{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TERESA L DILLSWORTH","gend":1,"add":"228 MILL STREAM AVE","city":"WALKERTON","state":"VA","zip":"23177-9998","dob":"1971-06-29","age":"","mstatus":"","insh":"20074274*01","cliId":"","pno":8044456132,"cno":8044456132,"email":"","ename":"","eno":"","pphy":"BIGGERS, JONATHAN W DO","ppno":8047693022,"pcpadd":"11814 KING WILLIAM ROAD","pcpcity":"AYLETT","pcpstate":"VA","pcpzip":"23009-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8047691253,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S93.402A","S81.012A","W01.0XXA","M19.072","M25.572","S93.492A","B37.0","B37.81","F41.1","F34.1","R06.02","I26.99","J96.01","J44.9","G62.9","M79.7","M06.9","M81.0","NO DATA","E78.5","F17.210","Z79.01","J18.9","J44.1","J90.","J94.2","Z71.9","E66.9","M05.79","M62.838","M19.011","Z68.35","Z79.899","F43.9","R13.10","Q39.0","K44.9","J92.9","R00.0","F33.1","C34.11","K21.9","R07.89","Z20.822","A41.9","R65.20","J96.11","D61.818","K59.00","E87.6","D64.9","N20.0","R10.33","R07.81","I10.","Z85.118","Z68.29","J96.20","J18.0","C34.90","L30.4","W57.XXXA","K13.0","R06.83","M47.812","J43.9","E78.00","K22.2","Z79.51","Z79.1","R13.19","K57.12","D69.6","K52.9","D61.810","Z86.711","M50.320","G56.90","D64.81","Z51.11","J96.21","E87.1","R60.9","E86.0","J30.89","J32.9","J44.0","J91.8","M05.9","E88.09","M19.90","Z90.49","G89.29","R59.0","R59.1","Z99.81","G89.3","T45.1X5A","K57.10","R93.5","C34.91","D84.9","R19.7","M54.16","M79.89","J20.9","J45.909","Z23.","Z91.048","Z88.2","K22.10","K05.30","R07.9","C34.92","D63.0","Z74.09","M54.30","R09.1","Z72.0","R40.0","G47.9","M54.31","M54.32","M15.0","F41.9","J40.","J98.11","M54.9","R12.","M54.12","R91.1","D72.829","I21.4","S81.022A","S89.92XA","Z79.891","Z51.81","G56.91","G56.92","R74.8","Z45.2","R53.81","R53.83","Z92.29","M47.817","M67.911","Z68.33","F33.2","C85.90","U07.1","D70.1","J94.9","L03.116","Z71.89","Z71.3","M25.472","M12.562","R09.02","Z79.02","C34.31","R04.0","Z53.20","G47.00","Z51.12","K57.52","R93.3","C78.2","E83.42","Z79.82","E43.","I24.8","E66.3","Z51.89","R53.1","J96.10","R29.6","M48.02","D72.89","I25.10","R77.8","C77.0","G90.09","Z51.5"],"date":["2021-07-04","2021-07-04","2021-07-04","2021-07-13","2021-07-13","2021-07-13","2023-04-07","2021-09-13","2022-11-03","2022-06-14","2023-03-04","2023-03-22","2023-04-14","2023-04-21","2022-05-20","2023-04-21","2023-04-11","2021-12-08","2023-04-21","2023-04-21","2023-03-04","2023-04-11","2023-03-22","2023-03-17","2022-09-06","2022-04-01","2022-06-14","2022-10-16","2023-01-05","2022-07-11","2022-02-21","2022-05-20","2023-04-11","2023-05-02","2023-03-17","2022-03-25","2023-04-07","2022-06-27","2023-01-03","2023-02-08","2023-04-19","2023-04-21","2023-01-03","2023-03-04","2023-03-17","2022-10-19","2023-04-11","2023-04-14","2022-10-20","2023-04-11","2023-03-22","2022-10-20","2022-10-20","2023-01-03","2023-04-11","2023-01-03","2023-01-05","2023-03-11","2023-03-17","2023-04-11","2021-06-01","2021-06-01","2021-06-01","2021-08-26","2023-04-22","2023-04-11","2022-05-20","2022-05-20","2022-05-20","2022-09-14","2022-05-20","2022-11-03","2023-04-14","2022-09-15","2023-04-11","2022-11-02","2022-09-20","2022-09-20","2023-04-19","2023-04-19","2023-03-18","2023-04-14","2022-10-16","2023-04-19","2021-10-13","2021-11-11","2021-12-08","2021-12-08","2021-12-08","2021-12-08","2021-12-08","2021-12-08","2022-11-03","2023-04-07","2022-06-27","2023-04-21","2023-04-11","2023-04-11","2022-09-14","2022-09-14","2022-10-16","2022-09-14