{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHAWN L WILSON","gend":0,"add":"117 TWINING LN","city":"RICHMOND","state":"VA","zip":"23223-9998","dob":"1990-02-03","age":"","mstatus":"","insh":"20054109*01","cliId":"","pno":8045222601,"cno":8045222601,"email":"","ename":"","eno":"","pphy":"HABIB, AYSHA MD","ppno":8046122980,"pcpadd":"STE 204 12320 W BROAD ST,","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":"23233-9998","pcpcounty":"","pcpid":"","pcpname":"Bon Secours Short Pump Primary Care","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8043602437,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.32","F41.1","F31.81","F43.10","J96.01","E66.01","R07.9","R22.43","F17.210","Z53.29","F12.20","F33.0","F90.2","F33.1","F12.122","G47.33","E11.65","I10.","I25.10","G47.30","Z79.4","Z79.899","Z68.44","R11.0","F31.31","F12.10","Z91.49","E11.69","Z79.84","E66.8","F33.9","E11.9","R60.0","E66.9","Z86.2","M79.89","F31.64","R00.0","F33.2","F33.3","F25.0","Z71.9","F32.9","Z20.822","E78.5","F41.9","Z59.0","Z91.19","F32.1","F41.0","F17.200","H53.8","E66.2","F31.2","I20.0","E08.65","R42.","Z91.14","Z68.43","Z20.828","U07.1","F31.9","L03.115","L03.116","R06.02","F11.20","R94.31","I51.7","Z11.3","E11.40","L84.","B35.1","F31.60","Z01.812","R06.89","R91.8","B34.9","Z51.81","R35.0","R73.9","Z03.818","R05.","J02.9","F25.9","N48.1","E11.41","K52.9","Z79.85","R10.9","M79.604","Z72.0","Z11.4","Z11.59","E11.42"],"date":["2021-09-29","2022-06-20","2022-02-23","2022-02-23","2021-05-19","2023-08-31","2022-06-15","2021-05-19","2023-06-13","2021-05-19","2022-07-05","2021-08-08","2022-08-21","2022-06-20","2022-06-20","2023-08-23","2023-08-31","2023-05-20","2023-05-20","2023-05-20","2023-08-31","2021-12-28","2022-10-31","2021-12-28","2022-06-30","2022-06-30","2022-06-30","2022-06-15","2022-07-18","2022-06-15","2023-08-23","2022-11-20","2022-10-31","2022-10-31","2023-05-20","2022-10-31","2021-02-07","2021-12-01","2022-08-16","2021-05-09","2021-06-27","2021-07-07","2021-07-07","2022-09-22","2021-07-31","2021-07-29","2021-07-29","2021-07-29","2022-09-13","2021-12-01","2021-12-01","2021-12-01","2022-04-18","2022-07-05","2022-06-14","2022-09-22","2022-11-20","2022-11-20","2023-05-20","2021-12-30","2022-01-03","2022-06-14","2021-05-05","2021-05-05","2022-02-14","2022-01-03","2021-12-01","2022-02-15","2022-07-18","2023-06-13","2023-01-25","2023-01-25","2021-05-12","2021-11-18","2022-01-03","2022-01-03","2022-01-03","2022-05-13","2022-07-18","2021-12-01","2022-10-31","2021-02-10","2021-09-20","2021-09-20","2023-03-17","2023-04-27","2023-05-20","2023-06-13","2023-05-20","2023-06-13","2023-08-23","2023-08-23","2023-08-23","2023-08-31"],"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":[["","63402030230","LATUDA","TAB 20MG","30","Select","Select",""],["","68462010905","TOPIRAMATE","TAB 100MG","60","Select","Select",""],["","68180031909","BUPROPN HCL","TAB 150MG XL","30","Select","Select",""],["","00378110101","PRAZOSIN HCL","CAP 1MG","60","Select","Select",""],["","57629010020","FERROUS SULF","TAB 325MG","60","Select","Select",""],["","00378718705","METFORMIN","TAB 1000MG","60","Select","Select",""],["","54295030815","UREA","CRE 0.4","57","Select","Select",""],["","69452015120","VITAMIN D","CAP 50000UNT","3","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","4","Select","Select",""],["","00093005401","BUSPIRONE","TAB 10MG","90","Select","Select",""],["","59651030901","FLUOXETINE","TAB 