{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HELEN GANGALE","gend":1,"add":"1654 POORHOUSE ROAD","city":"RICE","state":"VA","zip":"23966-9998","dob":"1966-06-12","age":"","mstatus":"","insh":"20074311*01","cliId":"","pno":4343901568,"cno":4343901568,"email":"","ename":"","eno":"","pphy":"KSIONSKI, SEBASTIAN MD","ppno":4343155340,"pcpadd":"935 S MAIN ST,","pcpcity":"FARMVILLE","pcpstate":"VA","pcpzip":"23901-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4342001679,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z99.3","L22.","N39.41","M25.571","M25.551","M62.81","M25.673","R26.2","R60.0","V54.16","NO DATA","E78.5","E55.9","R73.9","L03.90","E66.9","Z68.39","Z85.3","R20.0","R53.1","H57.03","M21.371","H02.402","R41.89","G62.9","M19.071","Z47.89","V54.17","Z76.89","I82.401","Z87.828","M47.816","M47.812","M21.379","R29.898","G89.29","Z79.891","Z87.891","R06.00","D51.0","J18.9","Z20.822","R41.0","R53.83","R68.83","R11.0","R05.9","E66.01","M79.671","B35.1","M79.2","M79.672","M79.7","M77.41","E11.40","Z79.84","L60.0","M79.674","N64.59","M19.92","G89.21","M25.519","I42.9","M54.89","C50.919","I82.90","R55.","R42.","G56.01","G56.03","M75.42","M43.10","H02.841","H02.842","H02.844","H02.845","J30.9","G43.709","Z23.","M18.0","M25.841","M25.842","M25.742","M54.5","G43.909"],"date":["2023-06-28","2023-06-28","2023-06-28","2022-06-27","2022-06-27","2022-06-27","2022-06-27","2022-06-27","2022-04-27","2022-06-27","2023-01-24","2022-06-15","2022-06-15","2022-06-15","2022-06-15","2022-06-15","2022-06-15","2022-08-12","2021-04-22","2021-04-22","2021-04-22","2021-07-30","2021-04-22","2021-04-22","2021-07-13","2021-07-13","2022-05-01","2022-05-01","2021-06-04","2021-06-04","2021-06-04","2023-07-03","2021-06-04","2021-10-25","2021-06-04","2023-07-03","2021-06-04","2022-11-08","2021-07-20","2021-07-20","2022-06-13","2022-06-13","2022-06-13","2022-06-13","2022-06-13","2022-06-13","2022-06-13","2022-06-13","2022-10-18","2022-10-18","2022-07-21","2022-10-18","2023-01-11","2021-10-21","2021-10-21","2021-10-21","2022-01-20","2022-01-20","2022-07-08","2022-07-08","2022-07-08","2023-07-03","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-06-07","2021-06-07","2022-11-08","2022-10-06","2023-04-20","2021-06-28","2021-07-07","2021-07-07","2021-07-07","2021-07-07","2021-10-20","2021-10-20","2021-10-20","2022-10-06","2022-10-06","2022-10-06","2022-10-06","2021-09-30","2021-12-14"],"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":[["","69097084805","ESCITALOPRAM TAB","10MG","90","Select","Select",""],["","50383070016","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","65862057490","MONTELUKAST TAB","10MG","90","Select","Select",""],["","72205001690","PREGABALIN CAP","200MG","90","Select","Select",""],["","69097052444","DICLOFENAC GEL","1%","100","Select","Select",""],["","00406051205","OXYCOD\/APAP TAB","5-325MG","60","Select","Select",""],["","58160082311","SHINGRIX INJ","50\/0.5ML","1","Select","Select",""],["","63304069301","CLINDAMYCIN CAP","300MG","15","Select","Select",""],["","69097015915","MELOXICAM TAB","15MG","15","Select","Select",""],["","65862017760","CEFDINIR CAP","300MG","14","Select","Select",""],["","57237000511","FLUCONAZOLE TAB","150MG","1","Select","Select",""],["","52817033010","CYCLOBENZAPR TAB","5MG","30","Select","Select",""],["","27808023302","DOXYCYCL HYC CAP","100MG","20","Select","Select",""],["","65862050320","AMOX\/K CLAV TAB","875-125","20","Select","Select",""],["","00781808926","AZITHROMYCIN TAB","250MG","6","Select","Select",""],["","16571020210","DICLOFENAC SODIUM","50 MG","20","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","69097084805","ESCITALOPRAM OXALATE","10 MG","90","Select","Select",""],["","00406051205","OXYCODONE-ACETAMINOPHEN","5 MG-325MG","40","Select","Select",""],["","00093314705","CEPHALEXIN","500 MG","20","Select","Select",""],["","65862057490","MONTELUKAST SODIUM","10 MG","90","Select","Select",""],["","72205001690","PREGABALIN","200 MG","90","Select","Select",""],["","58160084252","BOOSTRIX TDAP","2.5-8-5\/.5","0.5","Select","Select",""],["","45802011214","MUPIROCIN","2 %","15","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":""}]}]}