{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHRISTINE A PLOOF","gend":1,"add":"16041 BEULAH EST LN APT I","city":"BEAVERDAM","state":"VA","zip":"23015-9998","dob":"1965-05-14","age":"","mstatus":"","insh":"20052942*01","cliId":"","pno":8047739729,"cno":8047739729,"email":"","ename":"","eno":"","pphy":"BLATZER, LEAH NP","ppno":8048284060,"pcpadd":"9109 STONY POINT DR,","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":"23235-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8048285345,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F14.20","G47.33","M79.605","M54.5","G89.29","F31.9","K76.0","E66.01","K21.9","Z86.39","Z87.891","Z68.42","M54.16","D17.22","E11.9","F14.23","E66.9","Z01.419","Z78.0","N91.4","L30.4","R10.11","E11.65","E55.9","Z13.89","R73.9","S09.90XA","S50.812A","S00.81XA","NO DATA","E11.40","I11.0","I50.9","J44.9","Z79.51","Z79.82","Z79.84","M54.2","M25.512","F31.2","L72.0","D22.39","H90.3","F11.20","Z79.4","S09.8XXA","L30.9","M51.16","M41.9","F14.10","M54.17","F32.9","I11.9","M51.36","M43.16","M47.816","G47.10","G47.30","M25.562","M54.89","F17.200","Z23."],"date":["2023-08-03","2023-04-17","2021-09-15","2021-08-17","2022-02-07","2023-02-02","2023-09-20","2023-02-09","2023-02-09","2023-02-09","2023-02-09","2023-02-09","2022-02-07","2021-08-19","2022-06-01","2022-05-24","2022-06-01","2022-03-25","2022-03-25","2022-03-25","2022-03-25","2022-06-02","2022-06-02","2022-06-02","2022-06-02","2022-05-17","2022-06-17","2022-06-17","2022-06-17","2022-11-02","2023-06-05","2023-06-05","2023-06-05","2023-06-05","2023-06-05","2023-06-05","2023-06-05","2023-06-05","2023-06-05","2021-01-01","2021-05-21","2021-05-21","2021-05-03","2021-04-20","2022-05-10","2022-06-17","2021-04-20","2021-03-30","2021-03-30","2021-03-30","2021-10-28","2021-10-28","2021-05-05","2021-09-15","2021-09-15","2021-09-15","2021-03-12","2023-06-05","2023-06-05","2023-06-05","2023-06-05","2023-08-02"],"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":[["","00378932132","WIXELA INHUB","AER 250\/50","60","Select","Select",""],["","00093057610","LOVASTATIN","TAB 20MG","30","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","57896098110","ASPIRIN LOW","TAB 81MG EC","30","Select","Select",""],["","00228277911","PROPRANOLOL","CAP 80MG ER","30","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","70436005901","BUPROPION","TAB 150MG SR","30","Select","Select",""],["","08290320109","BD PEN NEEDL","MIS 31GX8MM","100","Select","Select",""],["","62756079788","DIVALPROEX","TAB 250MG DR","90","Select","Select",""],["","68382013914","TOPIRAMATE","TAB 50MG","180","Select","Select",""],["","68382032010","POT CHLORIDE","TAB 10MEQ ER","30","Select","Select",""],["","23155050201","HYDROXYZ HCL","TAB 50MG","60","Select","Select",""],["","65862001205","SERTRALINE","TAB 50MG","30","Select","Select",""],["","43547040110","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","68382080610","TRAZODONE","TAB 100MG","30","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","37864092001","VITAMIN D","3 50 MCG","30","Select","Select",""],["","62756014202","METFORMIN","TAB 500MG ER","60","Select","Select",""],["","00172409660","BACLOFEN","TAB 10MG","90","Select","Select",""],["","65757030001","VIVITROL","INJ 380MG","1","Select","Select",""],["","65862056090","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","00085113204","PROVENTIL","AER HFA","7","Select","Select",""],["","49348098023","SM ASPIRIN","TAB 81MG EC","30","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","15","Select","Select",""],["","00781729685","ALBUTEROL","AER HFA","7","Select","Select",""],["","70010077001","METHOCARBAM","TAB 