{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DEBRA  R SILER","gend":1,"add":"136 CANDACE LN","city":"ATKINS","state":"VA","zip":"24311-9998","dob":"1972-08-01","age":"","mstatus":"","insh":"20053365*01","cliId":"","pno":2767286847,"cno":2767286847,"email":"","ename":"","eno":"","pphy":"VANCE, TERESA QUESENBERRY DNP","ppno":2764964433,"pcpadd":"308 W MAIN ST","pcpcity":"SALTVILLE","pcpstate":"VA","pcpzip":"24370-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":2764965923,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","NO DATA","F13.10","F13.20","F12.10","F33.1","F31.60","S60.221A","S60.511A","L03.119","E78.5","E03.9","I10.","K21.9","E11.9","Z87.891","Z23.","Z79.84","Z79.82","Z79.899","Z79.51","M79.89","Z01.810","H25.811","R07.9","Z74.3","N30.00","I51.7","R11.2","K51.00","F41.9","F31.9","R11.0","R13.10","K62.5","K63.5","K59.00","S80.02XA","H25.812","Z20.822","N95.1","Z12.31","J45.909","M62.838","H04.123","K31.84","K59.04","R10.9","N30.91","Z96.0","R10.84","U07.1","K92.1","K29.71","Z88.5","Z88.8","K59.09","Z80.0","Z90.49","Z90.710","E78.00","E11.43","R19.7","R22.2","H01.009","H26.9","K29.70","K62.89","K64.8","K64.4","R00.2","R33.8","K58.2","E11.41","L03.113","R33.9","N30.01","A04.9","G40.909","R39.11","J30.2","E78.1","H25.813","I48.91","K44.9","Z86.010","Z12.11","N39.46","H35.033","H25.12","R10.13","E87.6","I16.0","L03.312","Z48.01","M54.6","K22.2","I48.0","G43.909","M51.36","E66.9","Z68.39","Z96.653","D63.8","G56.01","Z01.818","R11.10","R94.131"],"date":["2023-03-24","2023-03-16","2021-03-15","2021-08-05","2021-08-05","2022-11-28","2023-03-06","2022-02-08","2022-02-08","2022-02-08","2023-03-16","2023-04-11","2023-04-11","2023-04-11","2023-04-11","2022-10-03","2022-02-08","2023-04-11","2023-04-11","2023-04-11","2022-02-08","2022-02-08","2022-04-20","2022-05-02","2022-09-09","2022-11-29","2022-10-03","2022-05-20","2023-03-28","2023-03-19","2023-03-19","2023-03-28","2021-08-26","2023-02-17","2021-01-26","2021-11-03","2021-10-12","2022-04-21","2022-05-19","2023-03-16","2021-08-26","2021-08-26","2023-04-11","2021-08-26","2023-03-13","2023-04-03","2021-10-12","2023-02-01","2022-10-03","2022-10-03","2022-10-03","2022-11-30","2023-04-11","2023-02-17","2023-04-11","2023-04-11","2023-04-11","2023-04-11","2023-04-11","2023-04-11","2023-04-11","2023-04-03","2023-02-17","2023-04-03","2023-03-13","2023-03-13","2023-02-17","2021-11-03","2023-04-11","2021-11-03","2022-05-20","2022-09-29","2022-09-29","2022-09-29","2022-02-08","2022-09-25","2022-09-25","2022-09-25","2023-03-16","2021-12-09","2021-12-09","2021-12-09","2022-04-14","2023-02-17","2021-02-09","2021-02-09","2023-04-11","2022-01-11","2022-01-27","2022-01-27","2023-03-16","2023-03-28","2023-03-28","2023-04-07","2023-04-07","2023-04-07","2023-02-17","2023-03-16","2023-03-16","2023-03-16","2023-03-16","2023-03-16","2023-03-16","2023-04-03","2023-04-24","2023-04-24","2023-03-16","2023-04-13"],"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":[["","31722070190","LOSARTAN POT","TAB 50MG","90","Select","Select",""],["","55111025960","ZIPRASIDONE","CAP 80MG","60","Select","Select",""],["","00169369619","NOVOLOG MIX","INJ FLEXPEN","15","Select","Select",""],["","68462025601","ROPINIROLE","TAB 2MG","30","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","60","Select","Select",""],["","62756097083","BUPREN\/NALOX","SUB 8-2MG","56","Select","Select",""],["","57664047758","METOPROL TAR","TAB 50MG","180","Select","Select",""],["","00456120230","LINZESS","CAP 290MCG","30","Select","Select",""],["","70954001910","PRAZOSIN HCL","1 MG","30","Select","Select",""],["","45802086803","POLYETH GLYC","POW 3350 NF","510","Select","Select",""],["","45963067611","METOPROLOL","TAB 50MG ER","90","Select","Select",""],["","68546017260","AUSTEDO","12 MG","60","Select","Select",""],["","29300046810","CLONIDINE","TAB 0.1MG","90","Select","Select",""],["","00093520006","BUSPIRONE","TAB 30MG","60","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","28","Select","Select",""],["","00603243821","BENZTROPINE","TAB 1MG","60","Select","Select",""],["","65862049501","QUETIAPINE","TAB 400MG","60","Select","Select",""],["","65862022801","LAMOTRIGINE","100 MG","60","Select","Select",""],["","00378668977","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","43598081115","CETIRIZINE","TAB 10MG","90","Select","Select",""],["","59651005230","EZETIMIBE","10 MG","90","Select","Select",""],["","00378395205","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","65862060012","RIZATRIPTAN","TAB 