{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARY C VENEY","gend":1,"add":"127 TAYLOR ST","city":"BLACKSTONE","state":"VA","zip":"23824-9998","dob":"1966-04-03","age":"","mstatus":"","insh":"20058732*01","cliId":"","pno":8047614085,"cno":8047614085,"email":"","ename":"","eno":"","pphy":"YORK, LISA M MD","ppno":4342927261,"pcpadd":"213 N MAIN ST,","pcpcity":"BLACKSTONE","pcpstate":"VA","pcpzip":"23824-9998","pcpcounty":"","pcpid":"","pcpname":"Blackstone Family Practice Center","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4342927965,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N95.2","M25.561","R07.9","H54.61","Z86.73","R51.9","M77.11","I10.","G89.29","Z68.29","G43.909","F17.200","R53.1","M79.645","R58.","R29.810","R42.","R06.02","R10.9","K59.00","R94.31","Z68.30","G47.00","G43.119","N89.8","I25.10","E78.5","K83.8","I69.354","G40.909","K21.9","R93.5","Z95.5","M79.604","R05.9","R29.898","R20.0","G45.9","H53.8","R52.","W19.XXXA","I63.50","S76.912A","J45.20","I69.954","NO DATA","G60.8","Z82.5","Z87.09","Z80.9","Z79.02","Z88.6","I08.1","R10.11","Z20.822","I20.0","R94.39","I63.9","Z68.25","S82.61XA","S82.831A","S76.111A","E01.0","Z13.31","G45.3","Z79.899","E78.2","Z11.59","Z72.0","G47.33","F41.9","M54.81","R21.","E78.00","F17.210","Z12.31","R13.10","Z68.31","M54.41","H10.32","M54.5","G56.02","S61.012A","H35.3131","H25.13","H53.40","Z13.820","Z78.0","S40.022A","W23.0XXA","Y99.9","N76.0","R31.9","M47.899"],"date":["2021-02-20","2021-04-22","2022-12-29","2022-09-06","2023-03-17","2023-03-17","2022-06-24","2023-03-17","2023-08-25","2022-10-06","2022-08-21","2022-12-29","2022-12-29","2022-09-06","2022-10-10","2022-10-10","2023-01-11","2022-12-29","2022-12-29","2022-12-29","2022-12-30","2023-04-26","2023-02-01","2023-02-01","2021-02-17","2021-12-22","2021-12-22","2021-12-22","2021-12-21","2022-12-29","2023-04-26","2021-12-21","2021-12-21","2021-12-21","2021-12-21","2022-04-12","2022-02-18","2022-02-20","2022-02-20","2022-08-21","2022-08-21","2022-02-18","2022-04-12","2023-04-26","2022-12-29","2023-08-25","2022-12-29","2022-12-29","2022-12-29","2022-12-29","2022-12-29","2022-12-29","2022-12-30","2022-10-10","2021-12-21","2021-12-23","2021-12-23","2022-02-19","2022-02-19","2021-03-17","2021-03-17","2021-03-23","2022-10-06","2022-10-06","2022-11-10","2023-04-26","2022-10-06","2022-10-06","2023-03-17","2023-06-28","2023-02-21","2023-03-13","2023-06-19","2022-02-20","2022-02-20","2022-11-14","2023-03-17","2023-03-17","2023-07-26","2021-02-03","2021-09-15","2023-02-03","2021-04-22","2022-09-23","2022-11-10","2022-11-10","2023-04-26","2023-04-26","2023-06-27","2023-06-27","2023-06-27","2023-07-26","2023-07-26","2023-08-25"],"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":[["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","69367020305","BUT\/APAP\/CAF TAB","","15","Select","Select",""],["","55111019605","CLOPIDOGREL TAB","75MG","30","Select","Select",""],["","70377005511","ESOMEPRA MAG CAP","20MG DR","90","Select","Select",""],["","68180096301","ALBUTEROL AER HFA","","8","Select","Select",""],["","57896020110","PAIN RELIEF TAB","500MG","20","Select","Select",""],["","69097012715","AMLODIPINE TAB","5MG","90","Select","Select",""],["","51672411103","PHENYTOIN EX CAP","100MG","270","Select","Select",""],["","60505267108","ATORVASTATIN TAB","80MG","90","Select","Select",""],["","65862039110","ONDANSETRON TAB","8MG