{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WANDA  R GURLEY","gend":1,"add":"14003 STEVENHURST DR","city":"CHESTER","state":"VA","zip":"23831-9998","dob":"1967-10-20","age":"","mstatus":"","insh":"20040106*01","cliId":"","pno":8042955940,"cno":8042955940,"email":"","ename":"","eno":"","pphy":"BOHANNON, ARLINE MD","ppno":8048289357,"pcpadd":"417 N 11TH ST,","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":8048284926,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R51.9","J02.9","R06.09","M25.50","G89.29","I50.9","E11.40","F32.9","F41.9","I48.91","M79.7","M62.838","I49.5","N17.9","I13.0","I50.33","E11.22","N18.9","I48.0","E66.2","G62.9","L30.9","E66.01","Z68.43","I50.30","I51.7","R06.89","R91.8","Z95.811","Z95.0","M17.12","M19.90","R06.00","K02.9","Z99.81","E11.42","G47.00","NO DATA","E03.9","J96.11","G47.33","I10.","I50.32","E11.9","R30.0","N30.00","Z79.4","M15.9","R52.","Z23.","I89.0","D63.1","C50.912","Z01.411","N95.1","N94.10","N95.2","L03.90","Z11.51","Z12.4","K76.9","R94.5","R16.1","K80.20","E11.319","E11.65","E11.69","E78.5","E11.21","E66.8","E55.9","M79.2","L03.116","I87.2","K76.0","I11.0","R04.0","E78.1","I87.329","N17.8","R07.89","K75.81","J98.4","R39.11","E87.6","Z79.899","Z11.59","Z79.01","R06.02","D64.9","R60.0","I87.8","C50.419","Z17.0","M94.0","R05.","H92.09","H57.89","R13.10","E87.70","N39.0","M47.816","M25.561","M25.562","E66.9","F43.23","K21.9","I25.10","F41.8","R11.0","R07.9","R69.","Z20.822","R05.9","R53.82","Z51.81","I50.31","K08.89","Z87.891","S81.812A","K08.9","S89.92XA","W01.0XXA","I50.42","G89.4","L98.9","Z45.010","Z45.018","B37.3","E28.310","N90.5","B37.2","I45.81","I45.9","R00.2","I82.492","M54.5","G62.89","M17.0","Z86.010","L03.311","M25.569","M79.89","I08.1","J06.9","Z00.00","I12.0","L03.031","M89.49","C50.412","Z91.89","J40.","N30.10"],"date":["2021-10-15","2021-03-23","2021-05-10","2021-03-23","2023-01-26","2023-07-11","2021-11-23","2021-10-18","2023-06-20","2023-01-26","2021-11-02","2021-03-23","2023-06-28","2021-10-18","2023-03-31","2022-03-28","2023-03-31","2023-04-25","2021-10-18","2021-11-23","2023-06-20","2021-10-18","2023-03-31","2023-03-31","2021-12-15","2022-02-28","2022-02-28","2022-02-28","2022-02-28","2023-06-28","2022-02-28","2022-02-28","2022-02-28","2022-10-17","2023-07-03","2023-07-03","2022-02-28","2023-06-20","2022-02-28","2023-01-23","2023-01-23","2023-02-27","2023-07-03","2023-07-03","2023-02-27","2022-06-02","2023-07-03","2022-07-19","2023-02-27","2022-10-17","2023-07-11","2022-10-17","2023-06-20","2021-01-11","2021-01-11","2021-01-11","2021-01-11","2021-01-11","2021-01-11","2021-01-11","2021-05-04","2021-05-04","2021-05-04","2021-05-04","2021-10-19","2021-07-15","2021-07-15","2021-10-17","2021-06-17","2021-07-15","2021-07-15","2021-06-28","2021-11-23","2021-10-09","2021-11-23","2023-01-26","2021-11-23","2021-11-23","2021-10-07","2021-10-17","2021-10-17","2021-10-16","2023-07-11","2021-11-16","2021-12-15","2021-11-16","2022-04-22","2022-07-05","2023-07-11","2022-07-05","2023-01-07","2023-01-26","2023-01-26","2023-06-20","2021-02-09","2021-02-09","2021-02-09","2021-02-09","2021-02-09","2021-02-15","2021-02-22","2021-04-07","2021-04-07","2021-04-07","2021-04-07","2021-08-30","2021-10-07","2021-10-11","2021-10-26","2021-10-15","2021-10-19","2021-10-23","2021-10-26","2021-10-26","2022-03-28","2022-07-05","2022-03-28","2021-05-10","2021-12-15","2022-05-17","2021-08-09","2021-08-09","2021-08-09","2022-01-31","2022-05-17","2022-05-17","2023-03-28","2023-03-28","2021-05-03","2021-05-03","2021-05-03","2021-05-03","2021-10-06","2021-10-06","2021-12-15","2023-01-06","2021-01-05","2023-06-20","2021-01-05","2021-06-07","2021-10-05","2021-05-11","2021-10-05","2021-10-07","2021-11-02","2021-12-15","2021-12-15","2022-01-31","2022-01-31","2023-05-09","2023-05-09","2023-07-03","2023-07-03"],"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":[["","00002773701","INSULIN