10MG","6","Select","Select",""],["","69238183901","LEVOTHYROXIN","TAB 175MCG","90","Select","Select",""],["","68462012705","GABAPENTIN","800 MG","120","Select","Select",""],["","68180035302","SERTRALINE","TAB 100MG","60","Select","Select",""],["","73070020315","INS ASP PROT","INJ FLEXPEN","15","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","100","Select","Select",""],["","70010077001","METHOCARBAM","TAB 750MG","15","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","00378718505","METFORMIN","TAB 500MG","180","Select","Select",""],["","00310737220","BUDES\/FORMOT","AER 80-4.5","10","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00143312610","DICYCLOMINE","CAP 10MG","90","Select","Select",""],["","00065045407","SYSTANE GEL","DRO 0.4-0.3%","10","Select","Select",""],["","00113030601","CLEARLAX","POW ","119","Select","Select",""],["","65862016001","ZOLPIDEM","TAB 10MG","30","Select","Select",""],["","00186037220","SYMBICORT","80-4.5 MCG","30.6","Select","Select",""],["","00065048110","SYSTANE COMP","SOL 0.006","10","Select","Select",""],["","96439002001","RESET-O","MIS IOS\/ANDR","1","Select","Select",""],["","0","COMPOUND"," ","30","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","21","Select","Select",""],["","61314063705","PREDNISOLONE","SUS 1% OP","10","Select","Select",""],["","29033000305","SUCRALFATE","1 G","60","Select","Select",""],["","11877001140","BINAXNOW COV","KIT HOME TES","2","Select","Select",""],["","61314062810","POLYMYXIN B\/","SOL TRIMETHP","10","Select","Select",""],["","51293061201","PHENAZOPYRID","TAB 200MG","9","Select","Select",""],["","10702000350","PROMETHAZINE","TAB 25MG","30","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","00093083205","CLONAZEPAM","0.5 MG","60","Select","Select",""],["","00069034530","PAXLOVID","TAB 300-100","30","Select","Select",""],["","00310737220","BUDESONIDE-FORMOTEROL FUMARATE","80-4.5 MCG","30.6","Select","Select",""],["","68180096301","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","53885027210","ONETOUCH VERIO TEST STRIP","","100","Select","Select",""],["","72578003601","METFORMIN HCL ER","750 MG","90","Select","Select",""],["","11917017096","VITAMIN D","3 50 MCG","90","Select","Select",""],["","67877024801","QUETIAPINE FUMARATE","400 MG","60","Select","Select",""],["","45802081184","NALOXONE HCL","4 MG","2","Select","Select",""],["","00378668977","PANTOPRAZOLE SODIUM","40 MG","60","Select","Select",""],["","00093520006","BUSPIRONE HCL","30 MG","60","Select","Select",""],["","62756097083","BUPRENORPHINE-NALOXONE","8 MG-2 MG","56","Select","Select",""],["","69238183801","LEVOTHYROXINE SODIUM","150 MCG","90","Select","Select",""],["","27808023302","DOXYCYCLINE HYCLATE","100 MG","20","Select","Select",""],["","00173069600","ADVAIR DISKUS","250-50 MCG","180","Select","Select",""],["","65862016001","ZOLPIDEM TARTRATE","10 MG","30","Select","Select",""],["","53885000810","ONETOUCH DELICA PLUS LANCET","33 GAUGE","100","Select","Select",""],["","65862001305","SERTRALINE HCL","100 MG","60","Select","Select",""],["","65862020299","LOSARTAN POTASSIUM","50 MG","90","Select","Select",""],["","00093220401","METOCLOPRAMIDE HCL","5 MG","30","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","43598081115","CETIRIZINE HCL","10 MG","90","Select","Select",""],["","68462025601","ROPINIROLE HCL","2 MG","30","Select","Select",""],["","53885013610","ONETOUCH DELICA","33 GAUGE","200","Select","Select",""],["","68462015713","ONDANSETRON ODT","4 MG","20","Select","Select",""],["","57664047758","METOPROLOL TARTRATE","50 MG","180","Select","Select",""],["","68382004001","PROMETHAZINE HCL","12.5 MG","60","Select","Select",""],["","55111025960","ZIPRASIDONE HCL","80 MG","60","Select","Select",""],["","00781185220","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","14","Select","Select",""],["","12496130602","SUBOXONE","8 MG-2 MG","56","Select","Select",""],["","10702001801","OXYCODONE HCL","5 MG","12","Select","Select",""],["","00527058601","DICYCLOMINE HCL","10 MG","30","Select","Select",""],["","00378932132","WIXELA INHUB","250-50 MCG","180","Select","Select",""],["","43598083205","ATORVASTATIN CALCIUM","40 MG","90","Select","Select",""],["","00143992801","CIPROFLOXACIN HCL","500 MG","4","Select","Select",""],["","75826011410","PHENAZOPYRIDINE HCL","100 MG","6","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":""}]}]}