{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHELLY  Y STRINGFIELD","gend":1,"add":"209 KNIGHT ST","city":"WAKEFIELD","state":"VA","zip":"23888-9998","dob":"1973-11-12","age":"","mstatus":"","insh":"20072381*01","cliId":"","pno":8042553563,"cno":8042553563,"email":"","ename":"","eno":"","pphy":"HOLLOMAN, HEATHER NP","ppno":8048348871,"pcpadd":"344 W MAIN ST","pcpcity":"WAVERLY","pcpstate":"VA","pcpzip":"23890-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8048348875,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","E78.9","F43.10","M54.2","F41.9","G43.019","M17.11","N64.4","J45.20","M54.31","E53.8","K59.00","E66.9","R10.32","K21.9","F31.5","Z87.828","Z86.73","J45.909","F32.9","F33.1","F31.30","R10.84","F31.9","Z91.048","R14.0","B37.3","Z32.02","F31.89","E66.09","R45.89","R63.0","G47.19","F43.25","F39.","S83.231A","J06.9","Z79.899","E78.00","Z79.82","R09.81","Z68.38","N76.0","M54.16","B96.89","Z11.3","N89.8","Z01.419","N60.19","F33.0","R10.2","E66.8","Z71.3","N62.","N39.3","R39.9","R05.","Z11.59","M54.12","Z20.828","B34.9","N95.2","M54.10","Q67.5","I69.951","G47.10","E66.01","Z68.37","Z20.2","Z23.","M25.561","N92.0","D25.1","R10.13","Z86.010","K64.1","Z12.11","I25.10","M94.261","F50.89","Z03.818","R68.89","J01.90","R05.1","J01.10","G43.909","Z01.818","F31.81","Z68.36","Z79.890","F41.0","Z80.9","Z82.49","Z83.3","Z88.8","Z91.040","I63.9","F33.3","F41.1","K29.50"],"date":["2023-03-29","2022-08-04","2023-04-24","2023-03-14","2023-03-14","2023-03-14","2023-03-14","2021-11-30","2023-03-14","2023-03-14","2021-11-30","2023-03-14","2023-03-29","2022-03-17","2022-12-09","2022-10-02","2023-02-01","2023-03-29","2023-03-29","2023-02-01","2023-03-09","2022-12-05","2023-01-10","2023-04-24","2023-03-14","2023-03-14","2021-09-28","2022-12-02","2022-05-14","2022-12-01","2022-01-12","2022-01-12","2021-03-17","2022-01-12","2022-01-12","2022-07-18","2022-12-09","2023-03-29","2023-03-29","2023-03-29","2022-12-09","2023-02-23","2022-12-02","2021-09-28","2021-06-23","2021-08-26","2022-06-20","2022-09-12","2022-09-12","2022-12-27","2021-09-23","2021-10-28","2022-12-01","2022-10-07","2022-06-28","2022-06-28","2021-01-12","2021-01-12","2021-02-18","2021-12-21","2021-12-21","2022-08-15","2021-09-28","2021-09-28","2021-09-28","2021-11-18","2023-03-29","2022-10-24","2021-02-25","2022-01-14","2022-05-16","2022-12-02","2021-09-23","2022-05-25","2022-05-25","2022-05-25","2022-05-25","2022-05-25","2022-09-02","2022-09-13","2022-12-15","2022-12-15","2022-12-15","2022-12-15","2023-03-04","2023-03-04","2023-03-20","2023-03-29","2023-03-29","2023-03-29","2023-03-29","2023-03-29","2023-03-29","2023-03-29","2023-03-29","2023-03-29","2023-03-29","2023-04-04","2023-04-04","2023-03-29"],"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":[["","29300012810","HYDROCHLOROT","TAB 25MG","18","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00378395005","ATORVASTATIN","TAB 10MG","90","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","61874014530","VRAYLAR","CAP 4.5MG","19","Select","Select",""],["","00378729189","NORETHIN ACE","TAB 5MG","4","Select","Select",""],["","00591544210","PREDNISONE","TAB 10MG","14","Select","Select",""],["","67877024901","QUETIAPINE","TAB 50MG","60","Select","Select",""],["","68180035302","SERTRALINE","TAB 100MG","8","Select","Select",""],["","27808023302","DOXYCYCL HYC","CAP 100MG","14","Select","Select",""],["","70010008401","PRAZOSIN HCL","1 MG","120","Select","Select",""],["","69097082607","BENZTROPINE","TAB 0.5MG","60","Select","Select",""],["","00591024105","LORAZEPAM","TAB 1MG","120","Select","Select",""],["","00245086070","VANDAZOLE","GEL 