{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LEINE HOLLAND","gend":1,"add":"PO BOX 3053","city":"MARTINSVILLE","state":"VA","zip":"24115-9998","dob":"1987-02-26","age":"","mstatus":"","insh":"20071840*01","cliId":"","pno":2763408196,"cno":2763408196,"email":"","ename":"","eno":"","pphy":"AARON, CAREN MD","ppno":2766660452,"pcpadd":"SUITE 202 319 HOSPITAL DRIVE","pcpcity":"MARTINSVILLE","pcpstate":"VA","pcpzip":"24112-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":2766660363,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.32","F31.9","F41.9","F20.9","G44.229","F39.","M54.2","M54.6","E78.5","E83.42","F31.4","O60.14X0","O34.219","O99.324","O98.52","O99.345","O99.214","Z37.0","Z3A.27","F14.10","F32.9","E66.9","Z39.2","NO DATA","Z88.0","Z88.1","Z88.8","F14.20","F10.21","Z20.822","G43.909","K80.10","K21.9","I10.","Z68.34","O32.1XX0","F14.90","O99.344","F29.","O99.02","D64.9","D72.829","K59.00","O09.513","F31.60","J06.9","O99.03","Z39.1","H04.123","H52.223","M54.9","K80.00","R93.2","Z53.21","O42.012","O34.211","Z98.891","Z00.00","A60.9","Z76.0","M79.673","M79.669","E55.9","E87.6","F41.8","Z68.37","Z11.3","R10.9","B37.3","Z20.2","Z32.02","K80.80","R52.","Z01.419","Z12.4","N39.0","B34.8","Z51.81","R53.83","J01.00","R51.9"],"date":["2022-07-12","2023-03-30","2022-10-04","2023-03-15","2021-04-06","2021-04-06","2021-04-06","2022-09-07","2021-04-06","2021-04-06","2023-02-09","2022-05-22","2022-05-22","2022-05-22","2022-05-22","2022-05-22","2022-05-22","2022-05-24","2022-05-22","2022-05-22","2022-05-22","2022-05-22","2022-05-25","2023-03-22","2023-03-24","2023-03-24","2023-03-24","2023-04-06","2023-04-06","2023-03-08","2023-03-22","2021-08-31","2022-08-11","2021-08-31","2021-08-31","2022-05-22","2022-05-22","2022-05-22","2022-05-22","2022-05-22","2022-05-24","2022-05-24","2022-05-24","2022-05-22","2022-06-15","2021-12-08","2022-05-24","2022-06-06","2022-06-13","2022-06-13","2022-08-11","2021-08-11","2021-08-31","2022-09-28","2022-05-22","2022-05-22","2022-08-11","2022-08-23","2022-08-23","2022-08-23","2022-09-27","2022-09-27","2023-03-22","2023-03-22","2023-03-22","2023-04-17","2023-03-24","2023-03-24","2021-09-20","2021-09-20","2021-05-19","2021-08-31","2021-09-17","2023-03-30","2021-09-20","2021-09-20","2022-07-10","2023-01-27","2023-01-27","2023-04-17","2023-04-17"],"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":[["","33342006807","OLANZAPINE","5 MG","30","Select","Select",""],["","00093083205","CLONAZEPAM","0.5 MG","120","Select","Select",""],["","50428043852","MAGNESIUM OX","TAB 250MG","30","Select","Select",""],["","11534018701","BUT\/APAP\/CAF","CAP ","40","Select","Select",""],["","69097094312","GABAPENTIN","300 MG","90","Select","Select",""],["","27241009903","DULOXETINE","CAP 60MG","30","Select","Select",""],["","00378427577","VALACYCLOVIR","500 MG","30","Select","Select",""],["","50428916473","CVS ALLERGY","TAB 180MG","30","Select","Select",""],["","00245531911","KLOR-CON M20","TAB 20MEQ ER","60","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","90","Select","Select",""],["","68462015305","TOPIRAMATE","50 MG","60","Select","Select",""],["","55111078401","FEXOFENADINE","TAB 180MG","30","Select","Select",""],["","65862014636","SUMATRIPTAN","TAB 25MG","9","Select","Select",""],["","59088043005","LIDOCORT","CRE 3-0.5%","255","Select","Select",""],["","00023649810","UBRELVY","TAB 