{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHERRY R LONG","gend":1,"add":"267 ALPINE DR","city":"BRISTOL","state":"VA","zip":"24201-9998","dob":"1969-11-12","age":"","mstatus":"","insh":"20078387*01","cliId":"","pno":4109209637,"cno":4109209637,"email":"","ename":"","eno":"","pphy":"CULP, JOHN S MD","ppno":4239894050,"pcpadd":"208 MEDICAL PARK BLVD,","pcpcity":"BRISTOL","pcpstate":"TN","pcpzip":"37620-9998","pcpcounty":"","pcpid":"","pcpname":"ETSU Physicians & Associates - Family Medicine of Bristol","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4239903044,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I50.20","I51.89","A41.9","N39.0","N17.9","R11.2","U07.1","R09.81","NO DATA","F11.20","I42.8","I50.22","N12.","Z20.822","B96.20","E78.5","F11.10","I11.0","E86.0","E87.6","J45.909","Z79.890","Z79.51","Z79.82","J44.9","U09.9","E03.9","K21.9","G25.81","R06.02","I10.","M54.6","R31.9","F41.9","I50.9","R09.02","R07.9","R05.9","Z12.4","R51.9","M54.31","M54.32","R50.9","I50.42","R26.2","E07.9","R11.0","N30.90","R09.89","I95.89"],"date":["2023-07-02","2022-01-04","2022-03-18","2022-03-18","2022-03-16","2022-03-16","2022-08-02","2022-08-02","2022-08-02","2021-10-12","2022-03-12","2022-03-12","2022-03-12","2022-08-31","2022-03-12","2022-03-12","2022-03-12","2022-03-12","2022-03-12","2022-03-12","2022-12-05","2022-03-12","2022-03-12","2022-03-12","2022-09-01","2022-12-05","2023-06-08","2023-06-08","2022-12-05","2022-09-02","2021-11-17","2022-05-10","2022-05-10","2023-06-08","2023-06-08","2022-09-01","2022-08-31","2022-08-31","2021-11-05","2021-11-05","2021-11-05","2021-11-05","2022-08-12","2021-12-06","2021-12-06","2022-08-02","2022-08-02","2022-03-12","2022-07-30","2023-06-08"],"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":[["","55111012305","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","68462016505","CARVEDILOL","25 MG","60","Select","Select",""],["","43598058230","BUPREN\/NALOX","MIS 8-2MG","7","Select","Select",""],["","53746051105","SPIRONOLACT","TAB 25MG","23","Select","Select",""],["","00078065920","ENTRESTO","24 MG-26MG","60","Select","Select",""],["","68180035202","SERTRALINE","TAB 50MG","90","Select","Select",""],["","69238183107","LEVOTHYROXIN","TAB 50MCG","90","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","64980056310","FUROSEMIDE","40 MG","90","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","24","Select","Select",""],["","00406051205","OXYCOD\/APAP","TAB 5-325MG","12","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","21","Select","Select",""],["","00378668977","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","65862017760","CEFDINIR","CAP 300MG","14","Select","Select",""],["","39423066048","FLORAJEN3","CAP ","30","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","00310621030","FARXIGA","10 MG","30","Select","Select",""],["","66993007896","FLUTICAS HFA","AER 44MCG","11","Select","Select",""],["","42806071501","BENZONATATE","CAP 200MG","90","Select","Select",""],["","00031875118","ROBITUSSIN","LIQ SEVERE","118","Select","Select",""],["","64380080807","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","00173071820","FLOVENT HFA","44 MCG","10.6","Select","Select",""],["","76204060030","IPRATROPIUM\/","SOL ALBUTER","540","Select","Select",""],["","11917010352","MUCUS RELIEF","TAB 400MG","60","Select","Select",""],["","68382070718","DOXYCYC MONO","CAP 