno":7576783751,"cno":7576783751,"email":"","ename":"","eno":"","pphy":"LUCAS, JENNIFER F PA","ppno":7577877374,"pcpadd":"20306 BADGER LANE","pcpcity":"ONLEY","pcpstate":"VA","pcpzip":"23418-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7577874513,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M51.26","I10.","Z92.29","Z23.","E11.42","L84.","M54.41","M51.37","M54.42","G89.29","R10.84","M79.89","M17.9","R93.0","Z29.14","F33.3","NO DATA","F17.210","Z20.822","R68.89","R05.9","J44.9","J02.9","M79.604","M79.605","I82.811","M79.662","R94.31","R00.0","I49.9","I45.9","R10.9","R19.7","N89.8","L29.8","R82.998","E11.9","Z71.3","N64.4","E66.09","Z68.31","G43.909","Z79.01","S80.02XA","K31.89","Q39.9","K44.9","K22.2","R10.13","R13.10","M79.661","J45.909","F33.1","J06.9","Z79.899","F20.9","M17.12","Z68.33","G40.309","R51.9","R13.14","K21.9","R93.3","K59.04","R91.8","R91.1","R52.","E11.51","B35.1","I73.9","L85.1","D32.0","I82.409","R09.89","M20.11","M20.12","M79.671","M79.672","M20.41","M20.42","E83.42","R74.8","R53.1","Z09.","Z96.1","H52.223","H52.03","M17.11","S61.213A","K82.8","Z30.42","M51.16","M25.561","M25.562","L65.9","Z76.0","N94.9","M54.9","R60.9","L08.9","R30.0","R42.","I82.401","S61.452A","E11.40","Z86.718","R22.43","R05.1","M79.606","D32.9","G47.419","Z79.1","Z79.84","F17.200","M54.5","J44.1","Z87.440","J45.40","J40.","F20.3","M19.90","R16.0","J45.51","S00.93XA","S80.01XA","D68.318","V58.89","Z79.51","G40.909","N39.0","B96.89","K31.9","Z82.49","E66.9","Z20.3","R13.11","R56.9","T78.3XXA","B37.9","Z86.73","Z92.3","R63.4","Z02.89","W57.XXXA"],"date":["2022-03-18","2023-01-09","2021-04-07","2021-04-07","2023-04-24","2021-05-06","2021-05-12","2021-05-12","2021-05-12","2021-05-12","2021-09-16","2022-09-12","2021-12-19","2022-03-31","2022-04-23","2023-04-06","2023-01-18","2023-04-20","2023-03-22","2022-06-28","2022-06-28","2022-12-13","2022-10-28","2023-03-22","2023-03-22","2022-09-12","2023-03-22","2022-07-19","2022-07-19","2022-07-19","2022-07-19","2022-12-13","2022-11-18","2022-12-01","2022-12-01","2022-12-01","2023-04-20","2023-04-24","2023-02-17","2023-03-25","2023-04-20","2021-11-02","2022-08-22","2022-03-02","2022-04-08","2022-04-08","2022-04-08","2022-04-08","2022-04-08","2022-04-08","2023-03-22","2023-01-18","2023-03-17","2023-03-25","2023-03-25","2023-03-25","2023-04-07","2023-03-25","2021-08-19","2023-01-09","2022-04-08","2022-06-02","2021-12-16","2022-06-02","2022-03-02","2021-12-28","2022-02-26","2023-03-17","2023-03-17","2023-03-17","2023-03-17","2022-09-29","2022-07-28","2022-09-12","2023-01-06","2023-01-06","2023-01-06","2023-01-06","2023-01-06","2023-01-06","2021-08-27","2021-08-27","2021-08-27","2021-08-27","2021-09-02","2021-09-02","2021-09-02","2023-04-07","2022-02-21","2022-03-28","2023-04-20","2022-05-24","2022-05-24","2023-03-22","2022-05-24","2022-05-24","2022-06-13","2021-04-08","2021-06-11","2021-06-11","2023-04-07","2021-09-15","2021-11-09","2022-04-20","2023-03-22","2022-08-22","2022-08-22","2022-12-13","2022-09-02","2023-01-09","2022-04-08","2021-12-19","2023-03-22","2022-09-29","2021-04-08","2021-04-12","2021-04-12","2022-03-02","2021-05-05","2021-05-05","2022-04-08","2021-10-21","2022-01-13","2022-03-02","2022-03-02","2022-03-02","2022-05-05","2022-07-06","2023-01-09","2021-04-08","2021-04-08","2022-04-08","2022-04-08","2022-04-23","2022-04-23","2022-06-02","2022-07-06","2023-04-24","2023-04-10","2023-03-22","2023-03-22","2023-03-31","2023-03-31","2023-04-20"],"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":[["","59310057922","PROAIR