{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DOROTHY AIKEN","gend":1,"add":"1804 MOORE ST","city":"RICHMOND","state":"VA","zip":"23220-9998","dob":"1950-08-16","age":"","mstatus":"","insh":"20039875*01","cliId":"","pno":8043591273,"cno":8043591273,"email":"","ename":"","eno":"","pphy":"HONG, SUSAN MD","ppno":8048287999,"pcpadd":"1300 E MARSHALL 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":8048285941,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R29.6","M54.16","E11.42","I10.","E78.5","Z79.899","Z79.84","M21.372","NO DATA","E11.9","K21.9","Z12.11","K31.89","D12.0","D12.3","K57.30","R10.13","E87.6","E78.2","M43.02","M75.122","M75.112","R10.9","R35.0","R39.15","I12.9","E11.22","N18.1","J44.9","F17.210","C50.912","M25.512","F17.200","Z59.89","M81.8","I25.10","R91.1","I25.84","F17.290","M54.5","G89.29","Z79.82","Z72.0","S72.002A","Z96.619","F12.90","G25.81","M54.32","M81.0","W19.XXXA","Z20.822","Z23.","Z90.12","Z88.8","I51.7","R94.31","R00.0","H04.123","V54.13","W18.30XD","S72.009A","G62.9","Z08.","S22.32XA","Z85.3","Z80.3","Z15.01","M25.552","M96.1","F19.90","Z01.810","M54.9","M25.531","Z12.31","Z12.2","M79.645","S09.90XA","M54.2","R51.9","Z98.1","W01.0XXA","R63.4","C50.919","Z15.02","Z15.09","K29.70","E87.1","R74.8","Z66.","M47.812","E86.1","E83.42","Z71.6","M24.112","K26.9","R19.8","R07.81","E11.69","R06.02","Z87.891","E11.40","M47.816","Z79.1","M79.641","W18.30XA","K92.2","K92.1"],"date":["2023-06-19","2021-01-29","2021-01-29","2023-09-07","2023-06-19","2023-03-22","2023-03-22","2022-12-05","2023-09-07","2023-09-07","2023-03-06","2023-02-02","2023-02-02","2023-02-02","2023-02-02","2023-02-02","2023-04-14","2023-04-14","2023-04-14","2022-01-08","2022-07-13","2022-08-24","2022-10-15","2022-10-15","2022-10-15","2023-06-19","2023-06-19","2023-06-19","2022-12-24","2022-12-24","2023-04-14","2023-04-14","2023-06-19","2022-07-28","2023-08-09","2023-06-19","2023-04-14","2022-07-28","2022-07-28","2021-09-23","2022-01-09","2021-09-23","2021-09-23","2021-10-29","2021-10-28","2021-10-28","2023-04-14","2021-10-28","2023-03-06","2021-10-28","2022-01-07","2022-10-20","2022-01-07","2021-10-28","2022-12-25","2022-01-07","2022-12-25","2022-05-23","2021-11-24","2021-11-24","2021-11-24","2023-09-07","2022-10-20","2022-10-20","2023-04-14","2021-07-24","2023-08-09","2021-10-27","2021-10-27","2021-10-27","2021-10-28","2022-01-09","2023-09-07","2023-06-22","2022-07-28","2022-09-20","2022-09-20","2022-09-20","2022-09-20","2023-01-23","2021-10-29","2023-08-09","2023-06-22","2023-06-22","2023-08-09","2022-01-07","2023-04-14","2022-01-07","2022-01-07","2023-04-14","2022-01-07","2022-01-07","2022-07-28","2023-09-07","2023-02-02","2023-02-02","2023-04-14","2023-03-22","2023-03-22","2023-04-14","2023-06-19","2023-06-19","2023-06-19","2023-09-07","2023-09-07","2023-08-21","2023-08-21"],"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":[["","21922000909","DICLOFENAC","GEL 0.01","400","Select","Select",""],["","00228282011","HYDROCHLOROT","TAB 12.5MG","90","Select","Select",""],["","51991074810","DULOXETINE","CAP 60MG","30","Select","Select",""],["","65862055990","PANTOPRAZOLE","TAB 20MG","60","Select","Select",""],["","68180072109","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","70377002913","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","31722053401","METHOCARBAM","TAB 