{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TEANDRA  L BURNS","gend":1,"add":"1007 MOSBY ST","city":"RICHMOND","state":"VA","zip":"23223-9998","dob":"1978-01-21","age":"","mstatus":"","insh":"20054468*01","cliId":"","pno":8043009733,"cno":8043009733,"email":"","ename":"","eno":"","pphy":"HARMAN, KELSEY NP","ppno":8046284327,"pcpadd":"417 N 11TH ST","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":"23298-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8048284670,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I11.0","I50.33","I25.10","R10.9","M79.605","M79.604","I42.9","J43.9","G43.909","Z20.822","Z95.5","M54.9","Z95.1","E87.70","M54.5","Z88.6","Z88.1","Z88.5","N61.1","I10.","J45.909","F41.8","E66.9","J40.","N64.59","N64.4","R13.10","R10.13","K22.6","K21.9","G47.33","F41.1","F32.9","F42.2","R05.","I50.9","F41.9","M25.561","M25.562","M17.12","I13.0","K86.1","K86.81","I16.0","NO DATA","N18.2","N28.9","Z79.82","Z79.899","I50.32","Z72.0","G89.29","R06.09","R51.9","E78.5","M17.0","F11.90","I42.2","G89.22","M47.816","N64.51","R06.02","Z04.9","F43.21","I42.1","E11.29","D64.9","I25.110","Z68.41","K58.9","M79.89","I51.7","R07.9","J44.9","M79.606","N17.9","Z88.2","R94.31","V58.89","F33.1","F17.200","T88.8XXS","I35.0","R07.89","J44.1","Q24.5","E66.2","J30.1","G62.9","Z79.51","G56.03","M19.049","N61.0","N64.89","Z48.817","Z98.890","R23.8","Z87.891","R06.00","I70.209","R60.0","F17.210","M79.641","M79.642","Z53.21","J45.901","M25.569","I50.30","R26.89","Z23.","Z48.89","I35.1","I25.709","N27.1","G56.01","G56.02","R68.83","I08.0","I70.0","M79.609","E66.01","Z87.898","R45.4","M19.041","M19.042","Z68.39","K31.89","R00.2","I25.111","I50.43","B37.9","R13.14"],"date":["2023-04-11","2023-04-11","2023-04-11","2021-09-19","2021-09-18","2021-09-18","2021-09-19","2021-09-19","2023-04-11","2023-01-24","2021-09-04","2021-09-11","2023-01-24","2021-09-18","2021-09-19","2021-09-15","2021-09-15","2021-09-18","2023-04-18","2023-03-27","2023-04-11","2023-04-06","2023-01-24","2022-05-28","2022-09-11","2023-03-27","2023-01-20","2023-04-11","2023-01-20","2023-01-24","2023-02-17","2023-04-04","2023-04-04","2023-04-04","2021-01-12","2023-04-13","2023-01-24","2022-01-27","2022-01-27","2021-01-19","2021-03-12","2023-01-24","2023-01-24","2021-03-01","2023-04-11","2021-03-12","2021-03-01","2021-10-04","2021-10-04","2021-09-01","2021-09-01","2023-04-18","2021-09-16","2021-11-15","2021-11-15","2022-04-18","2022-01-27","2022-01-27","2022-04-18","2022-04-18","2022-05-27","2022-05-27","2022-07-14","2022-07-14","2023-01-24","2023-01-24","2023-01-24","2023-01-24","2023-04-11","2023-01-24","2023-02-05","2023-01-24","2021-03-02","2021-09-17","2021-03-12","2021-03-11","2021-09-17","2023-01-24","2022-10-21","2023-01-16","2023-01-23","2023-03-20","2021-03-02","2021-03-08","2021-03-06","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2023-03-13","2022-06-07","2022-08-24","2022-10-21","2022-11-08","2022-11-08","2023-03-20","2023-03-20","2021-03-01","2021-03-04","2021-05-11","2023-02-17","2023-03-13","2023-03-13","2023-03-13","2021-03-11","2021-05-04","2023-01-24","2021-09-22","2022-10-12","2022-10-12","2023-01-24","2021-03-03","2021-09-17","2022-06-07","2022-06-07","2022-09-10","2023-02-08","2023-02-08","2021-03-01","2023-04-11","2021-09-17","2021-09-21","2022-06-07","2022-06-07","2022-09-19","2023-04-11","2023-04-19","2023-04-06","2023-04-06","2023-03-27","2023-04-11"],"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":[["","00228203110","ALPRAZOLAM","1 