{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DERRICK C LANDIS","gend":0,"add":"826 LONG AVE APT G5","city":"COVINGTON","state":"VA","zip":"24426-9998","dob":"1992-01-22","age":"","mstatus":"","insh":"20041318*01","cliId":"","pno":5409681490,"cno":5409681490,"email":"","ename":"","eno":"","pphy":"STAPLETON II, JOHN C NP","ppno":5408397197,"pcpadd":"106 PARK DR,","pcpcity":"HOT SPRINGS","pcpstate":"VA","pcpzip":"24445-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5408394831,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.4","R39.81","N17.9","E44.0","Z20.822","E87.1","E86.0","E10.22","E10.43","E10.65","F12.10","F17.210","J45.909","K31.84","NO DATA","Z79.4","Z91.030","L02.421","L02.422","E10.40","F17.200","M79.7","E11.42","Z86.69","K21.9","R10.84","Z76.89","R14.0","K52.9","Q05.4","F31.9","F32.9","L03.115","E11.9","E10.621","L97.511","Z00.00","M79.641","F33.0","L03.031","M79.671","R11.2","Z13.220","L03.116","E10.3313","K08.89","E87.2","S90.422A","Z79.51","L08.9","S22.31XA","R07.9","Z09.","K04.7","K14.6","R05.9","L84.","L03.032","K58.0","J45.30","D72.829","R10.9","R11.10","R19.7","J02.9","Z86.39","Z87.19","N18.9","R50.9","X58.XXXA","I49.8","L97.513","R07.81","Z83.79","R10.31","Z11.59","R10.32","E10.319","I10.","S61.411A","L03.113","S05.01XA","H57.11","E11.621","Z89.422","W22.8XXA","E10.10","E43.","Z68.1","E87.6","F12.90","Z91.19","Z83.3","Z84.1","Z23.","E10.42","E78.1","D50.9","E10.9","M86.9","E10.628","M79.675","I70.213","G62.9","E10.21","F41.9","S22.39XA","M86.8X7"],"date":["2022-08-19","2023-09-09","2022-08-05","2021-04-01","2022-10-29","2021-04-01","2021-04-01","2023-02-12","2021-04-01","2023-07-24","2021-04-01","2023-02-12","2023-02-12","2021-04-01","2022-08-05","2023-07-24","2021-04-01","2021-06-08","2021-06-08","2023-02-12","2023-07-24","2023-02-12","2023-02-16","2021-08-17","2022-01-27","2021-08-17","2021-08-17","2021-08-17","2022-01-27","2021-08-17","2022-09-30","2021-08-31","2021-09-24","2021-10-10","2022-06-02","2022-06-02","2023-07-24","2022-05-05","2022-07-06","2021-09-24","2023-09-01","2022-08-05","2022-01-25","2022-02-09","2022-03-09","2022-03-11","2021-04-02","2022-08-25","2023-02-12","2021-08-11","2021-10-10","2022-01-13","2022-11-10","2022-11-10","2022-10-01","2022-10-14","2023-06-22","2023-02-16","2021-04-29","2021-04-29","2021-06-04","2022-08-05","2022-08-05","2022-08-05","2022-08-05","2022-08-05","2022-08-05","2023-02-12","2022-10-29","2021-08-11","2021-04-07","2021-09-28","2021-10-26","2022-01-27","2022-01-27","2022-01-27","2022-01-27","2022-02-16","2022-09-19","2022-06-06","2021-03-25","2022-06-19","2022-06-19","2022-08-25","2023-02-12","2022-06-19","2022-08-05","2022-08-05","2022-08-05","2022-08-05","2022-08-05","2022-08-05","2022-08-05","2022-08-05","2022-09-19","2022-09-19","2022-09-19","2022-09-19","2023-02-11","2023-02-12","2023-02-12","2023-02-12","2021-08-31","2021-08-31","2021-08-31","2021-08-31","2021-10-10","2023-02-11"],"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":[["","00169643810","LEVEMIR","INJ FLEXTOUC","15","Select","Select",""],["","53885027150","ONETOUCH","TES VERIO","400","Select","Select",""],["","00591079501","DICYCLOMINE","TAB 20MG","60","Select","Select",""],["","00093220305","METOCLOPRAM","TAB 10MG","120","Select","Select",""],["","00186091612","PULMICORT","INH 180MCG","1","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","15","Select","Select",""],["","65862052305","GABAPENTIN","600 MG","120","Select","Select",""],["","00536589688","NICOTINE TD","DIS 21MG\/24H","28","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00002771559","BASAGLAR","INJ 100UNIT","15","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","40","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","68180051303","LISINOPRIL","5 