750MG","180","Select","Select",""],["","59267100002","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","68645030059","METFORMIN","TAB 1000MG","180","Select","Select",""],["","80681016900","VITAMIN D3","TAB 25MCG","30","Select","Select",""],["","00904672080","ACETAMIN","TAB 500MG","60","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","30","Select","Select",""],["","00536589488","NICOTINE TD","DIS 7MG\/24HR","28","Select","Select",""],["","29300035505","TRAMADOL HCL","TAB 50MG","42","Select","Select",""],["","69618006610","ASPIRIN LOW","TAB 81MG EC","30","Select","Select",""],["","71930001730","ONDANSETRON","TAB 4MG","20","Select","Select",""],["","00023040330","REFRESH PLUS","DRO 0.5% OP","30","Select","Select",""],["","70954006020","PREDNISONE","TAB 20MG","10","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","00406048401","APAP\/CODEINE","TAB 300-30MG","20","Select","Select",""],["","45802065078","LORATADINE","TAB 10MG","30","Select","Select",""],["","00254101196","SUCRALFATE","SUS 1GM\/10ML","1200","Select","Select",""],["","00536122308","GAS RELIEF","CHW 125MG","30","Select","Select",""],["","69618003206","SIMETHICONE","CHW 125MG","30","Select","Select",""],["","58914060120","PYLERA","125-125 MG","48","Select","Select",""],["","31722017030","DULOXETINE HCL","60 MG","30","Select","Select",""],["","80681017000","VITAMIN D","3 50 MCG","90","Select","Select",""],["","65862056099","PANTOPRAZOLE SODIUM","40 MG","60","Select","Select",""],["","63304083090","ATORVASTATIN CALCIUM","80 MG","30","Select","Select",""],["","29300039805","AMLODIPINE BESYLATE","10 MG","90","Select","Select",""],["","00904640761","BISACODYL","5 MG","4","Select","Select",""],["","70010006505","METFORMIN HCL","1000 MG","180","Select","Select",""],["","45802086802","POLYETHYLENE GLYCOL","3350 17 G\/DOSE","238","Select","Select",""],["","31722071310","PANTOPRAZOLE TAB","40MG","30","Select","Select",""],["","45963053830","ONDANSETRON TAB","4MG","20","Select","Select",""],["","68645030059","METFORMIN TAB","1000MG","60","Select","Select",""],["","31722001701","FAMOTIDINE TAB","20MG","30","Select","Select",""],["","60505258008","ATORVASTATIN TAB","40MG","30","Select","Select",""],["","70954006020","PREDNISONE TAB","20MG","10","Select","Select",""],["","68180072003","AMLODIPINE TAB","5MG","90","Select","Select",""],["","51991074810","DULOXETINE CAP","60MG","30","Select","Select",""],["","21922000909","DICLOFENAC GEL","1%","400","Select","Select",""],["","45802065078","LORATADINE TAB","10MG","30","Select","Select",""],["","00023040330","REFRESH PLUS DRO","0.5% OP","30","Select","Select",""],["","00536589488","NICOTINE TD DIS","7MG\/24HR","28","Select","Select",""],["","69618006610","ASPIRIN LOW TAB","81MG EC","30","Select","Select",""],["","00406048401","APAP\/CODEINE TAB","300-30MG","20","Select","Select",""],["","49035091048","GAS RELIEF CHW","125MG","30","Select","Select",""],["","69618003206","SIMETHICONE CHW","125MG","30","Select","Select",""],["","58914060120","PYLERA CAP","","168","Select","Select",""],["","00904699446","GAS RELIEF CAP","125MG","30","Select","Select",""],["","10135059160","SIMETHICONE CAP","125MG","30","Select","Select",""],["","00254101196","SUCRALFATE SUS","1GM\/10ML","1200","Select","Select",""],["","16714097601","DICLOFENAC SODIUM","1 %","200","Select","Select",""],["","55111017915","TIZANIDINE HCL","2 MG","15","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":""}]}]}