{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LUCINA  R GALIMORE","gend":1,"add":"7474 BREEZEWOOD LN","city":"RUTHER GLEN","state":"VA","zip":"22546-9998","dob":"1981-09-16","age":"","mstatus":"","insh":"20059402*01","cliId":"","pno":8042381715,"cno":8042381715,"email":"","ename":"","eno":"","pphy":"FALCAO, RAQUEL APPA MD","ppno":8047641253,"pcpadd":"8200 MEADOWBRIDGE ROAD","pcpcity":"MECHANICSVILLE","pcpstate":"VA","pcpzip":"23116-9998","pcpcounty":"","pcpid":"","pcpname":"Memorial Medical Center","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8047641259,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01.411","Z11.51","Z11.3","I10.","F41.8","Z72.0","E13.43","K59.04","D06.0","R73.09","Z23.","D06.9","L02.419","E10.21","Z68.23","S16.1XXA","S20.212A","E11.65","NO DATA","Z79.4","R07.9","G43.909","E11.9","N17.9","R94.31","Z20.822","R11.2","R05.9","Z53.21","R10.84","N18.1","R03.0","E08.65","D72.829","E10.65","N76.0","B96.89","D06.7","Z32.02","A41.9","R65.20","J18.9","E87.5","E86.0","F17.210","I12.9","I49.3","R07.89","E10.3511","E10.3592","H35.82","J20.9","N18.2","R87.613","R92.8","K59.09","E10.22","L02.92","Z12.31","F32.9","Z56.0","N17.8","N18.4","E10.10","L97.512","M86.9","E11.42","L03.031","R10.9","R19.7","K85.90","N28.9","R11.10","E78.5","Z79.899","Z87.891","R53.1","M54.9","E11.22","N18.9","I25.10","M86.171","I20.0","R80.9","I15.2","R80.8","E55.9","E10.3553","H35.62","E10.319","I49.8","M79.89","M86.071","I48.91","I26.99","R22.43","Z04.9","E10.43","E10.69","I95.89","K31.84","E78.2","F41.1","I82.409","D64.9","Z68.22","F41.9","R87.619","R87.810","Z11.52","N87.9","Z71.89","Z01.812","K92.1","L03.115","E11.43","R74.8","F17.200","R10.817","R73.9","R11.0","F43.23","E10.649","E87.1","Z09.","R05.1","N28.1","K59.00","Z68.24","E11.628","L08.9","R06.02","I49.1","G44.89","J40.","R09.89","M86.471","S98.111A","R60.0","M79.674","F33.1","E10.42","B95.1","E10.621","L97.519","D63.1","J45.909"],"date":["2021-02-09","2021-02-09","2021-02-09","2023-02-06","2021-02-09","2023-02-17","2021-08-30","2021-08-30","2021-10-04","2021-10-04","2022-11-16","2021-10-04","2021-10-06","2023-01-16","2021-10-06","2022-02-02","2022-02-02","2023-03-15","2023-04-18","2023-04-06","2022-06-16","2022-05-18","2023-01-09","2023-02-10","2022-05-15","2023-01-12","2023-02-10","2022-06-13","2022-06-13","2022-06-13","2022-06-14","2022-06-14","2022-06-14","2022-06-14","2023-04-18","2022-10-06","2022-10-06","2022-10-06","2022-10-06","2023-01-16","2023-01-16","2023-01-20","2023-02-10","2023-01-13","2023-03-14","2023-03-16","2021-04-08","2022-06-16","2021-06-28","2021-06-28","2021-06-28","2021-09-27","2021-09-27","2021-09-27","2021-09-27","2021-09-27","2023-03-14","2021-09-27","2021-09-27","2022-09-16","2022-09-16","2023-02-10","2023-02-10","2023-02-10","2023-03-13","2023-03-13","2023-04-06","2023-03-13","2023-02-10","2023-02-10","2021-11-19","2021-11-19","2021-11-19","2023-01-13","2022-06-17","2021-11-19","2022-06-14","2022-06-16","2022-06-16","2023-03-16","2023-02-09","2023-03-28","2022-05-17","2022-08-01","2022-11-16","2022-11-16","2022-11-16","2022-06-10","2022-06-10","2023-02-17","2023-02-06","2023-03-05","2023-03-15","2023-03-16","2022-11-01","2022-05-16","2022-06-16","2023-03-14","2023-03-14","2022-06-17","2023-03-14","2022-06-17","2023-02-17","2022-09-29","2022-09-29","2022-09-29","2021-03-03","2021-05-17","2021-05-17","2021-07-27","2021-08-02","2021-08-02","2021-11-08","2022-06-16","2023-03-16","2022-06-14","2022-06-14","2023-02-06","2022-06-14","2022-06-14","2023-04-18","2022-11-14","2023-01-13","2023-01-13","2023-02-17","2023-01-20","2023-02-06","2023-02-06","2023-02-17","2023-03-28","2023-03-28","2022-06-13","2022-06-13","2022-06-13","2023-01-09","2023-04-18","2023-03-16","2023-04-06","2023-03-04","2023-03-16","2023-04-18","2023-03-14","2023-03-14","2023-03-14","2023-03-14","2023-03-14","2023-03-14"],"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":[["","08627005303","DEXCOM G6","MIS SENSOR","3","Select","Select",""],["","51672529701","PROMETHAZINE","SUP 25MG","12","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","15","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","15","Select","Select",""],["","13668000905","CITALOPRAM","TAB 