20MG","30","Select","Select",""],["","61874013020","VRAYLAR","CAP 3MG","30","Select","Select",""],["","55111012205","ATORVASTATIN","TAB 20MG","90","Select","Select",""],["","29300012810","HYDROCHLOROT","TAB 25MG","90","Select","Select",""],["","00054429931","FUROSEMIDE","TAB 40MG","10","Select","Select",""],["","67618010160","COLACE","CAP 100MG","90","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","60","Select","Select",""],["","60505265401","TRAZODONE","TAB 100MG","60","Select","Select",""],["","65862020399","LOSARTAN POT","TAB 100MG","90","Select","Select",""],["","00904645760","DOK","CAP 100MG","90","Select","Select",""],["","62037099901","POT CL MICRO","TAB 20MEQ ER","10","Select","Select",""],["","00115180301","HYDROXYZ PAM","CAP 25MG","60","Select","Select",""],["","00781106110","ALPRAZOLAM","TAB 0.25MG","60","Select","Select",""],["","68180098103","LISINOPRIL","TAB 20MG","90","Select","Select",""],["","00363237102","LANCETS MICR","MIS THIN 33G","100","Select","Select",""],["","00002880559","HUMULIN N","INJ U-100KWP","15","Select","Select",""],["","08290320109","BD PEN NEEDL","MIS 31GX8MM","100","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","100","Select","Select",""],["","56151146004","TRUE METRIX","TES GLUCOSE","50","Select","Select",""],["","00024586903","TOUJEO SOLO","INJ 300IU\/ML","10","Select","Select",""],["","68382050010","OMEPRAZOLE","CAP 40MG","90","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","00904699860","DOCUSATE SOD","CAP 100MG","90","Select","Select",""],["","08317236131","PEN NEEDLES","MIS 31GX6MM","100","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","100","Select","Select",""],["","08271036100","LANCETS ULTR","MIS THIN","100","Select","Select",""],["","00169413013","OZEMPIC","INJ 4MG\/3ML","9","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","11917007452","MULTIPLE VIT","TAB ","30","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","00536354710","DAILY-VITE","TAB ","30","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","74312001570","MULTI-DAY","TAB ","30","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","6","Select","Select",""],["","00002318280","TRULICITY","4.5 MG\/0.5","2","Select","Select",""],["","57599080000","FREESTY LIBR","KIT 2 SENSOR","6","Select","Select",""],["","57599000101","FREESTYLE","KIT SENSOR","1","Select","Select",""],["","00002771459","HUMALOG JR","INJ 100\/ML","15","Select","Select",""],["","00002775205","INSULIN LISP","INJ JUNIOR","15","Select","Select",""],["","33342006807","OLANZAPINE","TAB 5MG","30","Select","Select",""],["","00378427577","VALACYCLOVIR","TAB 500MG","6","Select","Select",""],["","00088222033","LANTUS","INJ 100\/ML","10","Select","Select",""],["","43547028810","BUPROPION","TAB 100MG SR","30","Select","Select",""],["","00955172805","INSULIN GLAR","INJ 100U\/ML","15","Select","Select",""],["","11917004813","INSULIN SYRG","MIS 1ML\/31G","100","Select","Select",""],["","56151014701","TRUPLUS LANC","MIS 33G","100","Select","Select",""],["","00536129901","MECLIZINE","CHW 25MG","20","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","20","Select","Select",""],["","08290320109","ULTRA-FINE SHORT PEN NEEDLE","31 GX5\/16\"","300","Select","Select",""],["","00472037945","CLOTRIMAZOLE-BETAMETHASONE","1 %-0.05 %","45","Select","Select",""],["","00002879959","HUMALOG KWIKPEN U-","100 100\/ML","15","Select","Select",""],["","45963055550","GABAPENTIN","100 MG","30","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","100\/ML (3)","15","Select","Select",""],["","51672130005","AMMONIUM LACTATE","12 %","225","Select","Select",""],["","00591079501","DICYCLOMINE HCL","20 MG","120","Select","Select",""],["","57237007830","ONDANSETRON ODT","8 MG","21","Select","Select",""],["","00169413602","OZEMPIC INJ","2\/1.5ML","3","Select","Select",""],["","00002880559","HUMULIN N INJ U-","100KWP","15","Select","Select",""],["","59651030901","FLUOXETINE TAB","20MG","30","Select","Select",""],["","08290320109","BD PEN NEEDL MIS","31GX8MM","100","Select","Select",""],["","00002318280","TRULICITY INJ","4.5\/0.5","2","Select","Select",""],["","57599080000","FREESTY LIBR KIT","2 SENSOR","6","Select","Select",""],["","57599000101","FREESTYLE KIT SENSOR","","1","Select","Select",""],["","00088221905","LANTUS SOLOS INJ","100\/ML","15","Select","Select",""],["","00002771459","HUMALOG JR INJ","100\/ML","15","Select","Select",""],["","00378718705","METFORMIN TAB","1000MG","60","Select","Select",""],["","00002775205","INSULIN LISP INJ JUNIOR","","15","Select","Select",""],["","43547035411","LISINOPRIL TAB","20MG","90","Select","Select",""],["","68180031909","BUPROPN HCL TAB","150MG XL","30","Select","Select",""],["","53885000810","ONETOUCH DEL MIS PLUS","33G","100","Select","Select",""],["","60505265401","TRAZODONE TAB","100MG","60","Select","Select",""],["","68462010905","TOPIRAMATE TAB","100MG","60","Select","Select",""],["","63402030430","LATUDA TAB","40MG","30","Select","Select",""],["","00115180301","HYDROXYZ PAM CAP","25MG","60","Select","Select",""],["","00093005401","BUSPIRONE TAB","10MG","90","Select","Select",""],["","55111012205","ATORVASTATIN TAB","20MG","90","Select","Select",""],["","65862020399","LOSARTAN POT TAB","100MG","90","Select","Select",""],["","00093719801","FLUOXETINE CAP","40MG","90","Select","Select",""],["","29300012810","HYDROCHLOROT TAB","25MG","90","Select","Select",""],["","00378427577","VALACYCLOVIR TAB","500MG","6","Select","Select",""],["","00088222033","LANTUS INJ","100\/ML","10","Select","Select",""],["","33342006807","OLANZAPINE TAB","5MG","30","Select","Select",""],["","53885024450","ONETOUCH TES ULTRA","","50","Select","Select",""],["","43547028810","BUPROPION TAB","100MG SR","30","Select","Select",""],["","56151146004","TRUE METRIX TES GLUCOSE","","50","Select","Select",""],["","53885004601","ONETOUCH KIT ULTRA","2","1","Select","Select",""],["","53885041901","ONETOUCH KIT ULT MINI","","1","Select","Select",""],["","00955172805","INSULIN GLAR INJ","100U\/ML","15","Select","Select",""],["","56151014701","TRUPLUS LANC MIS","33G","100","Select","Select",""],["","11917004813","INSULIN SYRG MIS","1ML\/31G","100","Select","Select",""],["","53885092701","ONETOUCH KIT VERIO RE","","1","Select","Select",""],["","53885027210","ONETOUCH TES VERIO","","100","Select","Select",""],["","68462010530","ONDANSETRON TAB","4MG","20","Select","Select",""],["","00536129901","MECLIZINE CHW","25MG","20","Select","Select",""],["","68462019005","NAPROXEN","500 MG","60","Select","Select",""],["","57599080300","FREESTYLE LIBRE","2 READER","1","Select","Select",""],["","00093720198","PRAVASTATIN SODIUM","20 MG","90","Select","Select",""],["","53885092701","ONETOUCH VERIO REFLECT METER","","1","Select","Select",""],["","53885024510","ONETOUCH ULTRA TEST STRIP","","100","Select","Select",""],["","53885027210","ONETOUCH VERIO TEST STRIP","","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":""}]}]}