MG","30","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","20","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","00548585000","GLUCAGON","KIT 1MG","1","Select","Select",""],["","57599080000","FREESTY LIBR","KIT 2 SENSOR","2","Select","Select",""],["","57237016250","OMEPRAZOLE","40 MG","30","Select","Select",""],["","67877021901","CEPHALEXIN","CAP 500MG","20","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","99073012101","FREESTYLE","TES ","400","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","00093227534","AMOX\/K CLAV","TAB 875-125","14","Select","Select",""],["","00002614511","BAQSIMI ONE","POW 3MG\/DOSE","1","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","15","Select","Select",""],["","43386031214","GAVILAX","POW ","510","Select","Select",""],["","70000041503","CLEARLAX","POW ","510","Select","Select",""],["","61314065605","CIPROFLOXACN","SOL 0.3% OP","5","Select","Select",""],["","65162019011","NAPROXEN","TAB 500MG","20","Select","Select",""],["","68645056354","IBUPROFEN","TAB 800MG","15","Select","Select",""],["","51672131200","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","60758090810","POLYMYXIN B\/","SOL TRIMETHP","10","Select","Select",""],["","16714029904","AMOXICILLIN","CAP 500MG","20","Select","Select",""],["","50383077504","LIDOCAINE","SOL 2% VISC","100","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","100\/ML (3)","15","Select","Select",""],["","00143924920","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","28","Select","Select",""],["","00169633910","NOVOLOG FLEXPEN","100\/ML (3)","15","Select","Select",""],["","65862052305","GABAPENTIN TAB","600MG","360","Select","Select",""],["","57599080000","FREESTY LIBR KIT","2 SENSOR","2","Select","Select",""],["","53885027150","ONETOUCH TES VERIO","","400","Select","Select",""],["","00002614511","BAQSIMI ONE POW","3MG\/DOSE","1","Select","Select",""],["","00591079501","DICYCLOMINE TAB","20MG","60","Select","Select",""],["","57237016250","OMEPRAZOLE CAP","40MG","30","Select","Select",""],["","00093227534","AMOX\/K CLAV TAB","875-125","14","Select","Select",""],["","00169633910","NOVOLOG INJ FLEXPEN","","15","Select","Select",""],["","63304069301","CLINDAMYCIN CAP","300MG","40","Select","Select",""],["","00088221905","LANTUS SOLOS INJ","100\/ML","15","Select","Select",""],["","00002771559","BASAGLAR INJ","100UNIT","15","Select","Select",""],["","70000041503","CLEARLAX POW","","510","Select","Select",""],["","43386031214","GAVILAX POW","","510","Select","Select",""],["","61314065605","CIPROFLOXACN SOL","0.3% OP","5","Select","Select",""],["","60758090810","POLYMYXIN B\/ SOL TRIMETHP","","10","Select","Select",""],["","65162019011","NAPROXEN TAB","500MG","20","Select","Select",""],["","68645056354","IBUPROFEN TAB","800MG","15","Select","Select",""],["","16714029904","AMOXICILLIN CAP","500MG","20","Select","Select",""],["","68180051303","LISINOPRIL TAB","5MG","30","Select","Select",""],["","68462015713","ONDANSETRON TAB","4MG ODT","10","Select","Select",""],["","67877021901","CEPHALEXIN CAP","500MG","20","Select","Select",""],["","51672131200","MUPIROCIN OIN","2%","22","Select","Select",""],["","50383077504","LIDOCAINE SOL","2% VISC","100","Select","Select",""],["","00186091612","PULMICORT FLEXHALER","180 MCG","1","Select","Select",""],["","08627007701","DEXCOM G","7 SENSOR","2","Select","Select",""],["","64380078508","PREDNISONE","20 MG","10","Select","Select",""],["","00781808926","AZITHROMYCIN","250 MG","6","Select","Select",""],["","68180096301","ALBUTEROL SULFATE HFA","90 MCG","8.5","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":""}]}]}