","2022-09-14","2021-11-23","2021-11-23","2021-11-25","2021-11-25","2021-11-25","2021-11-25","2021-11-25","2021-06-09","2021-07-29","2022-10-16","2022-11-03","2022-11-03","2022-11-03","2022-10-16","2022-12-07","2023-03-09","2021-07-19","2021-07-19","2021-09-07","2021-09-07","2022-09-23","2023-05-19","2021-11-11","2021-12-03","2021-12-03","2022-03-25","2022-05-26","2022-07-18","2023-03-22","2023-03-22","2021-06-27","2021-06-27","2022-05-04","2022-05-04","2022-05-04","2022-05-04","2022-05-23","2022-08-03","2023-03-18","2023-03-04","2022-01-13","2022-04-04","2022-07-11","2022-07-11","2023-05-19","2022-12-09","2023-04-07","2023-04-07","2022-12-09","2021-07-01","2021-07-01","2021-07-01","2021-07-01","2021-07-01","2021-11-25","2022-03-21","2023-04-21","2023-04-14","2023-04-11","2023-04-14","2023-04-07","2022-09-11","2022-09-11","2023-04-11","2023-04-11","2023-04-11","2023-03-04","2023-03-04","2023-03-04","2023-03-17","2023-03-17","2023-03-17","2023-03-17","2023-04-22","2023-03-17","2023-03-18","2023-03-14","2023-04-21","2023-04-21","2023-04-21"],"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":[["","00074055402","HUMIRA PEN","INJ 40\/0.4ML","2","Select","Select",""],["","00536303006","NICOTINE POL","GUM 4MG ORIG","50","Select","Select",""],["","68382018105","BUSPIRONE","TAB 10MG","180","Select","Select",""],["","16729010912","QUETIAPINE","TAB 150MG ER","30","Select","Select",""],["","50228018010","GABAPENTIN","300 MG","120","Select","Select",""],["","63304082805","ATORVASTATIN","TAB 20MG","90","Select","Select",""],["","00536589688","NICOTINE TD","DIS 21MG\/24H","28","Select","Select",""],["","80777027399","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","55111014512","FLUCONAZOLE","150 MG","1","Select","Select",""],["","00054455025","METHOTREXATE","TAB 2.5MG","32","Select","Select",""],["","59746017310","PREDNISONE","10 MG","6","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","21","Select","Select",""],["","57664037713","TRAMADOL HCL","TAB 50MG","15","Select","Select",""],["","57237001999","DULOXETINE","CAP 60MG","60","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","45","Select","Select",""],["","46122011846","ZINC OXIDE","OIN 0.2","57","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","30","Select","Select",""],["","00143924920","AMOX\/K CLAV","TAB 875-125","28","Select","Select",""],["","00074230630","RINVOQ","TAB 15MG ER","30","Select","Select",""],["","00406051201","OXYCOD\/APAP","TAB 5-325MG","5","Select","Select",""],["","31722072610","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","29300041519","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","69315012710","FOLIC ACID","1 MG","30","Select","Select",""],["","45802011222","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","16714008210","HYDROXYZ HCL","TAB 25MG","120","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","69452014430","BENZONATATE","CAP 200MG","90","Select","Select",""],["","00003089421","ELIQUIS","5 MG","60","Select","Select",""],["","00597010061","SPIRIVA","SPR 2.5MCG","4","Select","Select",""],["","43547028211","ESCITALOPRAM","TAB 20MG","30","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","27808006502","PROMETH\/COD","SOL 6.25-10","300","Select","Select",""],["","68645052354","SERTRALINE","TAB 100MG","45","Select","Select",""],["","00527512170","NYSTATIN","SUS 100000","224","Select","Select",""],["","70147031316","CODITUSSIN","LIQ AC","420","Select","Select",""],["","69238110002","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","50111078751","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","00456120130","LINZESS","CAP 145MCG","30","Select","Select",""],["","00254101196","SUCRALFATE","SUS 1GM\/10ML","500","Select","Select",""],["","00574010770","CLOTRIMAZOLE","TRO 10MG","40","Select","Select",""],["","51672126301","NYSTAT\/TRIAM","CRE ","15","Select","Select",""],["","65862044930","VALACYCLOVIR","TAB 1GM","21","Select","Select",""],["","65862039110","ONDANSETRON","TAB 8MG ODT","60","Select","Select",""],["","00054418425","DEXAMETHASON","TAB 4MG","32","Select","Select",""],["","16714052601","IPRATROPIUM","SPR 0.0003","30","Select","Select",""],["","69680013400","POT CHLORIDE","TAB 20MEQ ER","30","Select","Select",""],["","00069034530","PAXLOVID","TAB 300-100","30","Select","Select",""],["","00006505506","LAGEVRIO","CAP 200MG","40","Select","Select",""],["","00574110516","HYDROCOD\/HOM","SYP 5-1.5\/5","150","Select","Select",""],["","51801001130","EFFER-K","TAB 20MEQ","60","Select","Select",""],["","11877001140","BINAXNOW COV","KIT HOME TES","4","Select","Select",""],["","65862007701","CIPROFLOXACN","TAB 500MG","4","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","6","Select","Select",""],["","50383066730","LIDO\/PRILOCN","CRE 2.5-2.5%","30","Select","Select",""],["","00378912298","FENTANYL","50MCG\/HR","10","Select","Select",""],["","59746011506","PROCHLORPER","TAB 10MG","30","Select","Select",""],["","24510011010","XTAMPZA ER","CAP 9MG","60","Select","Select",""],["","31722072250","LEVOFLOXACIN","500 MG","7","Select","Select",""],["","57664050658","METOPROL TAR","TAB 25MG","60","Select","Select",""],["","67877021660","CEFUROXIME","TAB 500MG","10","Select","Select",""],["","00832532511","POT CL MICRO","TAB 20MEQ ER","60","Select","Select",""],["","00406324401","HYDROMORPHON","TAB 4MG","35","Select","Select",""],["","00406324401","HYDROMORPHONE HCL","4 MG","84","Select","Select",""],["","27808008201","MORPHINE SULFATE","100 MG\/5ML","30","Select","Select",""],["","69680013400","POTASSIUM CHLORIDE","20 MEQ","30","Select","Select",""],["","59746011506","PROCHLORPERAZINE MALEATE","10 MG","30","Select","Select",""],["","64380016001","MEGESTROL ACETATE","400MG\/10ML","240","Select","Select",""],["","00093005405","BUSPIRONE HCL","10 MG","60","Select","Select",""],["","60219204301","DEXAMETHASONE","4 MG","32","Select","Select",""],["","31722071390","PANTOPRAZOLE SODIUM","40 MG","60","Select","Select",""],["","65862006299","METOPROLOL TARTRATE","25 MG","60","Select","Select",""],["","29300041519","CYCLOBENZAPRINE HCL","10 MG","30","Select","Select",""],["","31722072610","MONTELUKAST SODIUM","10 MG","90","Select","Select",""],["","16571068701","HYDROXYCHLOROQUINE SULFATE","200 MG","60","Select","Select",""],["","65862039110","ONDANSETRON ODT","8 MG","60","Select","Select",""],["","65862007701","CIPROFLOXACIN HCL","500 MG","10","Select","Select",""],["","00093216568","NALOXONE HCL","4 MG","2","Select","Select",""],["","50742050510","SCOPOLAMINE","1 MG\/3 DAY","10","Select","Select",""],["","68645052354","SERTRALINE HCL","100 MG","45","Select","Select",""],["","50111033402","METRONIDAZOLE","500 MG","14","Select","Select",""],["","68585000612","MAGNESIUM OXIDE","400 MG","3","Select","Select",""],["","41100081125","AFRIN","0.05 %","30","Select","Select",""],["","00143924920","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","9","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":""}]}]}