MG","45","Select","Select",""],["","67877022401","GABAPENTIN","400 MG","90","Select","Select",""],["","00527169501","BUT\/APAP\/CAF","TAB ","90","Select","Select",""],["","66993058697","FLUTIC\/SALME","AER 500\/50","60","Select","Select",""],["","55111072510","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","00071041824","NITROSTAT","SUB 0.4MG","100","Select","Select",""],["","10702000201","PROMETHAZINE","TAB 12.5MG","30","Select","Select",""],["","70954000530","OXYBUTYNIN","TAB 5MG","90","Select","Select",""],["","68462041820","LIDOCAINE","5 %","35.44","Select","Select",""],["","00032122401","CREON","24-76-120K","180","Select","Select",""],["","43598050990","ESOMEPRA MAG","CAP 20MG DR","60","Select","Select",""],["","49483048112","ASPIRIN LOW","TAB 81MG EC","30","Select","Select",""],["","59762106101","DIPHEN\/ATROP","TAB 2.5MG","240","Select","Select",""],["","00378004710","METOPROL TAR","TAB 100MG","180","Select","Select",""],["","00185013001","BUMETANIDE","2 MG","150","Select","Select",""],["","68382065105","ISOSORB MONO","TAB 60MG ER","120","Select","Select",""],["","31722052201","HYDRALAZINE","TAB 100MG","120","Select","Select",""],["","53489014310","SPIRONOLACT","TAB 25MG","30","Select","Select",""],["","00173069700","ADVAIR DISKU","AER 500\/50","60","Select","Select",""],["","76204060001","IPRATROPIUM\/","SOL ALBUTER","180","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","60505258008","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","57896010410","ACETAMINOPHE","TAB 325MG","120","Select","Select",""],["","00536589688","NICOTINE TD","DIS 21MG\/24H","28","Select","Select",""],["","00904672080","ACETAMIN","TAB 500MG","30","Select","Select",""],["","00781169510","ISOSORB DIN","TAB 20MG","240","Select","Select",""],["","00591544310","PREDNISONE","TAB 20MG","6","Select","Select",""],["","47335067181","DILTIAZEM","24HR ER 240 MG","60","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","90","Select","Select",""],["","16729017401","AMITRIPTYLIN","TAB 75MG","30","Select","Select",""],["","59762330403","NITROGLYCERN","SUB 0.4MG","100","Select","Select",""],["","00527128210","DICYCLOMINE","TAB 20MG","120","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","26","Select","Select",""],["","00093506105","HYDROXYZ HCL","TAB 25MG","120","Select","Select",""],["","62332046431","VITAMIN D","2 1250 MCG","12","Select","Select",""],["","00093005301","BUSPIRONE","TAB 5MG","90","Select","Select",""],["","53746036110","FOLIC ACID","1 MG","30","Select","Select",""],["","07610003220","VITAMIN B-2","TAB 100MG","90","Select","Select",""],["","00245010810","FERROUS SULF","TAB 325MG EC","90","Select","Select",""],["","11845006935","VITAMIN B-12","TAB 1000MCG","30","Select","Select",""],["","65862056099","PANTOPRAZOLE","TAB 40MG","60","Select","Select",""],["","68382014005","TOPIRAMATE","100 MG","90","Select","Select",""],["","00597015290","JARDIANCE","10 MG","90","Select","Select",""],["","37000074084","METAMUCIL","POW 58.6%ORG","425","Select","Select",""],["","12843053642","BAYER LOW","TAB 