100MG","12","Select","Select",""],["","00591247501","TETRACYCLINE","CAP 500MG","56","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","31","Select","Select",""],["","73796069940","PEAK AIR FLO","MIS ADLT\/PED","1","Select","Select",""],["","00904720546","BISMUTH","CHW 262MG","56","Select","Select",""],["","68462025301","ROPINIROLE","TAB 0.25MG","30","Select","Select",""],["","70954005920","PREDNISONE","TAB 10MG","16","Select","Select",""],["","78206012701","DULERA","AER 100-5MCG","13","Select","Select",""],["","68462025301","ROPINIROLE HCL","0.25 MG","8","Select","Select",""],["","00378180377","LEVOTHYROXINE SODIUM","50 MCG","90","Select","Select",""],["","00378668977","PANTOPRAZOLE SODIUM","40 MG","90","Select","Select",""],["","68180035202","SERTRALINE HCL","50 MG","90","Select","Select",""],["","66993007896","FLUTICASONE PROPIONATE HFA","44 MCG","10.6","Select","Select",""],["","42806031250","DOXYCYCLINE HYCLATE","100 MG","14","Select","Select",""],["","53746051105","SPIRONOLACT TAB","25MG","90","Select","Select",""],["","69238183107","LEVOTHYROXIN TAB","50MCG","90","Select","Select",""],["","43598083205","ATORVASTATIN TAB","40MG","90","Select","Select",""],["","68180035202","SERTRALINE TAB","50MG","90","Select","Select",""],["","00054429931","FUROSEMIDE TAB","40MG","30","Select","Select",""],["","65862001705","AMOXICILLIN CAP","500MG","24","Select","Select",""],["","00078065920","ENTRESTO TAB","24-26MG","60","Select","Select",""],["","68462016505","CARVEDILOL TAB","25MG","60","Select","Select",""],["","00406012305","HYDROCO\/APAP TAB","5-325MG","12","Select","Select",""],["","00406051205","OXYCOD\/APAP TAB","5-325MG","12","Select","Select",""],["","65862017760","CEFDINIR CAP","300MG","14","Select","Select",""],["","50111033301","METRONIDAZOL TAB","250MG","56","Select","Select",""],["","52817033200","CYCLOBENZAPR TAB","10MG","30","Select","Select",""],["","00378668877","PANTOPRAZOLE TAB","20MG","28","Select","Select",""],["","39423066048","FLORAJEN","3 CAP","30","Select","Select",""],["","00310621030","FARXIGA TAB","10MG","30","Select","Select",""],["","64380080807","IBUPROFEN TAB","600MG","30","Select","Select",""],["","42806071501","BENZONATATE CAP","200MG","90","Select","Select",""],["","00173071820","FLOVENT HFA AER","44MCG","11","Select","Select",""],["","68382070718","DOXYCYC MONO CAP","100MG","12","Select","Select",""],["","00031875118","ROBITUSSIN LIQ SEVERE","","118","Select","Select",""],["","76204060030","IPRATROPIUM\/ SOL ALBUTER","","1620","Select","Select",""],["","70954005920","PREDNISONE TAB","10MG","16","Select","Select",""],["","66993007896","FLUTICAS HFA AER","44MCG","11","Select","Select",""],["","73796069940","PEAK AIR FLO MIS ADLT\/PED","","1","Select","Select",""],["","11917010352","MUCUS RELIEF TAB","400MG","180","Select","Select",""],["","00186037020","SYMBICORT AER","160-4.5","10","Select","Select",""],["","68462025301","ROPINIROLE TAB","0.25MG","30","Select","Select",""],["","00904720546","BISMUTH CHW","262MG","56","Select","Select",""],["","00310737020","BUDES\/FORMOT AER","160-4.5","10","Select","Select",""],["","69238152301","TETRACYCLINE CAP","500MG","56","Select","Select",""],["","78206012701","DULERA AER","100-5MCG","13","Select","Select",""],["","43598083205","ATORVASTATIN CALCIUM","40 MG","90","Select","Select",""],["","53746051105","SPIRONOLACTONE","25 MG","90","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":""}]}]}