LISP","INJ 100\/ML","10","Select","Select",""],["","00406012505","HYDROCO\/APAP","TAB 10-325MG","240","Select","Select",""],["","00093322308","ESTRADIOL","TAB 10MCG","8","Select","Select",""],["","65162003416","OMEGA-3-ACID","CAP 1GM","30","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","00172572860","FAMOTIDINE","20 MG","60","Select","Select",""],["","43598081115","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","23155013525","DOXYCYC MONO","TAB 100MG","20","Select","Select",""],["","00169413212","OZEMPIC","INJ 2\/1.5ML","2","Select","Select",""],["","68462012605","GABAPENTIN","600 MG","90","Select","Select",""],["","51672403501","WARFARIN","TAB 10MG","30","Select","Select",""],["","50111091701","TORSEMIDE","20 MG","240","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","80681016900","VITAMIN D","3 25 MCG","30","Select","Select",""],["","27241009903","DULOXETINE","CAP 60MG","60","Select","Select",""],["","00904672059","ACETAMIN","TAB 500MG","120","Select","Select",""],["","50580072636","ZYRTEC ALLGY","TAB 10MG","30","Select","Select",""],["","00088222033","LANTUS","100\/ML","20","Select","Select",""],["","50383066730","LIDO\/PRILOCN","CRE 2.5-2.5%","60","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","180","Select","Select",""],["","00781187431","AMOX\/K CLAV","TAB 250-125","14","Select","Select",""],["","00093083205","CLONAZEPAM","0.5 MG","60","Select","Select",""],["","61269073607","MICONAZOLE","7 SUP 100MG","7","Select","Select",""],["","62037099901","POT CL MICRO","TAB 20MEQ ER","2","Select","Select",""],["","10702025350","BUT\/APAP\/CAF","TAB ","30","Select","Select",""],["","11917004814","INSULIN SYRG","MIS 0.5\/31G","200","Select","Select",""],["","51672130005","AMMONIUM LAC","LOT 0.12","450","Select","Select",""],["","00536252525","CAPSAICIN","CRE 0.00025","60","Select","Select",""],["","60505265301","TRAZODONE","TAB 50MG","30","Select","Select",""],["","45802011214","MUPIROCIN","2 %","30","Select","Select",""],["","45963070911","METOPROL SUC","TAB 25MG ER","90","Select","Select",""],["","47469005964","MELATONIN","10 MG","30","Select","Select",""],["","63304083005","ATORVASTATIN","TAB 80MG","90","Select","Select",""],["","53746051401","SPIRONOLACT","TAB 50MG","180","Select","Select",""],["","00378617201","METOLAZONE","TAB 2.5MG","28","Select","Select",""],["","65862007601","CIPROFLOXACN","TAB 250MG","6","Select","Select",""],["","00536404610","MULTI-VITAMN","TAB ","90","Select","Select",""],["","70436015301","POT CHLORIDE","TAB 20MEQ ER","150","Select","Select",""],["","00002821501","HUMULIN R","100\/ML","50","Select","Select",""],["","68180035202","SERTRALINE","TAB 50MG","90","Select","Select",""],["","64980033912","MAGNESIUM-OX","TAB 400MG","30","Select","Select",""],["","60258017101","MAG OXIDE","TAB 400MG","30","Select","Select",""],["","65862020299","LOSARTAN POT","TAB 50MG","180","Select","Select",""],["","00574200802","NYSTOP","100000\/G","60","Select","Select",""],["","80681016900","VITAMIN D3","TAB 25MCG","30","Select","Select",""],["","69238183801","LEVOTHYROXIN","TAB 150MCG","102","Select","Select",""],["","00591352530","LIDOCAINE","5 %","30","Select","Select",""],["","80681002000","MULTIVITAMIN","","30","Select","Select",""],["","00169517604","VAGIFEM","TAB 10MCG","18","Select","Select",""],["","45802071708","TERCONAZOLE","SUP 80MG","15","Select","Select",""],["","11917004932","ONE DAILY","TAB MENS","90","Select","Select",""],["","00363017508","PAIN RELIEVE","TAB 500MG","120","Select","Select",""],["","68382004001","PROMETHAZINE","TAB 