{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KELLY KEGLEY","gend":1,"add":"608 TWIN ROAD","city":"DOLPHIN","state":"VA","zip":"23843-9998","dob":"1966-06-29","age":"","mstatus":"","insh":"20059787*01","cliId":"","pno":4348484844,"cno":4348484844,"email":"","ename":"","eno":"","pphy":"ACKERMAN, CHRISTOPHER J MD","ppno":4348480771,"pcpadd":"203 SHARP ST,","pcpcity":"LAWRENCEVILLE","pcpstate":"VA","pcpzip":"23868-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4348483814,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["V58.89","F33.2","Z87.891","R45.89","R10.84","Z20.822","T50.902A","F19.10","I35.0","R07.89","R07.9","G89.29","F11.90","F41.9","R11.2","R19.7","I25.10","I10.","R06.02","R30.0","R45.0","R10.13","R10.9","Z79.891","Z98.890","E43.","NO DATA","J44.9","Z68.1","E78.5","F17.210","R10.2","K21.9","G89.4","Z79.82","Z90.49","Z90.710","R00.2","E86.0","K52.9","N39.0","R94.31","K58.1","R11.0","R10.30","K80.50","K83.8","K85.90","K85.11","K59.00","F41.0","N94.89","K80.51","R62.7","F43.10","R63.4","E87.8","V62.84","F11.10","F13.10","R01.1","N32.81","F33.9","E44.0","F42.9","K59.09","J43.8","K80.80","R10.33","R74.8","G43.D0","Z79.899","M54.9","G43.711","G43.909","I25.9","R35.0","R39.15","N39.9","R05.9","K29.70","G43.A1","R74.01","K80.21","K58.9","K64.8","I49.8","Z90.89","I51.7","K80.70","R11.10","I49.1","I49.3","Z81.1","Z80.9","Z82.49","E78.00","I47.0","M51.36","M53.3","Z71.3","Z71.2"],"date":["2022-12-21","2022-12-28","2023-02-12","2022-12-21","2023-05-25","2023-02-21","2022-12-21","2022-12-28","2023-03-25","2023-02-02","2023-02-12","2023-05-25","2023-02-12","2023-03-28","2023-04-07","2023-02-12","2023-02-12","2023-03-28","2023-02-14","2023-02-12","2023-02-12","2023-02-12","2023-03-17","2023-05-25","2023-02-19","2023-02-21","2023-03-28","2023-03-28","2023-03-28","2023-02-21","2023-03-28","2023-05-25","2023-03-28","2023-02-21","2023-02-21","2023-02-21","2023-03-28","2023-04-28","2023-02-15","2022-08-19","2022-06-15","2022-04-28","2022-09-12","2023-03-31","2022-08-16","2022-06-21","2022-06-21","2023-04-07","2022-06-30","2023-04-21","2023-03-28","2022-08-25","2022-06-27","2022-06-27","2022-08-20","2023-01-27","2022-08-07","2022-12-22","2022-12-22","2022-12-22","2023-01-18","2023-03-28","2022-12-22","2023-03-28","2022-08-20","2022-03-03","2022-05-27","2022-06-12","2022-08-10","2022-08-25","2022-08-25","2022-12-14","2022-08-25","2022-09-11","2022-09-12","2023-02-14","2022-02-14","2022-02-14","2022-05-11","2022-06-03","2022-06-15","2022-09-16","2022-03-30","2022-06-06","2022-06-06","2022-06-08","2022-06-15","2022-08-16","2022-03-03","2022-11-29","2023-03-31","2022-05-10","2022-05-10","2023-03-28","2023-03-28","2023-03-28","2023-03-28","2023-04-28","2023-05-25","2023-05-25","2022-12-27","2022-12-27"],"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":[["","00172572860","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","43547034703","PAROXETINE","TAB 10MG","30","Select","Select",""],["","00093220301","METOCLOPRAM","TAB 10MG","90","Select","Select",""],["","69367024324","HYDROCORT AC","SUP 25MG","10","Select","Select",""],["","65862015901","ZOLPIDEM","TAB 5MG","30","Select","Select",""],["","00527512570","LACTULOSE","SOL 10GM\/15","600","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","60","Select","Select",""],["","00228203110","ALPRAZOLAM","1 MG","90","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","20","Select","Select",""],["","43386009019","GAVILYTE-G","SOL ","4000","Select","Select",""],["","65162004710","OXYCODONE","TAB 5MG","30","Select","Select",""],["","62559015710","POLYETH GLYC","POW 3350 