50MG","10","Select","Select",""],["","51672407406","HC BUTYRATE","CRE 0.001","135","Select","Select",""],["","00002143611","EMGALITY","INJ 120MG\/ML","1","Select","Select",""],["","51672130406","TERCONAZOLE","CRE 0.004","45","Select","Select",""],["","55513084101","AIMOVIG","INJ 70MG\/ML","1","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","20","Select","Select",""],["","59267100002","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","51672404801","CLOTRIM\/BETA","CRE DIPROP","15","Select","Select",""],["","69842090001","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","71930002643","BROM\/PSE\/DM","SYP ","300","Select","Select",""],["","00536406301","CL PRENATAL","TAB 28-0.8MG","30","Select","Select",""],["","68180069806","TRAMADOL HCL","TAB 200MG ER","30","Select","Select",""],["","62037099905","POT CL MICRO","TAB 20MEQ ER","180","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","15","Select","Select",""],["","43598081115","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","00904531346","PRENATAL","TAB 27-0.8MG","30","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","12","Select","Select",""],["","60505025203","TIZANIDINE","TAB 4MG","20","Select","Select",""],["","00713063737","METRONIDAZOL","GEL 0.0075","45","Select","Select",""],["","40985027503","MELATONIN","10 MG","30","Select","Select",""],["","00093031101","LOPERAMIDE","CAP 2MG","30","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","90","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","10","Select","Select",""],["","66993037083","MEDROXYPR AC","INJ 150MG\/ML","1","Select","Select",""],["","00074709430","QULIPTA","TAB 60MG","30","Select","Select",""],["","72618300002","NURTEC","TAB 75MG ODT","17","Select","Select",""],["","59267030401","PFIZER BIVAL","INJ BA4\/BA5","0","Select","Select",""],["","57237000511","FLUCONAZOLE","150 MG","3","Select","Select",""],["","00536118399","FLUTICASONE PROPIONATE","50 MCG","9.9","Select","Select",""],["","27241009903","DULOXETINE HCL","60 MG","30","Select","Select",""],["","27808023302","DOXYCYCLINE HYCLATE","100 MG","14","Select","Select",""],["","65862014636","SUMATRIPTAN SUCCINATE","25 MG","9","Select","Select",""],["","00002143380","TRULICITY","0.75MG\/0.5","2","Select","Select",""],["","00536408501","PRENATAL VITAMINS","28MG-0.8MG","30","Select","Select",""],["","70010013501","POTASSIUM CHLORIDE","20 MEQ","30","Select","Select",""],["","50111033401","METRONIDAZOLE","500 MG","30","Select","Select",""],["","43598081115","CETIRIZINE HCL","10 MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPRINE HCL","10 MG","21","Select","Select",""],["","42806071401","BENZONATATE","100 MG","30","Select","Select",""],["","72618300002","NURTEC ODT","75 MG","16","Select","Select",""],["","63824002335","MUCINEX","1200 MG","14","Select","Select",""],["","00093216568","NALOXONE HCL","4 MG","2","Select","Select",""],["","00574110416","BROMPHENIRAMINE-PSEUDOEPHED-DM","2-30-10\/5","118","Select","Select",""],["","60505620201","CYCLOSPORINE","0.05 %","60","Select","Select",""],["","42806040021","METHYLPREDNISOLONE","4 MG","21","Select","Select",""],["","00093770198","LEVOCETIRIZINE DIHYDROCHLORIDE","5 MG","90","Select","Select",""],["","55111018015","TIZANIDINE HCL","4 MG","28","Select","Select",""],["","00781808926","AZITHROMYCIN","250 MG","6","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":""}]}]}