12.5MG","120","Select","Select",""],["","61269073607","MICONAZOLE 7","SUP 100MG","7","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","28","Select","Select",""],["","08627001601","DEXCOM G6","MIS TRANSMIT","1","Select","Select",""],["","42192030160","BP VIT 3","CAP ","30","Select","Select",""],["","51862094505","NORTRIPTYLIN","CAP 10MG","30","Select","Select",""],["","67877021905","CEPHALEXIN","500 MG","21","Select","Select",""],["","00143980305","DOXYCYCL HYC","CAP 100MG","14","Select","Select",""],["","00597015290","JARDIANCE","TAB 10MG","30","Select","Select",""],["","00378668977","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","00093506001","HYDROXYZ HCL","TAB 10MG","30","Select","Select",""],["","00378699152","ALBUTEROL","NEB 0.63MG\/3","150","Select","Select",""],["","76329336901","NALOXONE","INJ 1MG\/ML","4","Select","Select",""],["","00591544305","PREDNISONE","TAB 20MG","7","Select","Select",""],["","59746012206","MECLIZINE","TAB 12.5MG","30","Select","Select",""],["","11917015888","BEDSIDE TOIL","MIS 3-IN-1","1","Select","Select",""],["","11917021385","MAGNESIUM","CAP 400MG","30","Select","Select",""],["","74312003822","FISH OIL","300-1000MG","120","Select","Select",""],["","65162062711","TRAMADOL HCL","TAB 50MG","60","Select","Select",""],["","68308015260","NYSTATIN","POW 100000","60","Select","Select",""],["","75826011410","PHENAZOPYRID","TAB 100MG","30","Select","Select",""],["","65862017760","CEFDINIR","CAP 300MG","20","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","51672403201","WARFARIN SODIUM","5 MG","154","Select","Select",""],["","23155050001","HYDROXYZINE HCL","10 MG","30","Select","Select",""],["","55111018015","TIZANIDINE HCL","4 MG","180","Select","Select",""],["","60505265301","TRAZODONE HCL","50 MG","30","Select","Select",""],["","00406012505","HYDROCODONE-ACETAMINOPHEN","10MG-325MG","240","Select","Select",""],["","27241009903","DULOXETINE HCL","60 MG","60","Select","Select",""],["","10006073038","MAGNESIUM OXIDE","400 MG","30","Select","Select",""],["","70436015301","POTASSIUM CHLORIDE","20 MEQ","150","Select","Select",""],["","43598083305","ATORVASTATIN CALCIUM","80 MG","90","Select","Select",""],["","43598081115","CETIRIZINE HCL","10 MG","30","Select","Select",""],["","53746051401","SPIRONOLACTONE","50 MG","180","Select","Select",""],["","11917004814","INSULIN SYRINGE","31 GX5\/16\"","200","Select","Select",""],["","53885027210","ONETOUCH VERIO TEST STRIP","","100","Select","Select",""],["","68180035202","SERTRALINE HCL","50 MG","90","Select","Select",""],["","69238183801","LEVOTHYROXINE SODIUM","150 MCG","102","Select","Select",""],["","65862020299","LOSARTAN POTASSIUM","50 MG","180","Select","Select",""],["","00378668977","PANTOPRAZOLE SODIUM","40 MG","90","Select","Select",""],["","42799012101","BUMETANIDE","2 MG","120","Select","Select",""],["","55111046601","METOPROLOL SUCCINATE","25 MG","90","Select","Select",""],["","00781717612","NALOXONE HCL","4 MG","2","Select","Select",""],["","00002773701","INSULIN LISPRO","100\/ML","10","Select","Select",""],["","68382020906","ANASTROZOLE","1 MG","30","Select","Select",""],["","59762285801","EXEMESTANE","25 MG","30","Select","Select",""],["","00574200830","NYSTOP POW","100000","60","Select","Select",""],["","69238183801","LEVOTHYROXIN TAB","150MCG","102","Select","Select",""],["","00591352530","LIDOCAINE PAD","5%","30","Select","Select",""],["","64980033912","MAGNESIUM-OX TAB","400MG","30","Select","Select",""],["","55111018015","TIZANIDINE TAB","4MG","180","Select","Select",""],["","00002821501","HUMULIN R INJ U-","100","50","Select","Select",""],["","51672403501","WARFARIN TAB","10MG","30","Select","Select",""],["","00093083205","CLONAZEPAM