NF","30","Select","Select",""],["","00254302902","LUBIPROSTONE","24MCG","60","Select","Select",""],["","16571066501","METRONIDAZOL","TAB 250MG","15","Select","Select",""],["","00054062263","DICYCLOMINE","SOL 10MG\/5ML","1200","Select","Select",""],["","62135030901","CIPROFLOXACN","TAB 500MG","20","Select","Select",""],["","43598044674","NICOTINE TD","DIS 7MG\/24HR","28","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","65862018730","ONDANSETRON","TAB 4MG","120","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","65162068210","PHENAZOPYRID","TAB 200MG","6","Select","Select",""],["","11822165230","RA SENNA","TAB 8.6MG","30","Select","Select",""],["","00406324301","HYDROMORPHON","TAB 2MG","60","Select","Select",""],["","68462038630","SOLIFENACIN","TAB 5MG","30","Select","Select",""],["","00574705012","BISACODYL","SUP 10MG","15","Select","Select",""],["","00406051201","OXYCOD\/APAP","TAB 5-325MG","18","Select","Select",""],["","00469260230","MYRBETRIQ","TAB 50MG","30","Select","Select",""],["","82607066026","FLOWFLEX","KIT TEST","1","Select","Select",""],["","65162079108","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","59746017306","PREDNISONE","TAB 10MG","40","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","27241009903","DULOXETINE","CAP 60MG","30","Select","Select",""],["","70710116101","MECLIZINE","TAB 12.5MG","30","Select","Select",""],["","67877075460","DRONABINOL","5 MG","60","Select","Select",""],["","68382004101","PROMETHAZINE","TAB 25MG","20","Select","Select",""],["","00832027311","MORPHINE SUL","TAB 15MG","28","Select","Select",""],["","29033000301","SUCRALFATE","1 G","60","Select","Select",""],["","00093216568","NALOXONE HCL","SPR 4MG","2","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","30","Select","Select",""],["","00904699880","DOCUSATE SOD","CAP 100MG","30","Select","Select",""],["","00591555401","PROPRANOLOL","TAB 10MG","120","Select","Select",""],["","00093506101","HYDROXYZ HCL","TAB 25MG","30","Select","Select",""],["","51672400101","NORTRIPTYLIN","CAP 10MG","30","Select","Select",""],["","60219204301","DEXAMETHASON","TAB 4MG","2","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","15","Select","Select",""],["","00185067601","HYDROXYZ PAM","CAP 50MG","60","Select","Select",""],["","42043022109","SUMATRIPTAN","TAB 50MG","9","Select","Select",""],["","00832027311","MORPHINE SULFATE","15 MG","28","Select","Select",""],["","31722088390","ROSUVASTATIN CALCIUM","10 MG","90","Select","Select",""],["","68462038630","SOLIFENACIN SUCCINATE","5 MG","30","Select","Select",""],["","00591555401","PROPRANOLOL HCL","10 MG","120","Select","Select",""],["","65862018730","ONDANSETRON HCL","4 MG","120","Select","Select",""],["","67877024201","QUETIAPINE FUMARATE","25 MG","90","Select","Select",""],["","70710116201","MECLIZINE HCL","25 MG","30","Select","Select",""],["","31722071390","PANTOPRAZOLE SODIUM","40 MG","60","Select","Select",""],["","00904675180","ASPIRIN EC","81 MG","30","Select","Select",""],["","63304045101","MORPHINE SULFATE ER","30 MG","32","Select","Select",""],["","50383077504","LIDOCAINE HCL VISCOUS","2 %","100","Select","Select",""],["","00713052612","PROMETHEGAN","25 MG","12","Select","Select",""],["","00536105224","POLYETHYLENE GLYCOL","3350 17 G\/DOSE","238","Select","Select",""],["","68382004101","PROMETHAZINE HCL","25 MG","30","Select","Select",""],["","27241009903","DULOXETINE HCL","60 MG","30","Select","Select",""],["","70954040310","DEXAMETHASONE","4 MG","14","Select","Select",""],["","00115180401","HYDROXYZINE PAMOATE","50 MG","60","Select","Select",""],["","13107007901","TRAZODONE