0.0075","70","Select","Select",""],["","74312052805","VITAMIN B-12","TAB 1000MCG","30","Select","Select",""],["","51672130200","TERCONAZOLE","CRE 0.008","20","Select","Select",""],["","00456120330","LINZESS","72 MCG","30","Select","Select",""],["","00527133001","BACLOFEN","TAB 10MG","90","Select","Select",""],["","69230030001","ALLERGY RELF","TAB 180MG","90","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","00378078293","FEXOFENADINE","TAB 180MG","90","Select","Select",""],["","68462018905","NAPROXEN","TAB 375MG","60","Select","Select",""],["","00169280015","SAXENDA","INJ 18MG\/3ML","9","Select","Select",""],["","42806071501","BENZONATATE","CAP 200MG","30","Select","Select",""],["","68180031909","BUPROPN HCL","TAB 150MG XL","30","Select","Select",""],["","08290320109","BD PEN NEEDL","MIS 31GX8MM","100","Select","Select",""],["","62175011843","OMEPRAZOLE","20 MG","7","Select","Select",""],["","00172572860","FAMOTIDINE","20 MG","56","Select","Select",""],["","43547028810","BUPROPION","TAB 100MG SR","30","Select","Select",""],["","00169406013","VICTOZA","INJ 18MG\/3ML","9","Select","Select",""],["","10572010001","PEG-3350","SOL ELECTROL","4000","Select","Select",""],["","00093354143","ESTRADIOL","0.01 %","42.5","Select","Select",""],["","00093005401","BUSPIRONE","TAB 10MG","12","Select","Select",""],["","23155013525","DOXYCYC MONO","TAB 100MG","14","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","10","Select","Select",""],["","00406048410","APAP\/CODEINE","TAB 300-30MG","20","Select","Select",""],["","00555032402","HYDROXYZ PAM","CAP 100MG","30","Select","Select",""],["","67618010160","COLACE","CAP 100MG","20","Select","Select",""],["","64950020603","HYDROC\/HOMAT","TAB 5-1.5MG","100","Select","Select",""],["","65862062690","RIZATRIPTAN","10 MG","12","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00093321205","CLONAZEPAM","1 MG","30","Select","Select",""],["","10702015016","HYDROCOD\/HOM","SYP 5-1.5\/5","100","Select","Select",""],["","70000041503","CLEARLAX","POW ","510","Select","Select",""],["","68462015305","TOPIRAMATE","50 MG","24","Select","Select",""],["","00904699860","DOCUSATE SOD","CAP 100MG","20","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","43547028810","BUPROPION HCL SR","100 MG","30","Select","Select",""],["","57237007710","ONDANSETRON ODT","4 MG","30","Select","Select",""],["","69230032437","POLYETHYLENE GLYCOL","3350 17 G","28","Select","Select",""],["","42192033901","HYOSCYAMINE SULFATE","0.125 MG","30","Select","Select",""],["","68180035302","SERTRALINE HCL","100 MG","60","Select","Select",""],["","43598083005","ATORVASTATIN CALCIUM","10 MG","90","Select","Select",""],["","00555032402","HYDROXYZINE PAMOATE","100 MG","30","Select","Select",""],["","29300012810","HYDROCHLOROTHIAZIDE","25 MG","7","Select","Select",""],["","00781185220","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","20","Select","Select",""],["","00093005401","BUSPIRONE HCL","10 MG","90","Select","Select",""],["","00378729189","NORETHINDRONE ACETATE","5 MG","30","Select","Select",""],["","00406055201","OXYCODONE HCL","5 MG","12","Select","Select",""],["","80681016900","VITAMIN D","3 25 MCG","30","Select","Select",""],["","10006073043","VITAMIN B-","12 1000 MCG","30","Select","Select",""],["","00781324664","ENOXAPARIN SODIUM","40MG\/0.4ML","5.6","Select","Select",""],["","63824020120","MUCINEX SINUS-MAX SEV CONGEST","200-5-325","20","Select","Select",""],["","45963055650","GABAPENTIN","300 MG","15","Select","Select",""],["","74312052805","B-","12 1000 MCG","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":""}]}]}