TAB","0.5MG","60","Select","Select",""],["","80681002000","MULTIVITAMIN TAB","","30","Select","Select",""],["","00378668977","PANTOPRAZOLE TAB","40MG","90","Select","Select",""],["","55111012405","ATORVASTATIN TAB","80MG","90","Select","Select",""],["","45963070911","METOPROL SUC TAB","25MG ER","90","Select","Select",""],["","65862020299","LOSARTAN POT TAB","50MG","180","Select","Select",""],["","00088222033","LANTUS INJ","100\/ML","20","Select","Select",""],["","27241009903","DULOXETINE CAP","60MG","60","Select","Select",""],["","00406012505","HYDROCO\/APAP TAB","10-325MG","180","Select","Select",""],["","60505265301","TRAZODONE TAB","50MG","30","Select","Select",""],["","23155050001","HYDROXYZ HCL TAB","10MG","30","Select","Select",""],["","68462012605","GABAPENTIN TAB","600MG","90","Select","Select",""],["","00904672059","ACETAMIN TAB","500MG","120","Select","Select",""],["","70436015301","POT CHLORIDE TAB","20MEQ ER","150","Select","Select",""],["","50111091801","TORSEMIDE TAB","100MG","180","Select","Select",""],["","65162003416","OMEGA-","3-ACID CAP 1GM","30","Select","Select",""],["","68180035202","SERTRALINE TAB","50MG","90","Select","Select",""],["","59746012206","MECLIZINE TAB","12.5MG","30","Select","Select",""],["","00093314505","CEPHALEXIN CAP","250MG","28","Select","Select",""],["","00378617201","METOLAZONE TAB","2.5MG","28","Select","Select",""],["","00536252525","CAPSAICIN CRE","0.025%","60","Select","Select",""],["","60258017101","MAG OXIDE TAB","400MG","30","Select","Select",""],["","00172572860","FAMOTIDINE TAB","20MG","180","Select","Select",""],["","00591264101","BUT\/APAP\/CAF CAP CODEINE","","20","Select","Select",""],["","53746051401","SPIRONOLACT TAB","50MG","120","Select","Select",""],["","50383066730","LIDO\/PRILOCN CRE","2.5-2.5%","60","Select","Select",""],["","65862050130","AMOX\/K CLAV TAB","250-125","14","Select","Select",""],["","43598081115","CETIRIZINE TAB","10MG","30","Select","Select",""],["","11917015888","BEDSIDE TOIL MIS","3-IN-1","1","Select","Select",""],["","51672131201","MUPIROCIN OIN","2%","30","Select","Select",""],["","47469005964","MELATONIN TAB","10MG CR","30","Select","Select",""],["","65862001705","AMOXICILLIN CAP","500MG","30","Select","Select",""],["","51672130005","AMMONIUM LAC LOT","12%","450","Select","Select",""],["","11917004814","INSULIN SYRG MIS","0.5\/31G","200","Select","Select",""],["","00904404360","FISH OIL CAP","1000MG","120","Select","Select",""],["","65162062711","TRAMADOL HCL TAB","50MG","28","Select","Select",""],["","11917021385","MAGNESIUM CAP","400MG","30","Select","Select",""],["","68308015260","NYSTATIN POW","100000","60","Select","Select",""],["","51293061101","PHENAZOPYRID TAB","100MG","30","Select","Select",""],["","65862017760","CEFDINIR CAP","300MG","20","Select","Select",""],["","10702025350","BUT\/APAP\/CAF TAB","","30","Select","Select",""],["","76329336901","NALOXONE INJ","1MG\/ML","4","Select","Select",""],["","00781808926","AZITHROMYCIN TAB","250MG","6","Select","Select",""],["","45802071708","TERCONAZOLE SUP","80MG","15","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE","50 MCG","48","Select","Select",""],["","00832712315","DIVALPROEX SODIUM","250 MG","90","Select","Select",""],["","27808023302","DOXYCYCLINE HYCLATE","100 MG","20","Select","Select",""],["","75826011410","PHENAZOPYRIDINE HCL","100 MG","30","Select","Select",""],["","00574204230","LIDOCAINE-PRILOCAINE","2.5 %-2.5%","60","Select","Select",""],["","00078077720","ENTRESTO","49 MG-51MG","60","Select","Select",""],["","00904723860","FISH OIL OMEGA-","3 300-1000MG","120","Select","Select",""],["","53885013610","ONETOUCH DELICA","33 GAUGE","100","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":""}]}]}