750MG","90","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","15","Select","Select",""],["","08470354001","UNFINE PNTP","MIS 32GX4MM","90","Select","Select",""],["","00169406013","VICTOZA","INJ 18MG\/3ML","9","Select","Select",""],["","43598050930","ESOMEPRA MAG","CAP 20MG DR","30","Select","Select",""],["","08470352901","UNIFINE PNTP","MIS 29GX12MM","100","Select","Select",""],["","65862044830","VALACYCLOVIR","TAB 500MG","6","Select","Select",""],["","70000041503","CLEARLAX","POW ","510","Select","Select",""],["","00781107701","ALPRAZOLAM","TAB 0.5MG","2","Select","Select",""],["","00173069600","ADVAIR DISKU","AER 250\/50","60","Select","Select",""],["","41100082071","MIRALAX","POW 3350 NF","510","Select","Select",""],["","00172572880","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","00573245028","NEXIUM 24HR","CAP 20MG","30","Select","Select",""],["","70000055601","CAPSAICIN","PAD 0.00025","14","Select","Select",""],["","00904699860","DOCUSATE SOD","CAP 100MG","60","Select","Select",""],["","73070010315","INSULIN ASPA","INJ FLEXPEN","15","Select","Select",""],["","00093227534","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","59762444002","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00904645760","DOK","CAP 100MG","60","Select","Select",""],["","80777027398","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","57599080300","FREESTY LIBR","MIS 2 READER","1","Select","Select",""],["","54629090970","VITAMIN D3","CAP 2000UNIT","30","Select","Select",""],["","00574200815","NYSTOP","POW 100000","15","Select","Select",""],["","00088222033","LANTUS","100\/ML","10","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","12","Select","Select",""],["","68462026190","ROSUVASTATIN","TAB 5MG","30","Select","Select",""],["","10702000601","CYCLOBENZAPR","TAB 5MG","42","Select","Select",""],["","00832046515","NYAMYC","POW 100000","15","Select","Select",""],["","08290324912","INSULIN SYRG","MIS 1ML\/31G","100","Select","Select",""],["","29300024601","BUSPIRONE","TAB 15MG","30","Select","Select",""],["","68180032002","BUPROPN HCL","TAB 300MG XL","30","Select","Select",""],["","65162010250","GABAPENTIN","300 MG","30","Select","Select",""],["","00093314701","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","51660052601","ALLERGY RELF","TAB 10MG","30","Select","Select",""],["","08627009111","DEXCOM G6","MIS RECEIVER","1","Select","Select",""],["","00169280015","SAXENDA","3 MG\/0.5ML","15","Select","Select",""],["","00597015330","JARDIANCE","25 MG","30","Select","Select",""],["","57896050410","ONE-DAILY","TAB MULT VIT","30","Select","Select",""],["","68462011944","FLUCONAZOLE","150 MG","2","Select","Select",""],["","00185012201","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","00536105224","PEG3350","POW ","238","Select","Select",""],["","21922000909","DICLOFENAC SODIUM","1 %","100","Select","Select",""],["","42806016105","HYDROXYZINE HCL","50 MG","60","Select","Select",""],["","27808015501","ROSUVASTATIN CALCIUM","5 MG","30","Select","Select",""],["","59651039001","BUSPIRONE HCL","7.5 MG","60","Select","Select",""],["","00536105224","POLYETHYLENE GLYCOL","3350 17 G\/DOSE","238","Select","Select",""],["","68180035202","SERTRALINE HCL","50 MG","30","Select","Select",""],["","16729044416","BUPROPION XL","300 MG","30","Select","Select",""],["","16729030017","TRAZODONE HCL","100 MG","30","Select","Select",""],["","68001047303","DIVALPROEX SODIUM","250 MG","90","Select","Select",""],["","75834050005","METFORMIN HCL ER","500 MG","60","Select","Select",""],["","08290320119","ULTRA-FINE MINI PEN NEEDLE","31 