ODT","16","Select","Select",""],["","00173068220","VENTOLIN HFA AER","","18","Select","Select",""],["","45802016000","DICLOFENAC GEL","1%","100","Select","Select",""],["","29300034905","ALLOPURINOL TAB","100MG","30","Select","Select",""],["","51991096158","POLYETH GLYC POW","3350 NF","238","Select","Select",""],["","70010075401","METHOCARBAM TAB","500MG","30","Select","Select",""],["","16729018317","HYDROCHLOROT TAB","25MG","90","Select","Select",""],["","43598044674","NICOTINE TD DIS","7MG\/24HR","28","Select","Select",""],["","76204020025","ALBUTEROL NEB","0.083%","75","Select","Select",""],["","68180051902","LISINOP\/HCTZ TAB","20-12.5","30","Select","Select",""],["","43547028010","ESCITALOPRAM TAB","5MG","30","Select","Select",""],["","69367020301","BUTALBITAL-ACETAMINOPHEN-CAFFE","50-325-40","20","Select","Select",""],["","31722053301","METHOCARBAMOL","500 MG","90","Select","Select",""],["","68180096301","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","00093081101","NORTRIPTYLINE HCL","25 MG","90","Select","Select",""],["","69097052444","DICLOFENAC SODIUM","1 %","100","Select","Select",""],["","43598050930","ESOMEPRAZOLE MAGNESIUM","20 MG","60","Select","Select",""],["","68180051902","LISINOPRIL-HYDROCHLOROTHIAZIDE","20-12.5 MG","30","Select","Select",""],["","50228018010","GABAPENTIN","300 MG","90","Select","Select",""],["","55111019605","CLOPIDOGREL","75 MG","30","Select","Select",""],["","13668013501","ESCITALOPRAM OXALATE","5 MG","30","Select","Select",""],["","42806040021","METHYLPREDNISOLONE","4 MG","21","Select","Select",""],["","70710168400","FAMOTIDINE","40 MG","30","Select","Select",""],["","00713022880","TRIAMCINOLONE ACETONIDE","0.1 %","80","Select","Select",""],["","65162044211","MECLIZINE HCL","25 MG","30","Select","Select",""],["","43598044674","NICOTINE PATCH","7MG\/24HR","28","Select","Select",""],["","00378827052","ALBUTEROL SULFATE","2.5 MG\/3ML","75","Select","Select",""],["","00093101042","MUPIROCIN","2 %","22","Select","Select",""],["","51672127502","CLOTRIMAZOLE","1 %","60","Select","Select",""],["","29300022705","METRONIDAZOLE","500 MG","14","Select","Select",""],["","67877021905","CEPHALEXIN","500 MG","6","Select","Select",""],["","69097012715","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","51672411103","PHENYTOIN EX","CAP 100MG","270","Select","Select",""],["","42571017410","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","43598050930","ESOMEPRA MAG","CAP 20MG DR","20","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","57896020110","PAIN RELIEF","TAB 500MG","20","Select","Select",""],["","69367020305","BUT\/APAP\/CAF","TAB ","20","Select","Select",""],["","65862039110","ONDANSETRON","TAB 8MG ODT","16","Select","Select",""],["","29300034905","ALLOPURINOL","TAB 100MG","30","Select","Select",""],["","45802016000","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","51991096158","POLYETH GLYC","POW 3350 NF","238","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","30","Select","Select",""],["","00173068220","VENTOLIN HFA","AER ","18","Select","Select",""],["","43598044674","NICOTINE TD","DIS 7MG\/24HR","28","Select","Select",""],["","16729018317","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","68180051902","LISINOP\/HCTZ","TAB 20-12.5","30","Select","Select",""],["","43547028010","ESCITALOPRAM","TAB 5MG","30","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":""}]}]}