{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARK E FREELAND","gend":0,"add":"333 PARK AVE","city":"APPALACHIA","state":"VA","zip":"24216-9998","dob":"1962-04-01","age":"","mstatus":"","insh":"20042627*01","cliId":"","pno":7573768091,"cno":7573768091,"email":"","ename":"","eno":"","pphy":"SCHACK, TIFFANY M NP","ppno":2766795874,"pcpadd":"671 HWY 58 EAST,","pcpcity":"NORTON","pcpstate":"VA","pcpzip":"24273-9998","pcpcounty":"","pcpid":"","pcpname":"Bhma Spine And Rehabilitation Rog","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":2766796912,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I47.1","E11.9","E22.2","E78.2","F31.9","G47.33","R13.10","F43.10","F90.0","F41.9","F33.1","F41.1","H35.033","H00.12","H25.13","M47.816","R21.","L30.9","L85.3","Z71.9","L60.0","B35.3","B35.1","E11.42","E11.69","J44.9","E11.40","I10.","L71.9","K21.9","K22.70","K22.9","Z86.010","E11.621","L97.519","K04.7","E11.8","F90.9","NO DATA","K22.4","Z23.","Z00.00","E66.9","E11.43","A49.02","Z79.899","M54.16","G70.9","Z12.11","M51.36","K57.30","Z53.8","H52.01","H52.223","H52.4","M53.3"],"date":["2021-01-14","2023-05-31","2022-04-26","2022-04-26","2022-04-26","2021-09-29","2021-01-14","2022-04-18","2022-04-18","2022-07-08","2023-08-03","2023-08-03","2021-06-21","2021-06-21","2021-06-21","2023-02-14","2021-09-29","2021-02-11","2021-02-11","2021-02-11","2021-09-15","2021-09-15","2021-09-15","2022-02-08","2022-02-08","2021-09-20","2021-09-15","2022-04-26","2021-09-20","2022-02-17","2021-10-26","2021-10-26","2023-04-25","2022-07-22","2022-07-22","2022-06-24","2022-06-24","2022-06-24","2022-07-08","2022-07-08","2022-06-24","2022-06-24","2022-04-26","2022-04-26","2022-07-08","2023-05-22","2022-02-14","2022-02-14","2023-04-25","2023-05-22","2023-04-25","2023-04-25","2023-05-31","2023-05-31","2023-05-31","2023-06-13"],"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":[["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","10702010101","METHYLPHENID","TAB 10MG","60","Select","Select",""],["","63402030630","LATUDA","60 MG","30","Select","Select",""],["","27241017101","DOXEPIN HCL","100 MG","30","Select","Select",""],["","70436005901","BUPROPION","TAB 150MG SR","30","Select","Select",""],["","69584009406","BUSPIRONE","TAB 30MG","30","Select","Select",""],["","51991029401","OXCARBAZEPIN","TAB 600MG","45","Select","Select",""],["","70377002811","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","70436015301","POT CHLORIDE","TAB 20MEQ ER","30","Select","Select",""],["","57237001401","TAMSULOSIN","CAP 0.4MG","30","Select","Select",""],["","70010049110","METFORMIN","TAB 500MG ER","30","Select","Select",""],["","69452015120","VITAMIN D","2 1250 MCG","2","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","30","Select","Select",""],["","59651000305","OMEPRAZOLE","40 MG","60","Select","Select",""],["","68682000710","DILTIAZEM","TAB 60MG","90","Select","Select",""],["","00378247401","DICLOFEN POT","TAB 50MG","60","Select","Select",""],["","53885024450","ONETOUCH","TES ULTRA","50","Select","Select",""],["","71093011105","GABAPENTIN","600 MG","90","Select","Select",""],["","45802005505","TRIAMCINOLON","OIN 0.001","454","Select","Select",""],["","00169406013","VICTOZA","3-PAK 0.6 MG\/0.1","9","Select","Select",""],["","00116200116","CHLORHEX GLU","SOL 0.0012","473","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","6","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","45802013835","CICLOPIROX","CRE 0.0077","90","Select","Select",""],["","51672130601","ALCLOMETASON","CRE 0.0005","15","Select","Select",""],["","08290320550","BD PEN NEEDL","MIS 32GX5\/32","100","Select","Select",""],["","70461032103","FLUCLVX QUAD","INJ 2021-22","0","Select","Select",""],["","68084079425","SOD CHLORIDE","TAB 