{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHERYL M BURD","gend":1,"add":"1138 SINKS ROAD","city":"BLACKWATER","state":"VA","zip":"24221-9998","dob":"1971-08-16","age":"","mstatus":"","insh":"20054467*01","cliId":"","pno":2762100557,"cno":2762100557,"email":"","ename":"","eno":"","pphy":"PROVANCE, PAUL T MD","ppno":4237941820,"pcpadd":"105 W STONE DR STE 3A,","pcpcity":"KINGSPORT","pcpstate":"TN","pcpzip":"37660-9998","pcpcounty":"","pcpid":"","pcpname":"Holston Medical Group PC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R07.89","I51.81","I25.10","I10.","E78.1","E11.40","K21.9","F32.9","F41.9","E66.9","Z68.34","I45.10","Z79.02","Z79.82","Z95.5","Z79.84","Z79.899","E11.69","Z12.31","M79.606","Z23.","G47.00","J44.9","E05.00","F33.2","NO DATA","R07.9","E11.9","R77.8","I21.4","F17.210","Z86.39","R11.2","E03.9","E03.2","G62.9","F17.200","E53.8","R53.83","J01.90","R10.2","E78.5","Z86.79","Z82.49","Z86.59","Z87.19","J06.9","R05.","R73.03","R74.8","J34.89","F32.1","K76.0","Z91.14","R79.81","G56.00","R39.9","R32.","R10.84","Z72.0"],"date":["2022-05-28","2022-05-30","2022-05-30","2023-05-19","2023-02-02","2022-05-30","2022-05-30","2021-04-24","2021-06-16","2023-05-19","2021-04-24","2021-04-25","2021-04-24","2021-04-24","2022-05-30","2021-04-24","2023-09-19","2023-05-19","2022-09-22","2022-09-22","2022-09-22","2022-09-22","2023-05-19","2023-05-19","2023-03-08","2023-03-08","2022-05-28","2022-05-30","2022-05-30","2022-05-30","2022-05-30","2022-05-30","2022-05-30","2022-05-30","2022-05-30","2022-05-30","2022-05-30","2022-11-10","2023-05-19","2023-05-19","2022-05-28","2022-05-30","2022-05-28","2022-05-28","2022-05-28","2022-05-28","2021-10-22","2021-02-24","2021-10-22","2021-04-25","2023-02-02","2022-03-22","2022-05-30","2022-05-30","2022-06-22","2022-06-22","2021-10-22","2021-10-22","2022-05-28","2022-05-28"],"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":[["","16729045117","LEVOTHYROXIN TAB","100MCG","90","Select","Select",""],["","50228010705","METFORMIN TAB","1000MG","180","Select","Select",""],["","65862052305","GABAPENTIN TAB","600MG","90","Select","Select",""],["","50111045002","TRAZODONE TAB","150MG","90","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","16729031801","OXYBUTYNIN TAB","10MG ER","30","Select","Select",""],["","16729021816","CLOPIDOGREL TAB","75MG","90","Select","Select",""],["","56151014701","TRUPLUS LANC MIS","33G","100","Select","Select",""],["","69097094705","ATORVASTATIN TAB","80MG","90","Select","Select",""],["","66993001968","ALBUTEROL AER HFA","","18","Select","Select",""],["","68180051201","LISINOPRIL TAB","2.5MG","90","Select","Select",""],["","00172572960","FAMOTIDINE TAB","40MG","90","Select","Select",""],["","69680011225","CYANOCOBALAM INJ","1000MCG","1","Select","Select",""],["","56151146304","TRUE METRIX TES GLUCOSE","","50","Select","Select",""],["","60505082901","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","36800046768","ASPIRIN LOW CHW","81MG","30","Select","Select",""],["","00093227534","AMOX\/K CLAV TAB","875-125","14","Select","Select",""],["","65862001305","SERTRALINE TAB","100MG","180","Select","Select",""],["","16729043315","EZETIMIBE TAB","10MG","90","Select","Select",""],["","65162052111","PROMETHAZINE TAB","25MG","48","Select","Select",""],["","00597007541","SPIRIVA CAP HANDIHLR","","30","Select","Select",""],["","70756021590","FENOFIBRATE TAB","160MG","30","Select","Select",""],["","00169413212","OZEMPIC