{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SERENA  B JOHNSON- WILSON","gend":1,"add":"4318 PUDDLEDOCK ROAD","city":"PRINCE GEORGE","state":"VA","zip":"23875-9998","dob":"1981-12-31","age":"","mstatus":"","insh":"20076014*01","cliId":"","pno":8045046353,"cno":8045046353,"email":"","ename":"","eno":"","pphy":"VILLANUEVA, JOHN G MD","ppno":8044525800,"pcpadd":"SUITE 2 4260 CROSSINGS BLVD,","pcpcity":"PRINCE GEORGE","pcpstate":"VA","pcpzip":"23875-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8044525801,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25.511","M62.838","M54.2","M54.9","I10.","E11.9","F17.200","Z79.84","Z79.4","R25.3","E10.43","R10.817","R10.84","R12.","N13.2","E78.5","Z79.82","R68.83","E11.3311","R94.31","NO DATA","R10.9","R11.0","E11.43","J45.909","Z87.891","R19.7","E11.65","U07.1","R68.89","R06.02","K31.84","K59.00","K29.80","R10.13","M06.4","Z79.899","R00.0","J20.9","R51.9","Z86.73","R10.31","R11.2","E11.3292","H04.123","K52.9","N76.0","G43.909","N20.0","N20.1","E66.9","Z68.30","Z79.85","R30.0","R03.0","R05.9","K29.50","E10.9","E78.00","Z79.52","N83.209","E78.2","G51.4","Z71.3","Z71.89","H53.149","R10.30","M79.7","E86.0","D69.6","D25.9","R10.2","E83.42","Z51.81","R10.32"],"date":["2021-10-08","2021-10-06","2022-04-07","2022-10-04","2023-06-30","2022-12-09","2021-10-06","2022-12-05","2022-12-09","2022-03-16","2022-08-10","2022-08-10","2023-04-25","2022-08-10","2022-11-11","2023-06-30","2023-04-25","2022-11-11","2023-02-14","2023-06-30","2023-07-18","2022-10-04","2022-10-04","2023-04-25","2022-10-04","2023-04-25","2021-10-27","2023-06-30","2021-12-30","2021-12-20","2021-12-30","2022-12-05","2022-11-10","2022-11-10","2022-11-10","2023-03-13","2023-03-13","2021-12-28","2022-01-07","2022-07-12","2022-03-16","2023-06-30","2022-08-07","2023-02-14","2023-02-14","2022-02-28","2022-08-11","2022-08-22","2022-12-02","2022-12-05","2022-12-05","2022-12-05","2023-06-30","2022-12-09","2021-11-26","2021-12-28","2022-02-28","2022-02-28","2022-02-28","2022-02-28","2022-08-10","2022-02-01","2022-03-23","2022-03-23","2022-03-23","2022-07-12","2022-08-07","2023-07-18","2023-06-30","2023-06-30","2023-06-30","2023-06-30","2023-06-30","2023-07-18","2023-06-30"],"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":[["","57896020110","PAIN RELIEF","TAB 500MG","20","Select","Select",""],["","62332008090","VALSART\/HCTZ","TAB 160-12.5","30","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","15","Select","Select",""],["","65862006299","METOPROL TAR","TAB 25MG","10","Select","Select",""],["","00002143480","TRULICITY","1.5 MG\/0.5","2","Select","Select",""],["","45802088830","OMEPRAZOLE","20 MG","60","Select","Select",""],["","65162046650","IBUPROFEN","TAB 800MG","56","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","10","Select","Select",""],["","29300039805","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","00378395305","ATORVASTATIN","TAB 80MG","30","Select","Select",""],["","59746017206","PREDNISONE","5 MG","50","Select","Select",""],["","72647033104","METHYLPRED","TAB 4MG","21","Select","Select",""],["","11822316910","RA ASPIRIN","TAB 81MG EC","30","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA","100","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","100","Select","Select",""],["","31722070090","LOSARTAN POT","TAB 25MG","30","Select","Select",""],["","57513000628","PEN NEEDLES","MIS 31GX6MM","50","Select","Select",""],["","68180021509","LOSARTAN\/HCT","TAB 50-12.5","30","Select","Select",""],["","63824004112","MUCINEX D","TAB 120-1200","14","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","59746021106","CYCLOBENZAPR","TAB 5MG","20","Select","Select",""],["","31722015490","VALSARTAN","TAB 320MG","30","Select","Select",""],["","43386031214","GAVILAX","POW ","510","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","00378172493","AMLOD\/VALSAR","TAB 10-320MG","30","Select","Select",""],["","31722058630","NEBIVOLOL","TAB 5MG","30","Select","Select",""],["","80777027399","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","49884030702","CLONAZEP ODT","TAB 0.25MG","30","Select","Select",""],["","52536010303","ERYTHROMYCIN","TAB 250MG BS","90","Select","Select",""],["","72618300002","NURTEC","TAB 75MG ODT","8","Select","Select",""],["","00002771559","BASAGLAR","INJ 100UNIT","15","Select","Select",""],["","70010013901","NAPROXEN","TAB 500MG","60","Select","Select",""],["","00074709430","QULIPTA","TAB 60MG","90","Select","Select",""],["","00023650110","UBRELVY","TAB 100MG","20","Select","Select",""],["","00093077801","CARBAMAZEPIN","CHW 100MG","60","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","51672130406","TERCONAZOLE","CRE 0.004","45","Select","Select",""],["","16729017217","AMITRIPTYLIN","TAB 25MG","60","Select","Select",""],["","54092054701","MOTEGRITY","TAB 2MG","30","Select","Select",""],["","00904675180","ASPIRIN LOW","TAB 81MG EC","30","Select","Select",""],["","00456120130","LINZESS","145 MCG","30","Select","Select",""],["","31722072250","LEVOFLOXACIN","TAB 500MG","14","Select","Select",""],["","00456140530","BYSTOLIC","5 MG","30","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","15","Select","Select",""],["","65862059805","TAMSULOSIN","CAP 0.4MG","7","Select","Select",""],["","53885014301","ONETOUCH DELICA","33 GAUGE","100","Select","Select",""],["","53885000810","ONETOUCH DELICA PLUS LANCET","33 GAUGE","100","Select","Select",""],["","53885024510","ONETOUCH ULTRA TEST STRIP","","100","Select","Select",""],["","63044040201","VITAMIN D","3 1250 MCG","4","Select","Select",""],["","00378172493","AMLODIPINE-VALSARTAN","10MG-320MG","30","Select","Select",""],["","08317236132","TECHLITE PEN NEEDLE","32 GX 1\/4\"","30","Select","Select",""],["","00378395305","ATORVASTATIN CALCIUM","80 MG","30","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","100\/ML (3)","15","Select","Select",""],["","57513000628","PEN NEEDLE","31 G X1\/4\"","50","Select","Select",""],["","69238131009","PREGABALIN","25 MG","60","Select","Select",""],["","64764024060","AMITIZA","24MCG","60","Select","Select",""],["","68462010530","ONDANSETRON HCL","4 MG","30","Select","Select",""],["","00254302902","LUBIPROSTONE","24MCG","60","Select","Select",""],["","00088221905","LANTUS SOLOS INJ","100\/ML","15","Select","Select",""],["","63824004112","MUCINEX D TAB","120-1200","14","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","00002143480","TRULICITY INJ","1.5\/0.5","2","Select","Select",""],["","00093317431","ALBUTEROL AER HFA","","8","Select","Select",""],["","80777027399","MODERNA VAC INJ COVID-","19","0","Select","Select",""],["","62332008090","VALSART\/HCTZ TAB","160-12.5","30","Select","Select",""],["","11822316910","RA ASPIRIN TAB","81MG EC","30","Select","Select",""],["","00378395305","ATORVASTATIN TAB","80MG","30","Select","Select",""],["","31722015490","VALSARTAN TAB","320MG","30","Select","Select",""],["","31722058630","NEBIVOLOL TAB","5MG","30","Select","Select",""],["","00378172493","AMLOD\/VALSAR TAB","10-320MG","30","Select","Select",""],["","00781286810","OMEPRAZOLE CAP","20MG","60","Select","Select",""],["","29300039805","AMLODIPINE TAB","10MG","30","Select","Select",""],["","52536010303","ERYTHROMYCIN TAB","250MG BS","90","Select","Select",""],["","68308025010","ERYTHROMYCIN CAP","250MG EC","90","Select","Select",""],["","49884030702","CLONAZEP ODT TAB","0.25MG","30","Select","Select",""],["","13668027101","CARBAMAZEPIN CHW","100MG","60","Select","Select",""],["","00074709430","QULIPTA TAB","60MG","90","Select","Select",""],["","72618300002","NURTEC TAB","75MG ODT","8","Select","Select",""],["","00023650110","UBRELVY TAB","100MG","20","Select","Select",""],["","51672130406","TERCONAZOLE CRE","0.4%","45","Select","Select",""],["","00002771559","BASAGLAR INJ","100UNIT","9","Select","Select",""],["","31722099601","HYDROCO\/APAP TAB","5-325MG","12","Select","Select",""],["","70010013901","NAPROXEN TAB","500MG","60","Select","Select",""],["","65162046650","IBUPROFEN TAB","800MG","56","Select","Select",""],["","16729017217","AMITRIPTYLIN TAB","25MG","60","Select","Select",""],["","65862039010","ONDANSETRON TAB","4MG ODT","20","Select","Select",""],["","65862059805","TAMSULOSIN CAP","0.4MG","7","Select","Select",""],["","54092054701","MOTEGRITY TAB","2MG","30","Select","Select",""],["","00456120130","LINZESS CAP","145MCG","30","Select","Select",""],["","00456140530","BYSTOLIC TAB","5MG","30","Select","Select",""],["","31722072250","LEVOFLOXACIN TAB","500MG","14","Select","Select",""],["","57513000628","PEN NEEDLES MIS","31GX6MM","50","Select","Select",""],["","53885024510","ONETOUCH TES ULTRA","","100","Select","Select",""],["","00093031401","KETOROLAC TAB","10MG","15","Select","Select",""],["","00904675180","ASPIRIN LOW TAB","81MG EC","30","Select","Select",""],["","53885014301","ONETOUCH MIS LANCETS","","100","Select","Select",""],["","45802088830","OMEPRAZOLE TAB","20MG","60","Select","Select",""],["","00832605211","DICYCLOMINE HCL","20 MG","15","Select","Select",""],["","50228043301","NAPROXEN SODIUM","550 MG","20","Select","Select",""],["","00173068220","VENTOLIN HFA","90 MCG","18","Select","Select",""],["","23155050110","HYDROXYZINE HCL","25 MG","21","Select","Select",""],["","27241009803","DULOXETINE HCL","30 MG","30","Select","Select",""],["","49502010202","EPINEPHRINE","0.3MG\/0.3","2","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":""}]}]}