1000MG","30","Select","Select",""],["","49483060350","IBUPROFEN","600 MG","90","Select","Select",""],["","55111052130","ATOMOXETINE","CAP 40MG","30","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","20","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","41","Select","Select",""],["","00093117410","PENICILLN VK","TAB 500MG","30","Select","Select",""],["","08080783100","CURITY IODO","MIS STRIP","1","Select","Select",""],["","49281042250","FLUZONE QUAD","INJ 2022-23","0","Select","Select",""],["","80777028299","MODERNA BIVA","INJ BA4\/BA5","0","Select","Select",""],["","29300024605","BUSPIRONE HCL","15 MG","60","Select","Select",""],["","68682000750","DILTIAZEM HCL","60 MG","90","Select","Select",""],["","00115821101","TAMSULOSIN HCL","0.4 MG","30","Select","Select",""],["","68462013901","OXCARBAZEPINE","600 MG","45","Select","Select",""],["","59746000103","METHYLPREDNISOLONE","4 MG","21","Select","Select",""],["","67877056110","METFORMIN HCL","500 MG","30","Select","Select",""],["","68084079425","SODIUM CHLORIDE","1000 MG","90","Select","Select",""],["","55111052130","ATOMOXETINE HCL","40 MG","30","Select","Select",""],["","67877051210","ATORVASTATIN CALCIUM","20 MG","30","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","47335063983","LURASIDONE HCL","60 MG","30","Select","Select",""],["","43386009019","GAVILYTE-G","236-22.74G","4000","Select","Select",""],["","61874011530","VRAYLAR","1.5 MG","30","Select","Select",""],["","53885027210","ONETOUCH VERIO TEST STRIP","","100","Select","Select",""],["","53885004401","ONETOUCH VERIO FLEX METER","","1","Select","Select",""],["","53885000810","ONETOUCH DELICA PLUS LANCET","33 GAUGE","100","Select","Select",""],["","59651000305","OMEPRAZOLE CAP","40MG","60","Select","Select",""],["","69584009350","BUSPIRONE TAB","15MG","60","Select","Select",""],["","59651017701","DOXEPIN HCL CAP","100MG","30","Select","Select",""],["","69452015120","VITAMIN D CAP","50000UNT","2","Select","Select",""],["","51991029401","OXCARBAZEPIN TAB","600MG","45","Select","Select",""],["","68682000710","DILTIAZEM TAB","60MG","90","Select","Select",""],["","63402030630","LATUDA TAB","60MG","30","Select","Select",""],["","57237001401","TAMSULOSIN CAP","0.4MG","30","Select","Select",""],["","70377002811","ATORVASTATIN TAB","20MG","30","Select","Select",""],["","53885024450","ONETOUCH TES ULTRA","","50","Select","Select",""],["","71093011105","GABAPENTIN TAB","600MG","90","Select","Select",""],["","00054327099","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","00169406013","VICTOZA INJ","18MG\/3ML","18","Select","Select",""],["","10702010101","METHYLPHENID TAB","10MG","60","Select","Select",""],["","70010049110","METFORMIN TAB","500MG ER","30","Select","Select",""],["","00223176001","SOD CHLORIDE TAB","1GM","30","Select","Select",""],["","49483060450","IBUPROFEN TAB","800MG","90","Select","Select",""],["","70436005901","BUPROPION TAB","150MG SR","30","Select","Select",""],["","00093117410","PENICILLN VK TAB","500MG","30","Select","Select",""],["","08080783100","CURITY IODO MIS STRIP","","1","Select","Select",""],["","55111052130","ATOMOXETINE CAP","40MG","30","Select","Select",""],["","65862042005","SMZ\/TMP DS TAB","800-160","20","Select","Select",""],["","53746010901","HYDROCO\/APAP TAB","5-325MG","12","Select","Select",""],["","00093310905","AMOXICILLIN CAP","500MG","41","Select","Select",""],["","80777028299","MODERNA BIVA INJ BA","4\/BA5","0","Select","Select",""],["","49281042250","FLUZONE QUAD INJ","2022-23","0","Select","Select",""],["","43547030303","ARIPIPRAZOLE","5 MG","30","Select","Select",""],["","70461032303","FLUCELVAX QUAD","2023-2024 60MCG\/.5ML","0.5","Select","Select",""],["","00005200010","PREVNAR","20 0.5 ML","0.5","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":""}]}]}