HCL","50 MG","30","Select","Select",""],["","31722071390","PANTOPRAZOLE TAB","40MG","60","Select","Select",""],["","00172572860","FAMOTIDINE TAB","20MG","60","Select","Select",""],["","65862015901","ZOLPIDEM TAB","5MG","30","Select","Select",""],["","00093220301","METOCLOPRAM TAB","10MG","90","Select","Select",""],["","00527512570","LACTULOSE SOL","10GM\/15","600","Select","Select",""],["","00228203110","ALPRAZOLAM TAB","1MG","90","Select","Select",""],["","00527128201","DICYCLOMINE TAB","20MG","90","Select","Select",""],["","82607066026","FLOWFLEX KIT TEST","","1","Select","Select",""],["","43547034703","PAROXETINE TAB","10MG","30","Select","Select",""],["","69367024324","HYDROCORT AC SUP","25MG","10","Select","Select",""],["","16571066501","METRONIDAZOL TAB","250MG","15","Select","Select",""],["","43386009019","GAVILYTE-G SOL","","4000","Select","Select",""],["","65162004710","OXYCODONE TAB","5MG","30","Select","Select",""],["","00093031401","KETOROLAC TAB","10MG","20","Select","Select",""],["","00254302902","LUBIPROSTONE CAP","24MCG","60","Select","Select",""],["","62559015710","POLYETH GLYC POW","3350 NF","30","Select","Select",""],["","68462038630","SOLIFENACIN TAB","5MG","30","Select","Select",""],["","43598044674","NICOTINE TD DIS","7MG\/24HR","28","Select","Select",""],["","00597007541","SPIRIVA CAP HANDIHLR","","30","Select","Select",""],["","68180096301","ALBUTEROL AER HFA","","8","Select","Select",""],["","00574705012","BISACODYL SUP","10MG","15","Select","Select",""],["","65862018730","ONDANSETRON TAB","4MG","60","Select","Select",""],["","62135030901","CIPROFLOXACN TAB","500MG","20","Select","Select",""],["","65162068210","PHENAZOPYRID TAB","200MG","6","Select","Select",""],["","00469260230","MYRBETRIQ TAB","50MG","30","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","00406051201","OXYCOD\/APAP TAB","5-325MG","18","Select","Select",""],["","67877075460","DRONABINOL CAP","5MG","60","Select","Select",""],["","00904699880","DOCUSATE SOD CAP","100MG","30","Select","Select",""],["","11822165230","RA SENNA TAB","8.6MG","30","Select","Select",""],["","00406324301","HYDROMORPHON TAB","2MG","30","Select","Select",""],["","65162079108","LIDOCAINE PAD","5%","30","Select","Select",""],["","70710116101","MECLIZINE TAB","12.5MG","30","Select","Select",""],["","31722017030","DULOXETINE CAP","60MG","15","Select","Select",""],["","68382004101","PROMETHAZINE TAB","25MG","20","Select","Select",""],["","59746017306","PREDNISONE TAB","10MG","40","Select","Select",""],["","00093216568","NALOXONE HCL SPR","4MG","2","Select","Select",""],["","63304045101","MORPHINE SUL TAB","30MG ER","60","Select","Select",""],["","60219204301","DEXAMETHASON TAB","4MG","2","Select","Select",""],["","00254101196","SUCRALFATE SUS","1GM\/10ML","1200","Select","Select",""],["","00591555401","PROPRANOLOL TAB","10MG","120","Select","Select",""],["","42043022109","SUMATRIPTAN TAB","50MG","9","Select","Select",""],["","00093506101","HYDROXYZ HCL TAB","25MG","30","Select","Select",""],["","55111018015","TIZANIDINE TAB","4MG","30","Select","Select",""],["","00054062263","DICYCLOMINE SOL","10MG\/5ML","1200","Select","Select",""],["","51672400101","NORTRIPTYLIN CAP","10MG","30","Select","Select",""],["","00185067601","HYDROXYZ PAM CAP","50MG","60","Select","Select",""],["","50111056001","TRAZODONE TAB","50MG","15","Select","Select",""],["","16714029802","AMOXICILLIN","250 MG","30","Select","Select",""],["","00406055201","OXYCODONE HCL","5 MG","28","Select","Select",""],["","00093083201","CLONAZEPAM","0.5 MG","60","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":""}]}]}