{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KIRA WOOTON","gend":1,"add":"5914 SEMINARY ROAD","city":"FALLS CHURCH","state":"VA","zip":"22041-9998","dob":"1955-02-09","age":"","mstatus":"","insh":"20064973*01","cliId":"","pno":7035368902,"cno":7035368902,"email":"","ename":"","eno":"","pphy":"WISMAN, ERIN MD","ppno":7032373446,"pcpadd":"8221 WILLOW OAKS CORPORATE DR STE 4,","pcpcity":"FAIRFAX","pcpstate":"VA","pcpzip":"22031-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7032243629,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","F10.20","F33.2","V62.84","Z59.0","Z20.822","F10.929","F43.20","F32.2","F17.200","I10.","R56.9","Z74.3","J44.1","W19.XXXA","N39.0","F10.99","F10.230","F33.9","F11.23","F17.210","F43.12","F11.10","J44.9","E87.6","G40.909","Z91.14","V58.69","Z91.120","Z91.128","Z91.51","Z56.0","F10.239","F10.10","Z76.0","NO DATA","F41.9","G40.89","R94.31","I50.30","F10.129","F15.99","F14.23","F31.32","F90.2","F33.1","F39.","F43.10","F14.20","F20.9","F42.2","F12.10","F11.21","Z59.00","Z23.","R74.01","F11.229","I95.1","E43.","Z68.1","F10.229","Z63.4","F43.23","Z79.899","G40.A09","F33.41","Z59.01","Z66.","Z81.1","Z81.3","Z91.19","R53.1","Z00.8","T50.901A","Z91.89","F17.290","F11.90","R68.89","R03.0","F23.","R00.0","D75.1","F32.9","Z71.89","Z71.41","F43.21","T14.91XA","Z62.820","F14.21","F10.21","B19.20","R51.9","R25.1"],"date":["2023-04-04","2023-04-04","2023-04-04","2023-05-22","2021-09-28","2023-02-21","2022-07-19","2022-07-30","2023-05-30","2023-02-25","2023-05-30","2023-05-30","2023-05-19","2022-08-28","2022-08-28","2022-08-28","2022-08-28","2022-09-11","2023-03-28","2022-09-30","2023-05-22","2022-09-11","2023-05-19","2022-09-11","2022-09-11","2023-04-04","2022-09-11","2022-09-11","2022-09-11","2022-09-11","2022-09-14","2022-09-11","2023-05-22","2023-02-21","2022-09-26","2023-05-30","2023-05-22","2022-09-30","2023-02-21","2022-08-08","2023-02-21","2021-06-08","2021-06-08","2021-06-08","2023-03-28","2023-05-22","2021-08-03","2023-03-28","2021-08-03","2021-08-03","2021-08-03","2021-08-03","2023-05-22","2023-02-27","2022-03-01","2022-07-30","2022-08-08","2022-08-14","2022-07-31","2022-07-31","2022-07-31","2022-08-25","2022-07-31","2022-08-25","2022-08-25","2022-08-25","2022-08-25","2022-08-25","2022-08-25","2022-08-25","2022-08-25","2022-09-11","2023-05-19","2022-09-11","2022-09-14","2022-09-27","2023-02-25","2023-02-25","2022-09-30","2022-09-26","2022-09-26","2021-10-04","2023-03-28","2022-07-23","2022-07-23","2023-03-28","2023-03-28","2023-03-28","2023-03-28","2023-03-28","2023-03-28","2023-05-19","2023-05-19"],"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":[["","12496120803","SUBOXONE","8 MG-2 MG","30","Select","Select",""],["","70954001910","PRAZOSIN HCL","1 MG","14","Select","Select",""],["","69547035302","NARCAN","4 MG","2","Select","Select",""],["","68180097903","LISINOPRIL","40 MG","30","Select","Select",""],["","14539067405","HYDROXYZ PAM","CAP 25MG","28","Select","Select",""],["","23155002405","BUSPIRONE","TAB 10MG","28","Select","Select",""],["","65862001205","SERTRALINE","TAB 50MG","21","Select","Select",""],["","00781717612","NALOXONE","SPR 4MG","2","Select","Select",""],["","51991081801","PROPRANOLOL","CAP 80MG ER","30","Select","Select",""],["","68382080701","TRAZODONE","TAB 150MG","15","Select","Select",""],["","65862069201","PHENYTOIN EX","CAP 100MG","90","Select","Select",""],["","43598044874","NICOTINE TD","DIS 21MG\/24H","21","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","43598058230","BUPREN\/NALOX","MIS 8-2MG","7","Select","Select",""],["","16729018201","HYDROCHLOROT","TAB 12.5MG","30","Select","Select",""],["","80681009800","VITAMIN B-1","TAB 100MG","30","Select","Select",""],["","00173085910","BREO