GX3\/16\"","100","Select","Select",""],["","51660052601","ALLERGY RELIEF","10 MG","30","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","100\/ML (3)","15","Select","Select",""],["","64380080807","IBUPROFEN","600 MG","30","Select","Select",""],["","08290324909","VEO INSULIN SYRINGE","31GX15\/64\"","100","Select","Select",""],["","00093342210","CYCLOBENZAPRINE HCL","10 MG","12","Select","Select",""],["","65757030001","VIVITROL INJ","380MG","1","Select","Select",""],["","11845015015","VITAMIN D CAP","2000UNIT","30","Select","Select",""],["","57599080000","FREESTY LIBR KIT","2 SENSOR","2","Select","Select",""],["","57599080300","FREESTY LIBR MIS","2 READER","1","Select","Select",""],["","16729030017","TRAZODONE TAB","100MG","30","Select","Select",""],["","23155050201","HYDROXYZ HCL TAB","50MG","60","Select","Select",""],["","08470354001","UNFINE PNTP MIS","32GX4MM","100","Select","Select",""],["","00088221905","LANTUS SOLOS INJ","100\/ML","15","Select","Select",""],["","16729021616","SERTRALINE TAB","50MG","30","Select","Select",""],["","00169406013","VICTOZA INJ","18MG\/3ML","9","Select","Select",""],["","00093227534","AMOX\/K CLAV TAB","875-125","20","Select","Select",""],["","69315011610","FUROSEMIDE TAB","20MG","30","Select","Select",""],["","75834050005","METFORMIN TAB","500MG ER","60","Select","Select",""],["","65862056090","PANTOPRAZOLE TAB","40MG","30","Select","Select",""],["","00574200815","NYSTOP POW","100000","15","Select","Select",""],["","08290324912","INSULIN SYRG MIS","1ML\/31G","100","Select","Select",""],["","00088222033","LANTUS INJ","100\/ML","20","Select","Select",""],["","00832046515","NYAMYC POW","100000","15","Select","Select",""],["","29300013905","DIVALPROEX TAB","250MG DR","90","Select","Select",""],["","16729044416","BUPROPN HCL TAB","300MG XL","30","Select","Select",""],["","68462026190","ROSUVASTATIN TAB","5MG","30","Select","Select",""],["","65162010250","GABAPENTIN CAP","300MG","30","Select","Select",""],["","29300024601","BUSPIRONE TAB","15MG","30","Select","Select",""],["","70436005901","BUPROPION TAB","150MG SR","30","Select","Select",""],["","00591352530","LIDOCAINE PAD","5%","30","Select","Select",""],["","10702000601","CYCLOBENZAPR TAB","5MG","42","Select","Select",""],["","65862044830","VALACYCLOVIR TAB","500MG","6","Select","Select",""],["","00093031401","KETOROLAC TAB","10MG","12","Select","Select",""],["","51660052601","ALLERGY RELF TAB","10MG","30","Select","Select",""],["","00169280015","SAXENDA INJ","18MG\/3ML","15","Select","Select",""],["","08627005303","DEXCOM G","6 MIS SENSOR","3","Select","Select",""],["","08290320119","BD PEN NEEDL MIS","31GX5MM","100","Select","Select",""],["","00597015330","JARDIANCE TAB","25MG","30","Select","Select",""],["","68462011944","FLUCONAZOLE TAB","150MG","2","Select","Select",""],["","00093314701","CEPHALEXIN CAP","500MG","28","Select","Select",""],["","57896050410","ONE-DAILY TAB MULT VIT","","30","Select","Select",""],["","00185012201","NITROFURANTN CAP","100MG","10","Select","Select",""],["","00536105224","PEG","3350 POW","238","Select","Select",""],["","31722071390","PANTOPRAZOLE SODIUM","40 MG","30","Select","Select",""],["","69315090401","LORAZEPAM","0.5 MG","2","Select","Select",""],["","00781729685","ALBUTEROL SULFATE HFA","90 MCG","6.7","Select","Select",""],["","58160081552","TWINRIX","720-20\/ML","1","Select","Select",""],["","00005200010","PREVNAR","20 0.5 ML","0.5","Select","Select",""],["","57599000101","FREESTYLE LIBRE","14 DAY SENSOR","2","Select","Select",""],["","33332042310","AFLURIA QUAD","2023-2024 60MCG\/.5ML","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":""}]}]}