81MG EC","30","Select","Select",""],["","42858010401","OXYCOD\/APAP","TAB 10-325MG","30","Select","Select",""],["","37205066710","NATURL FIBER","POW 0.586","425","Select","Select",""],["","10702005601","OXYCODONE","TAB 10MG","10","Select","Select",""],["","00173068220","VENTOLIN HFA","90 MCG","18","Select","Select",""],["","65862050301","AMOX\/K CLAV","TAB 875-125","14","Select","Select",""],["","27808023302","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","45802095301","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","30","Select","Select",""],["","55111012701","CIPROFLOXACN","TAB 500MG","28","Select","Select",""],["","11845007141","B-2","TAB 100MG","30","Select","Select",""],["","00135019502","NICODERM CQ","DIS 14MG\/24H","14","Select","Select",""],["","00406324301","HYDROMORPHON","TAB 2MG","20","Select","Select",""],["","00168000730","NYSTATIN","OIN 100000","30","Select","Select",""],["","16103035611","ASPIRIN","TAB 81MG EC","30","Select","Select",""],["","00536117201","ACETAMINOPHEN","500 MG","30","Select","Select",""],["","69238110005","DOXYCYCLINE HYCLATE","100 MG","20","Select","Select",""],["","00591264001","BUTALBITAL-ACETAMINOPHEN-CAFFE","50-300-40","90","Select","Select",""],["","00378004710","METOPROLOL TARTRATE","100 MG","90","Select","Select",""],["","16103035611","ASPIRIN EC","81 MG","30","Select","Select",""],["","30768060693","B-","12 1000 MCG","30","Select","Select",""],["","70954000530","OXYBUTYNIN CHLORIDE","5 MG","90","Select","Select",""],["","60505258008","ATORVASTATIN CALCIUM","40 MG","30","Select","Select",""],["","68382004001","PROMETHAZINE HCL","12.5 MG","30","Select","Select",""],["","60687040583","IPRATROPIUM-ALBUTEROL","0.5-3MG\/3","180","Select","Select",""],["","16729017401","AMITRIPTYLINE HCL","75 MG","90","Select","Select",""],["","00591079501","DICYCLOMINE HCL","20 MG","120","Select","Select",""],["","55111014512","FLUCONAZOLE","150 MG","2","Select","Select",""],["","11845007141","VITAMIN B-","2 100 MG","90","Select","Select",""],["","59746000103","METHYLPREDNISOLONE","4 MG","21","Select","Select",""],["","00245010810","FERROUS SULFATE","325(65) MG","90","Select","Select",""],["","68180065208","DOXYCYCLINE MONOHYDRATE","100 MG","20","Select","Select",""],["","00173069700","ADVAIR DISKUS","500-50 MCG","60","Select","Select",""],["","49884002210","ISOSORBIDE DINITRATE","20 MG","240","Select","Select",""],["","31722072610","MONTELUKAST SODIUM","10 MG","30","Select","Select",""],["","59762106101","DIPHENOXYLATE-ATROPINE","2.5-.025MG","240","Select","Select",""],["","00093005301","BUSPIRONE HCL","5 MG","90","Select","Select",""],["","10702005601","OXYCODONE HCL","10 MG","10","Select","Select",""],["","00536589653","NICOTINE PATCH","21 MG\/24HR","28","Select","Select",""],["","59762330403","NITROGLYCERIN","0.4 MG","100","Select","Select",""],["","00597007541","SPIRIVA HANDIHALER","18 MCG","30","Select","Select",""],["","10702001150","HYDROXYZINE HCL","25 MG","120","Select","Select",""],["","53489014310","SPIRONOLACTONE","25 MG","30","Select","Select",""],["","43598050990","ESOMEPRAZOLE MAGNESIUM","20 MG","60","Select","Select",""],["","42571016201","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","28","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":""}]}]}