ELLIPTA","100-25MCG","60","Select","Select",""],["","00378827093","ALBUTEROL","NEB 0.00083","90","Select","Select",""],["","00536354710","DAILY-VITE","TAB ","30","Select","Select",""],["","53746036110","FOLIC ACID","1 MG","14","Select","Select",""],["","00173069500","ADVAIR DISKU","AER 100\/50","60","Select","Select",""],["","00603533828","PREDNISONE","TAB 10MG","30","Select","Select",""],["","65862018730","ONDANSETRON","TAB 4MG","6","Select","Select",""],["","00781717612","NALOXONE HCL","4 MG","2","Select","Select",""],["","51672404102","CARBAMAZEPIN","CHW 100MG","90","Select","Select",""],["","12496030001","SUBLOCADE","300 MG\/1.5","1.5","Select","Select",""],["","70677003001","NICOTINE PATCH","7MG\/24HR","14","Select","Select",""],["","68462043518","ACAMPROSATE CALCIUM","333 MG","180","Select","Select",""],["","00093342610","LORAZEPAM","1 MG","20","Select","Select",""],["","45963053930","ONDANSETRON HCL","8 MG","30","Select","Select",""],["","00603020922","MAGNESIUM OXIDE","400 MG","14","Select","Select",""],["","16714043901","NITROFURANTOIN MONO-MACRO","100 MG","14","Select","Select",""],["","67877019810","AMLODIPINE BESYLATE","5 MG","30","Select","Select",""],["","50111045001","TRAZODONE HCL","150 MG","30","Select","Select",""],["","23155050201","HYDROXYZINE HCL","50 MG","120","Select","Select",""],["","00185067405","HYDROXYZINE PAMOATE","25 MG","20","Select","Select",""],["","57896050101","ONE-DAILY MULTI-VITAMIN","","30","Select","Select",""],["","57896085101","VITAMIN B-","1 100 MG","30","Select","Select",""],["","00173069600","ADVAIR DISKUS","250-50 MCG","60","Select","Select",""],["","16571066701","PHENOBARBITAL","64.8 MG","3","Select","Select",""],["","66993058597","FLUTICASONE-SALMETEROL","250-50 MCG","60","Select","Select",""],["","59746038306","TERAZOSIN HCL","1 MG","30","Select","Select",""],["","43598058230","BUPRENORPHINE-NALOXONE","8 MG-2 MG","30","Select","Select",""],["","13107003134","MIRTAZAPINE","15 MG","14","Select","Select",""],["","00378110110","PRAZOSIN HCL CAP","1MG","14","Select","Select",""],["","12496120803","SUBOXONE MIS","8-2MG","28","Select","Select",""],["","00185067405","HYDROXYZ PAM CAP","25MG","28","Select","Select",""],["","65862001305","SERTRALINE TAB","100MG","14","Select","Select",""],["","23155002405","BUSPIRONE TAB","10MG","28","Select","Select",""],["","00781717612","NALOXONE SPR","4MG","2","Select","Select",""],["","68180098103","LISINOPRIL TAB","20MG","60","Select","Select",""],["","51991081801","PROPRANOLOL CAP","80MG ER","30","Select","Select",""],["","68382080701","TRAZODONE TAB","150MG","15","Select","Select",""],["","65162041503","BUPREN\/NALOX SUB","8-2MG","7","Select","Select",""],["","43598044874","NICOTINE TD DIS","21MG\/24H","21","Select","Select",""],["","00173069500","ADVAIR DISKU AER","100\/50","60","Select","Select",""],["","00173085910","BREO ELLIPTA INH","100-25","60","Select","Select",""],["","51672411101","PHENYTOIN EX CAP","100MG","90","Select","Select",""],["","51672404102","CARBAMAZEPIN CHW","100MG","90","Select","Select",""],["","00536354710","DAILY-VITE TAB","","30","Select","Select",""],["","76204020025","ALBUTEROL NEB","0.083%","75","Select","Select",""],["","43598058230","BUPREN\/NALOX MIS","8-2MG","7","Select","Select",""],["","16729018201","HYDROCHLOROT TAB","12.5MG","30","Select","Select",""],["","66993001968","ALBUTEROL AER HFA","","18","Select","Select",""],["","58657015110","FOLIC ACID TAB","1MG","30","Select","Select",""],["","00603533828","PREDNISONE TAB","10MG","30","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","65862018730","ONDANSETRON TAB","4MG","6","Select","Select",""],["","45802081184","NALOXONE HCL SPR","4MG","2","Select","Select",""],["","12496030001","SUBLOCADE INJ","300\/1.5","2","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":""}]}]}