INJ","2\/1.5ML","2","Select","Select",""],["","53885027150","ONETOUCH TES VERIO","","50","Select","Select",""],["","16729053308","DODEX INJ","","1","Select","Select",""],["","29300014701","QUETIAPINE TAB","25MG","90","Select","Select",""],["","00904052360","VITAMIN C TAB","500MG","30","Select","Select",""],["","29300014701","QUETIAPINE FUMARATE","25 MG","30","Select","Select",""],["","53885000810","ONETOUCH DELICA PLUS LANCET","33 GAUGE","100","Select","Select",""],["","69680011225","CYANOCOBALAMIN INJECTION","1000MCG\/ML","1","Select","Select",""],["","16729021716","SERTRALINE HCL","100 MG","180","Select","Select",""],["","67877051490","ATORVASTATIN CALCIUM","80 MG","90","Select","Select",""],["","53885027150","ONETOUCH VERIO TEST STRIP","","50","Select","Select",""],["","65862052305","GABAPENTIN","600 MG","90","Select","Select",""],["","00597007541","SPIRIVA HANDIHALER","18 MCG","30","Select","Select",""],["","72578005518","DOXYCYCLINE HYCLATE","100 MG","20","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","90 MCG","18","Select","Select",""],["","68180051201","LISINOPRIL","2.5 MG","90","Select","Select",""],["","50228010705","METFORMIN HCL","1000 MG","180","Select","Select",""],["","53746052101","PROMETHAZINE HCL","25 MG","48","Select","Select",""],["","55111019605","CLOPIDOGREL","75 MG","90","Select","Select",""],["","00169418113","OZEMPIC .","25 OR 0.5","9","Select","Select",""],["","16729045117","LEVOTHYROXINE SODIUM","100 MCG","90","Select","Select",""],["","16729031801","OXYBUTYNIN CHLORIDE ER","10 MG","90","Select","Select",""],["","60505403301","ICOSAPENT ETHYL","1 G","120","Select","Select",""],["","16729043315","EZETIMIBE","10 MG","90","Select","Select",""],["","00172572960","FAMOTIDINE","40 MG","90","Select","Select",""],["","53885004401","ONETOUCH VERIO FLEX METER","","1","Select","Select",""],["","00904052360","VITAMIN C","500 MG","90","Select","Select",""],["","00002143380","TRULICITY","0.75MG\/0.5","2","Select","Select",""],["","45802011222","MUPIROCIN","2 %","22","Select","Select",""],["","70756021590","FENOFIBRATE","160 MG","90","Select","Select",""],["","70010006510","METFORMIN","TAB 1000MG","60","Select","Select",""],["","00527328443","LEVOTHYROXIN","TAB 100MCG","30","Select","Select",""],["","50111045002","TRAZODONE","TAB 150MG","90","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","16729031801","OXYBUTYNIN","TAB 10MG ER","30","Select","Select",""],["","65862001305","SERTRALINE","TAB 100MG","180","Select","Select",""],["","00143962101","CYANOCOBALAM","INJ 1000MCG","1","Select","Select",""],["","65162052111","PROMETHAZINE","TAB 25MG","48","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","36800046768","ASPIRIN LOW","CHW 81MG","30","Select","Select",""],["","56151014701","TRUPLUS LANC","MIS 33G","100","Select","Select",""],["","69097094705","ATORVASTATIN","TAB 80MG","30","Select","Select",""],["","56151146304","TRUE METRIX","TES GLUCOSE","50","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","00093227534","AMOX\/K CLAV","TAB 875-125","14","Select","Select",""],["","00169413212","OZEMPIC","INJ 2\/1.5ML","2","Select","Select",""],["","53885027150","ONETOUCH","TES VERIO","50","Select","Select",""],["","16729053308","DODEX","INJ ","1","Select","Select",""],["","29300014701","QUETIAPINE","TAB 25MG","90","Select","Select",""],["","36800046768","ASPIRIN","81 MG","30","Select","Select",""],["","08290320119","ULTRA-FINE MINI PEN NEEDLE","31 GX3\/16\"","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":""}]}]}