{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LISA  R BASKERVILLE","gend":1,"add":"361 HENDRICK CROW ROAD","city":"BOYDTON","state":"VA","zip":"23917-9998","dob":"1964-09-26","age":"","mstatus":"","insh":"20075968*01","cliId":"","pno":4342102026,"cno":4342102026,"email":"","ename":"","eno":"","pphy":"HOBBS, AMY NP","ppno":4345842273,"pcpadd":"1755 N MECKLENBURG AVENUE","pcpcity":"SOUTH HILL","pcpstate":"VA","pcpzip":"23970-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4345845509,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R04.2","R06.83","R53.83","R51.9","R42.","F17.210","G47.33","J44.9","B37.0","E11.9","K21.9","I10.","Z79.4","Z99.89","E11.40","E78.5","E66.9","Z68.32","G90.522","G62.9","M48.00","E08.42","H25.093","I49.5","L60.0","B35.3","B35.1","E10.59","M51.36","E11.42","G47.00","E87.6","E78.2","F41.9","F32.9","Z79.82","K57.30","M10.9","Z85.3","Z88.0","NO DATA","G89.4","R10.12","G89.29","I49.1","I49.3","I47.1","I44.0","R06.09","H04.123","H47.233","H04.121","H04.122","Z04.9","M54.16","R26.2","Z12.31","Z79.899","T14.8XXA","Z68.33","R07.89","R10.13","F32.89","H25.811","Z20.828","F17.200","J43.9","Z71.6","L84.","M79.671","M79.605","C50.912","Z95.0","Z72.0","Z45.010","Z45.018","I44.7","Z12.2","M48.061","M25.562","Z87.891","M79.606","M99.9","M47.816","Z68.34","E11.69","E08.43","Z88.1","Z20.822","R50.9","J43.8","R00.2","I45.2","R06.02","R94.31","M79.672","R20.0","G47.61","M79.604","M79.662","M47.819","M76.61","J18.9","R00.0","K92.1","R80.9","H25.13","H52.4","G56.00","J43.2","R46.89","F41.8","H25.092","E11.3293","M51.16","H25.812","E11.36","R63.5"],"date":["2021-07-02","2021-06-07","2021-06-07","2021-06-07","2021-06-07","2022-07-07","2023-03-24","2023-04-12","2021-12-27","2022-09-21","2023-03-21","2023-04-12","2023-04-06","2021-10-04","2023-04-06","2022-09-21","2023-02-22","2022-06-01","2022-09-28","2022-11-07","2022-11-07","2022-11-07","2022-10-18","2023-03-03","2023-03-01","2023-03-01","2023-03-01","2023-03-01","2022-11-07","2023-04-12","2023-03-24","2022-09-28","2023-04-12","2022-04-22","2022-06-01","2022-04-22","2022-09-28","2022-09-28","2023-02-22","2022-06-01","2023-03-10","2022-09-28","2022-07-27","2022-07-27","2022-10-12","2022-10-12","2022-10-12","2022-10-12","2023-04-25","2022-04-11","2021-09-27","2021-09-27","2021-09-27","2021-10-13","2022-10-10","2021-11-29","2022-02-28","2022-07-07","2022-08-27","2022-12-30","2023-02-21","2022-11-04","2022-12-19","2023-03-21","2022-01-19","2022-12-30","2023-03-21","2022-06-28","2022-06-28","2022-06-28","2022-07-07","2023-04-19","2023-03-17","2023-02-22","2023-03-03","2023-03-03","2023-03-03","2023-04-25","2021-06-22","2022-06-22","2021-06-22","2021-09-01","2021-09-21","2021-09-21","2021-09-21","2021-10-13","2022-06-22","2021-12-13","2022-01-28","2022-01-28","2022-08-18","2022-09-21","2022-09-21","2022-09-21","2022-09-21","2022-11-07","2021-06-14","2021-08-02","2021-09-01","2022-02-09","2022-03-07","2022-06-22","2022-07-10","2022-07-10","2022-09-28","2022-09-28","2022-04-11","2021-07-27","2021-09-17","2022-12-30","2023-04-06","2023-04-12","2023-03-28","2022-04-11","2023-03-10","2023-04-12","2023-04-12","2023-04-06"],"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":[["","60258015001","SF 5000 PLUS","CRE 0.011","102","Select","Select",""],["","55111064530","OMEPRAZOLE","40 MG","30","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","15","Select","Select",""],["","16729017317","AMITRIPTYLIN","TAB 50MG","30","Select","Select",""],["","65862020399","LOSARTAN POT","TAB 100MG","30","Select","Select",""],["","00023916360","RESTASIS","EMU 0.0005","60","Select","Select",""],["","49035018121","ARTHRTS PAIN","TAB 650MG","60","Select","Select",""],["","62332012390","PREGABALIN","150 MG","90","Select","Select",""],["","80681011000","MAG OXIDE","TAB 420MG","90","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","21","Select","Select",""],["","60758011905","PREDNISOLONE","SUS 1% OP","10","Select","Select",""],["","68645057559","GLIPIZIDE","TAB 