HFA","AER ","26","Select","Select",""],["","00054429931","FUROSEMIDE","TAB 40MG","180","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","60","Select","Select",""],["","00093342601","LORAZEPAM","1 MG","90","Select","Select",""],["","10702025350","BUT\/APAP\/CAF","TAB ","60","Select","Select",""],["","50228017801","GABAPENTIN","800 MG","90","Select","Select",""],["","65862049301","QUETIAPINE","TAB 200MG","90","Select","Select",""],["","50228043605","NAPROXEN","TAB 500MG","60","Select","Select",""],["","80681016900","VITAMIN D","3 25 MCG","60","Select","Select",""],["","63402030830","LATUDA","TAB 80MG","30","Select","Select",""],["","00456120230","LINZESS","CAP 290MCG","30","Select","Select",""],["","59746017509","PREDNISONE","20 MG","10","Select","Select",""],["","65862001305","SERTRALINE","TAB 100MG","60","Select","Select",""],["","43547034306","RISPERIDONE","3 MG","60","Select","Select",""],["","00186037020","SYMBICORT","160-4.5MCG","10.2","Select","Select",""],["","68462039610","OMEPRAZOLE","20 MG","90","Select","Select",""],["","67877056205","METFORMIN","TAB 850MG","60","Select","Select",""],["","00713031788","CICLOPIROX","SOL 0.08","7","Select","Select",""],["","00536404401","MULTILEX","TAB ","90","Select","Select",""],["","00536354710","DAILY-VITE","TAB ","90","Select","Select",""],["","29300042110","AMITRIPTYLIN","TAB 50MG","30","Select","Select",""],["","16714089803","LORATADINE","10 MG","90","Select","Select",""],["","80681002000","MULTIVITAMIN","","30","Select","Select",""],["","80681016900","VITAMIN D3","TAB 25MCG","30","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","65162021210","PHENYTOIN EX","CAP 100MG","360","Select","Select",""],["","44523061707","UREA","40 %","198.4","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","14","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","30","Select","Select",""],["","29300039810","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","70010077001","METHOCARBAM","TAB 750MG","40","Select","Select",""],["","68462011060","TOPIRAMATE","TAB 200MG","90","Select","Select",""],["","68462015813","ONDANSETRON","TAB 8MG ODT","30","Select","Select",""],["","68645055254","LISINOPRIL","10 MG","90","Select","Select",""],["","00904698640","MUCUS RELIEF","TAB 600MG ER","30","Select","Select",""],["","00378932232","WIXELA INHUB","AER 500\/50","60","Select","Select",""],["","00093506201","HYDROXYZ HCL","TAB 50MG","60","Select","Select",""],["","00173069700","ADVAIR DISKU","AER 500\/50","60","Select","Select",""],["","13811071910","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","00781183120","AMOX\/K CLAV","TAB 500-125","20","Select","Select",""],["","45802005935","NYSTATIN","100000\/G","45","Select","Select",""],["","51672131201","MUPIROCIN","OIN 0.02","15","Select","Select",""],["","70010019905","GUAIFENESIN","TAB 600MG ER","30","Select","Select",""],["","00093720198","PRAVASTATIN","TAB 20MG","90","Select","Select",""],["","65862056090","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","00003089321","ELIQUIS","2.5 