10MG","90","Select","Select",""],["","57599080000","FREESTY LIBR","KIT 2 SENSOR","2","Select","Select",""],["","63304082905","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","00172392670","DIAZEPAM","TAB 5MG","3","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","0","COMPOUND"," ","100","Select","Select",""],["","70710113908","FLUCONAZOLE","150 MG","1","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","16","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","63304069205","CLINDAMYCIN","CAP 150MG","21","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","43386009019","GAVILYTE-G","SOL ","4000","Select","Select",""],["","68180098103","LISINOPRIL","TAB 20MG","90","Select","Select",""],["","65862064169","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00169266015","TRESIBA FLEX","INJ 100UNIT","15","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","43386006019","GAVILYTE-C","SOL ","4000","Select","Select",""],["","08290320550","BD PEN NEEDL","MIS 32GX5\/32","100","Select","Select",""],["","00574722612","COMPRO","SUP 25MG","6","Select","Select",""],["","99073013001","FREESTYLE","MIS LANCETS","100","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","20","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","9","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","10","Select","Select",""],["","52268020101","SUTAB","TAB ","24","Select","Select",""],["","00143122701","DICYCLOMINE","TAB 20MG","20","Select","Select",""],["","00003089421","ELIQUIS","5 MG","60","Select","Select",""],["","00536589588","NICOTINE TD","DIS 14MG\/24H","14","Select","Select",""],["","76385011250","CARVEDILOL","12.5 MG","120","Select","Select",""],["","00093220305","METOCLOPRAM","TAB 10MG","15","Select","Select",""],["","00003376474","ELIQUIS ST P","TAB 5MG","74","Select","Select",""],["","65162006205","SUCRALFATE","SUS 1GM\/10ML","414","Select","Select",""],["","71093014005","METHOCARBAM","TAB 500MG","42","Select","Select",""],["","69452015120","VITAMIN D","2 1250 MCG","5","Select","Select",""],["","13668042905","PANTOPRAZOLE","TAB 40MG","20","Select","Select",""],["","69097081312","GABAPENTIN","100 MG","90","Select","Select",""],["","27241009903","DULOXETINE","CAP 60MG","90","Select","Select",""],["","80681016800","VITAMIN D3","TAB 25MCG","30","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","53436008404","VELTASSA","POW 8.4GM","12","Select","Select",""],["","00169266015","TRESIBA FLEXTOUCH U-","100 100\/ML (3)","15","Select","Select",""],["","53489011905","DOXYCYCLINE HYCLATE","100 MG","14","Select","Select",""],["","69452020720","CALCITRIOL","0.25 MCG","7","Select","Select",""],["","57896076315","CALCIUM CARBONATE","200(500)MG","45","Select","Select",""],["","62542030103","HYDROCODONE-CHLORPHENIRAMNE ER","10-8MG\/5ML","70","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","59746000103","METHYLPREDNISOLONE","4 MG","21","Select","Select",""],["","42806071501","BENZONATATE","200 MG","20","Select","Select",""],["","42858010201","OXYCODONE-ACETAMINOPHEN","5 MG-325MG","20","Select","Select",""],["","73070040315","INSULIN DEGLUDEC PEN (U-","100) 100\/ML (3)","10","Select","Select",""],["","00169633910","NOVOLOG FLEXPEN","100\/ML (3)","15","Select","Select",""],["","70377002911","ATORVASTATIN CALCIUM","40 MG","90","Select","Select",""],["","65862050320","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","10","Select","Select",""],["","65862039010","ONDANSETRON ODT","4 MG","30","Select","Select",""],["","27241009903","DULOXETINE HCL","60 MG","30","Select","Select",""],["","10702005601","OXYCODONE HCL","10 MG","15","Select","Select",""],["","70954006020","PREDNISONE","20 MG","10","Select","Select",""],["","68180072103","AMLODIPINE BESYLATE","10 MG","90","Select","Select",""],["","65862002106","MIRTAZAPINE","15 MG","30","Select","Select",""],["","57599080000","FREESTYLE LIBRE","2 SENSOR","2","Select","Select",""],["","99073070805","FREESTYLE LITE METER","","1","Select","Select",""],["","99073070827","FREESTYLE LITE TEST STRIP","","100","Select","Select",""],["","99073013001","FREESTYLE LANCETS","28 GAUGE","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":""}]}]}