10MG","90","Select","Select",""],["","00832532511","POT CL MICRO","TAB 20MEQ ER","30","Select","Select",""],["","16729018317","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","00527512170","NYSTATIN","SUS 100000","140","Select","Select",""],["","08290320550","BD PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","62756014202","METFORMIN","TAB 500MG ER","120","Select","Select",""],["","69097012815","AMLODIPINE","TAB 10MG","3","Select","Select",""],["","49035080283","8HR ARTHRITS","TAB 650MG ER","60","Select","Select",""],["","00002821501","HUMULIN R","INJ U-100","10","Select","Select",""],["","42571012290","LEVOCETIRIZI","TAB 5MG","30","Select","Select",""],["","37205064113","CAPSAICIN","CRE 0.001","84","Select","Select",""],["","00002143480","TRULICITY","1.5 MG\/0.5","2","Select","Select",""],["","16729028417","ROSUVASTATIN","TAB 5MG","30","Select","Select",""],["","00002822259","INSULIN LISP","INJ 100\/ML","15","Select","Select",""],["","00173086910","ANORO ELLIPT","AER 62.5-25","60","Select","Select",""],["","45802010901","TRIAMCINOLON","AER 55MCG\/AC","17","Select","Select",""],["","70710113803","FLUCONAZOLE","TAB 100MG","8","Select","Select",""],["","27241009990","DULOXETINE","CAP 60MG","30","Select","Select",""],["","59267100002","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","45802091987","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","00173068220","VENTOLIN HFA","AER ","18","Select","Select",""],["","00591352530","LIDOCAINE","5 %","60","Select","Select",""],["","57664037713","TRAMADOL HCL","TAB 50MG","7","Select","Select",""],["","49884094499","VARENICLINE","PAK 0.5X1MG","53","Select","Select",""],["","65862007705","CIPROFLOXACN","TAB 500MG","28","Select","Select",""],["","50111078751","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","68382056410","METOPROL SUC","TAB 25MG ER","15","Select","Select",""],["","76282066339","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","49502039475","INSULIN GLAR","INJ 100U\/ML","15","Select","Select",""],["","68382009305","CARVEDILOL","6.25 MG","60","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","21","Select","Select",""],["","49502025175","SEMGLEE","INJ 100U\/ML","15","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","00093506105","HYDROXYZ HCL","TAB 25MG","30","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","100\/ML (3)","30","Select","Select",""],["","61314012605","KETOROLAC TROMETHAMINE","0.5 %","5","Select","Select",""],["","08290320550","NANO","2ND GEN PEN NEEDLE 32GX 5\/32\"","100","Select","Select",""],["","67877041301","METFORMIN HCL ER","500 MG","240","Select","Select",""],["","00078074303","ILEVRO","0.3 %","3","Select","Select",""],["","69097012815","AMLODIPINE BESYLATE","10 MG","30","Select","Select",""],["","45802091987","CETIRIZINE HCL","10 MG","30","Select","Select",""],["","27241009903","DULOXETINE HCL","60 MG","30","Select","Select",""],["","65862020399","LOSARTAN POTASSIUM","100 MG","30","Select","Select",""],["","60758011905","PREDNISOLONE ACETATE","1 %","10","Select","Select",""],["","21922000909","DICLOFENAC SODIUM","1 %","100","Select","Select",""],["","55111011230","MOXIFLOXACIN HCL","400 MG","10","Select","Select",""],["","08290320749","ULTRA-FINE MICRO PEN NEEDLE","32 GX 1\/4\"","100","Select","Select",""],["","45802010901","TRIAMCINOLONE ACETONIDE","55 MCG","16.9","Select","Select",""],["","49483069901","ACETAMINOPHEN ER","650 MG","60","Select","Select",""],["","72205000390","ROSUVASTATIN CALCIUM","10 MG","30","Select","Select",""],["","00126001661","PREVIDENT","5000 DRY MOUTH 1.1 %","100","Select","Select",""],["","16714008210","HYDROXYZINE HCL","25 MG","30","Select","Select",""],["","68645051054","HYDROCHLOROTHIAZIDE","25 MG","90","Select","Select",""],["","00832141003","MOXIFLOXACIN","0.5 %","3","Select","Select",""],["","00116200116","CHLORHEXIDINE GLUCONATE","0.12 %","473","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":""}]}]}