MG","60","Select","Select",""],["","86227012205","ALCOHOL","PAD PREP","100","Select","Select",""],["","74312001570","MULTI-DAY","TAB ","90","Select","Select",""],["","62037071001","POT CL MICRO","TAB 10MEQ CR","60","Select","Select",""],["","45802016000","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","55111014512","FLUCONAZOLE","150 MG","1","Select","Select",""],["","63304007601","POT CHLORIDE","TAB 10MEQ ER","60","Select","Select",""],["","00591352530","LIDOCAINE","5 %","30","Select","Select",""],["","52544008001","FIORICET","CAP ","15","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","46122006271","8HR PAIN REL","TAB 650MG","120","Select","Select",""],["","42806040021","METHYLPRED","TAB 4MG","21","Select","Select",""],["","11877001140","BINAXNOW COV","KIT HOME TES","8","Select","Select",""],["","00904672059","ACETAMIN","TAB 500MG","30","Select","Select",""],["","63481068706","LIDODERM","DIS 0.05","30","Select","Select",""],["","00143993905","AMOXICILLIN","CAP 500MG","20","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","00363017508","PAIN RELIEVE","TAB 500MG","30","Select","Select",""],["","76204060030","IPRATROPIUM\/","SOL ALBUTER","270","Select","Select",""],["","00093406701","PRAZOSIN HCL","1 MG","30","Select","Select",""],["","64380071306","BENZONATATE","CAP 200MG","15","Select","Select",""],["","60432060416","PROMETHAZINE","SYP DM","100","Select","Select",""],["","00904688365","ACETAMINOPHE","TAB 650MG ER","120","Select","Select",""],["","00536131108","CHEST CONGES","TAB 400MG","60","Select","Select",""],["","63824000832","MUCINEX","TAB 600MG ER","60","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","00591079401","DICYCLOMINE","CAP 10MG","240","Select","Select",""],["","67877056205","METFORMIN HCL","850 MG","10","Select","Select",""],["","10702025350","BUTALBITAL-ACETAMINOPHEN-CAFFE","50-325-40","60","Select","Select",""],["","68645052354","SERTRALINE HCL","100 MG","60","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","90 MCG","18","Select","Select",""],["","70010013601","POTASSIUM CHLORIDE","10 MEQ","60","Select","Select",""],["","49035054483","ARTHRITIS PAIN","650 MG","120","Select","Select",""],["","42806016105","HYDROXYZINE HCL","50 MG","60","Select","Select",""],["","65162083366","DICLOFENAC SODIUM","1 %","100","Select","Select",""],["","49348004214","PAIN RELIEVER","500 MG","60","Select","Select",""],["","27808022501","PALIPERIDONE ER","9 MG","30","Select","Select",""],["","29300041519","CYCLOBENZAPRINE HCL","10 MG","180","Select","Select",""],["","68180044801","QUETIAPINE FUMARATE","200 MG","90","Select","Select",""],["","65862039110","ONDANSETRON ODT","8 MG","30","Select","Select",""],["","50268005215","ARTHRITIS PAIN RELIEF","650 MG","120","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","16729017317","AMITRIPTYLINE HCL","50 MG","30","Select","Select",""],["","00536116361","MUCUS RELIEF ER","600 MG","360","Select","Select",""],["","00904672059","ACETAMINOPHEN","500 MG","30","Select","Select",""],["","29300039810","AMLODIPINE BESYLATE","10 MG","90","Select","Select",""],["","65162021210","PHENYTOIN SODIUM EXTENDED","100 MG","20","Select","Select",""],["","72205001590","PREGABALIN","150 MG","60","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":""}]}]}